Bridging the Gap: Integrating POCUS Training into Internal Medicine Residency

The field of ultrasound has advanced significantly since its inception in the 1960s, evolving into a vital tool across various medical specialties. Among the most transformative developments in ultrasound is the rise of point-of-care ultrasound (POCUS)—a focused, bedside application of ultrasound that allows providers to make immediate clinical decisions. While POCUS is now firmly established in specialties such as emergency medicine and critical care, its incorporation into internal medicine (IM) residency training remains a work in progress.

A pivotal study titled “A Road Map for Point-of-Care Ultrasound Training in Internal Medicine Residency” by LoPresti, Schnobrich, Dversdal, and Schembri (published in The Ultrasound Journal, 2019) provides valuable insights into the challenges and successes of integrating POCUS into IM programs. Let's explore the findings of this study, reflect on the barriers faced by residency programs, and consider the broader implications for ultrasound education in internal medicine.

The State of POCUS in Internal Medicine

POCUS has become an essential diagnostic and procedural tool in internal medicine, offering advantages such as faster diagnoses, improved procedural safety, and enhanced clinical decision-making. Despite its clear benefits, the path toward integrating structured POCUS training into IM residencies has been uneven. Many program directors agree that POCUS should be a core component of IM education, and learners themselves have expressed a strong desire for such training. However, the study highlights persistent obstacles, including:

• Lack of formal guidelines from major medical societies.
  
  
• Limited faculty expertise in ultrasound.
  
  
• Challenges in integrating POCUS into an already packed curriculum.
  
  
• Resource constraints, such as access to equipment and patients.
  
  

To address these gaps, the authors analyzed the experiences of four internal medicine residency programs that successfully developed and integrated POCUS curricula. Their findings offer a practical blueprint for other institutions.

Key Components of Successful POCUS Programs

The four IM programs profiled in the study shared several common elements that contributed to their success:

1. Competency-Based Training

A core principle across these programs was the emphasis on competency-based education. Residents began with a structured introductory course—typically spanning one to two weeks—covering fundamental POCUS applications. This was followed by ongoing reinforcement through longitudinal learning, such as monthly ultrasound rounds or dedicated electives in later years of residency.

2. Diverse Educational Methods

Effective POCUS education combined various teaching modalities:

• Didactic lectures (both online and in-person)
  
  
• Hands-on scanning with live models or simulation
  
  
• Image interpretation workshops
  
  
• Formative assessments, including pre- and post-course evaluations
  
  

Residents reported that hands-on scanning and interactive lectures were the most valuable learning experiences, while passive methods like quizzes were less impactful.

3. Supervision and Quality Assurance

A critical component of these programs was the establishment of supervision systems to ensure safe and effective ultrasound use by residents. This included mechanisms like:

• Image review portfolios for feedback and assessment.
  
  
• Middleware solutions to facilitate secure image storage and quality assurance.
  
  
• Formalized assessment tools, such as the CLUE-CEX exam, to determine competency.
  
  

Faculty development was also essential, given that many internal medicine attendings lacked POCUS expertise. Programs relied on collaborations across departments, including emergency medicine, cardiology, and radiology, to provide hands-on instruction and mentorship.

4. Core Applications

While no universal curriculum yet exists, the programs highlighted certain core POCUS applications as foundational for IM residents, including:

• Cardiac (e.g., assessing left ventricular function)
  
  
• Pulmonary (e.g., detecting pleural effusion)
  
  
• Abdominal (e.g., identifying ascites)
  
  

These applications were chosen based on their clinical relevance, feasibility of learning within residency constraints, and evidence supporting resident proficiency with focused training and mentorship.

Moving Forward: The Need for Standardization and Support

Despite the encouraging results from these four programs, the study emphasizes the need for broader institutional support to standardize POCUS education across internal medicine (IM) residency programs. The internal medicine community is still awaiting formal guidelines from major medical societies, which could provide essential direction on curriculum development, competency benchmarks, and quality assurance processes.

Additionally, the study underscores a critical alignment issue between undergraduate medical education (UME) and graduate medical education (GME). Medical schools are increasingly incorporating POCUS into their curricula, meaning that new residents often arrive with ultrasound skills that are underutilized or unsupported during residency. Bridging this gap is essential for ensuring continuity and advancing POCUS competency throughout medical training.

How SonoSim Can Help Overcome POCUS Training Barriers

The challenges outlined in this study—limited faculty expertise, access to equipment, and the need for repetitive, hands-on practice—are precisely the barriers that SonoSim is designed to overcome.

At SonoSim, we believe that ultrasound education should be accessible, scalable, and effective for all learners. Our comprehensive Ultrasound Training Ecosystem offers:

• Cloud-based, didactic courses across 85+ ultrasound topics, covering hundreds of ultrasound applications, all accessible anytime, anywhere.
  
  
• Unlimited hands-on scanning opportunities with real patient cases via the SonoSimulator®, providing learners with essential practice in image acquisition and interpretation without the limitations of machine or patient availability.
  
  
• Faculty support tools, including performance tracking, automated image assessment, and curriculum integration resources, help programs efficiently manage and assess learner progress.
  
  
• Simulation-based procedural training enables safe, deliberate practice of ultrasound-guided procedures like IV placement, thoracentesis, and paracentesis.
  
  

By providing scalable, high-quality ultrasound education tools, SonoSim empowers internal medicine programs to integrate POCUS training seamlessly into their curricula, supporting both learners and educators every step of the way.

As internal medicine continues its journey toward universal POCUS integration, solutions like SonoSim can help ensure that all residents develop the ultrasound skills they need to enhance patient care.