Point of care ultrasound competency in recent medical school graduates: what to expect from trainees when designing an ultrasound curriculum

Integration of Point-of-care ultrasound (POCUS) training into residency curricula has been pursued in a variety of specialties. There are no standard milestones for medical student POCUS education or competency. We designed a cross-sectional, single-center study of incoming recent medical school graduates at our Internal Medicine residency program to assess POCUS exposure, knowledge and aptitude. In 2023, we assessed the POCUS training, knowledge and skill of incoming PGY-1 internal medicine residents at a single center via a novel survey, written knowledge assessment, and an Observed Structured Clinical Exam (OSCE) developed for this study. The OSCE measured POCUS image acquisition skill for the following exams: focused cardiac, inferior vena cava, internal jugular, pulmonary, and renal. The results were analyzed via univariate analysis to identify potential associations between medical school POCUS experiences and subsequent POCUS knowledge and skill. Our study included 61 of 61 incoming PGY-1 internal medicine trainees representing 45 different medical schools. While 80% of participants received ultrasound training in medical school, OSCE performance was variable. Those who received medical school POCUS training obtained an average of 2.71 out of a possible 5.00 acceptable images on the OSCE, while those who were untrained were able to obtain 1.77 out of a possible 5.00 (difference = 0.94, p=0.029). A variety of specific medical school experiences were associated with improved OSCE performance, including preclinical didactic sessions, POCUS use on clinical rotations, and POCUS use on sub-Internship rotations. POCUS use during sub-internship rotations was the only aspect of training associated with improved knowledge assessment performance. While 80% of participants reported some form of POCUS training in medical school, the setting, manner, and content of ultrasound training was variable, as was performance on assessments of POCUS knowledge and skill. Image acquisition skill was generally higher among those who received hands on training in medical school, but even within this group performance was highly variable. While this single-center, cross sectional study should be interpreted with caution, it is apparent that residency programs designing POCUS curricula should account for variation in baseline POCUS competency in recent medical school graduates.