1. POCUS Faculty Development Course Department of Family Medicine and Community Health, University of Minnesota Tim Ramer, MD; Erik Solberg, MA, MEd; Liz McElligott

2. Objectives 1.Summarize the development of the University of Minnesota’s POCUS course. 2.Articulate the need for training family medicine teaching faculty in point of care ultrasound skills. 3.Determine possible barriers to the integration of point-of-care ultrasound skills in residency teaching

3. Department of Family Medicine and Community Health, University of Minnesota 7 affiliated FM residencies throughout Minnesota Sites range from 6-10 residents per year and are based at rural regional hospitals, to tertiary care at UMMC 6+ Faculty performed ObUS for 10+years though no faculty had POCUS US experience 1-2 day optional departmental Course in ObUS since 1993

4. Why? Improves diagnostic accuracy when paired with clinical exam Ascites, pneumothorax, pleural effusion No radiation, low risk reassurance High touch imaging Our residents want the skills

5. Why? POCUS is here

6. Procedure Guidance IOM report recommended use of US for central line access Standard of care for Para and Thoracentesis

7. Procedure Guidance Cellulitis Vs abscess Avoiding unneeded Incision

8. Procedure Guidance Foreign Body localization Risk factor being a 13 yo boy

9. We started small 2 OBUS competent faculty went to 2-3 local courses to understand what the needed skills were Started by adding FAST Exam to the OBUS course Residents expressed increased interest in POCUS and decreased interest in learning complete ObUS. Course was gradually transformed from 100% ObUS to 30% OB and 70 % other scans We found that residents were gaining skills though few faculty had the experience to precept them and so skills were rapidly lost

10. Sample Agenda

11. Pre-Course Work for Learners Setting expectations for completing pre-work Course website (Moodle) 5 required articles; 6 required videos Pre-course self-assessment of skill from novice to expert Links to recommended e-learning modules for novice learners Regular reminders to emphasize importance of being prepared

12. Course Budget Educational Grant from SimPORTAL (Simulation PeriOperative Resource for Training and Learning) Facilities + staff + equipment + models = $8,640 Patient volunteer + food/beverage = $680 Estimated faculty time: $28,000 4 faculty instructors; 10 faculty learners Hosted by Family Medicine Faculty - Fall 2016 Facilities + staff + equipment + models = $0 Own machines/loan from GE; department location Patient volunteer + food/beverage = $830 Estimated faculty time: $40,000 5 faculty instructors; 15 faculty learners $9,320 $37,320 $830 $40,830

13. Evaluation Structure Learner evaluation Pre and post course self assessment of skills and knowledge Pre and post course instructor assessment of skills Program evaluation Post-course, includes assessment of effectiveness of faculty teaching Faculty debriefing and ongoing planning Formal planning meetings Informal feedback (emails, etc)

14. Fill in - eval form

15. Evaluation: Selected Results Pre and post course results: Learner self assessment & Faculty Assessment Scale for instructor assessment: 1=Cannot Perform → 5=Performs as an expert, can teach the procedure to others Scale for self assessment: 1=Not at all confident or cannot perform → 5=Extremely confident

16. Learner Evaluation: Preliminary Conclusions “We moved the needle” Increases were noted in all of the skill and knowledge domains assessed Instruction at the course appears effective Statistical comparison of pre-post scores suggests the course had an impact in the majority of skill & knowledge domains The course provided good training...and… Opportunities to refine and maintain ultrasound skills following the course must be identified

17. Evaluation: Program Evaluation by learners Qualitative feedback: Selected questions and responses How well did this curriculum meet your educational needs? If it did not fit your educational needs, how could it be improved? Great! I hope I can use these skills. Better inpatient care What was the most significant thing you learned today? Ways to easily use U/S bedside machine at hospital. Liked the paradigm shift to “an extension of the physical exam” Better probe handling Additional comments? Use of models excellent. Perhaps some obese models for comparison & pearls with these groups of models More cases! These were awesome I think it would be more useful to have the same information over 2 days or 1.5 days instead of putting it all into one day. It felt like such a barrage of information to have all in the same day. I'm not confident that I will retain as much as if I had had time to digest the info and then get my hands on an ultrasound machine the following day.

18. Evaluation: Program Evaluation by instructors Discussions at department-wide meetings and at course planning sessions: To teach...or...not to teach? US Guided procedures Practice makes progress: Finding opportunities to practice skills The right tools: purchase of new POCUS ultrasound equipment

20. Lessons learned Build it and they will come

21. Lessons learned Build it and they will come Eat an elephant one bite at a time

22. Lessons learned Build it and they will come Eat an elephant one bite at a time Remember you have a team