Looking Inward: Examining Intrinsic Motivators and Barriers to POCUS Among High and Low Utilizers

Point-of-care ultrasound (POCUS) is an integral component of patient care in the emergency department. However, there is wide variation in POCUS utilization among residents, with some struggling to achieve the amount required for their education. We conducted a qualitative study of emergency medicine residents to identify barriers and strategies for POCUS use.

Using a constructivist approach with a deductive framework based on self-determination theory (SDT), we performed semi-structured qualitative interviews with 16 PGY 2-4 residents divided into high versus low utilizers from four different training programs. A codebook was iteratively developed with two coders, and thematic saturation was reached.

Both high and low utilizers experienced competence, autonomy, and relatedness, but also incompetence, feeling like a burden on the team, and lack of autonomy. Notably, respondents who experienced incompetence associated a lack of mentorship and exposure with this feeling. Low-utilizer participants who experienced incompetence suggested they would avoid opportunities for deliberate practice. Junior low-utilizer residents were concerned that they were a burden to the team if they asked for guidance, compounding feelings of incompetence and making the pursuit of feedback in deliberate practice less likely. However, learners acknowledged the importance of performing POCUS and the benefits it could bring to the team.

Several key themes were identified regarding intrinsic motivation, with differences between high and low utilizers. Programs would benefit from tailoring POCUS curricula to bolster the SDT needs, with a focus on increased faculty support, hands-on experiences, and enhanced exposure to pathology, providing opportunities for deliberate practice.