Published in:
01-02-2015 | Original Research
Pocket-Sized Ultrasound as an Aid to Physical Diagnosis for Internal Medicine Residents: A Randomized Trial
Authors:
Jason C. Ojeda, MD, FACP, James A. Colbert, MD, Xinyi Lin, PhD, Graham T. McMahon, MD, MMSc, Peter M. Doubilet, MD, PhD, Carol B. Benson, MD, Justina Wu, MD, PhD, Joel T. Katz, MD, Maria A. Yialamas, MD
Published in:
Journal of General Internal Medicine
|
Issue 2/2015
Login to get access
ABSTRACT
BACKGROUND
Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded.
OBJECTIVE
We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice.
DESIGN
This was a randomized parallel group controlled trial.
PARTICIPANTS
Forty internal medicine residents in a single program at an academic medical center participated in the study.
INTERVENTION
Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice.
MAIN MEASURES
The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound.
KEY RESULTS
Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p = 0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group’s 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p = 0.023).
CONCLUSIONS
The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice.