Assessing Internist Competency in Point-of-Care Ultrasound Using the Entrustable Professional Activity Framework

Area of Science:

• Medical Education
• Point-of-Care Ultrasound (POCUS)
• Competency Assessment

Background:

• Point-of-care ultrasound (POCUS) is a critical skill in internal medicine (IM).
• Robust methods are needed to effectively assess POCUS competency in IM learners.
• Current assessment strategies may not fully capture the nuances of POCUS proficiency.

Purpose of the Study:

• To develop an Entrustable Professional Activity (EPA) framework for POCUS competency.
• To create a validated instrument for assessing POCUS skills in IM residents.
• To establish a reliable and feasible method for workplace-based POCUS evaluation.

Main Methods:

• An expert panel of IM POCUS educators developed the EPA framework and assessment instrument.
• Validity, reliability, and feasibility were evaluated through bedside assessments of IM learners.
• Data from 604 assessments on 48 learners across three academic sites were analyzed using G-study and D-study statistics.

Main Results:

• An EPA titled "Assessing the acutely ill patient using POCUS" was developed.
• Learner variance ranged from 27.7% to 31.4%, indicating significant individual differences in POCUS skills.
• Reliability indices of 0.8 required 9-11 observations, and assessment completion time averaged 4.65 minutes.

Conclusions:

• An EPA-based instrument for workplace POCUS assessment in IM was successfully developed.
• Evidence of validity, reliability, and feasibility supports bedside POCUS competency assessment for IM learners.
• This tool is expected to be highly valuable for IM programs assessing POCUS competence.