Development and Assessment of Simulation-Based Point-of-Care Ultrasound Curriculum in Undergraduate Medical Education.

OBJECTIVES: Implementation barriers and lack of standardized point-of-care ultrasound (POCUS) curricula make the development of effective POCUS curricula and methods of assessment challenging. The authors aim to develop a longitudinal POCUS curriculum through staged intervention. In the first stage, the authors hypothesized that the use of high-fidelity ultrasound simulation during the Internal Medicine clerkship would improve POCUS confidence and knowledge among medical students, minimizing the need for trained faculty. METHODS: A quasi-experimental study of third-year students on the Internal Medicine clerkship at a large academic medical center in the United States was performed assessing the efficacy of ultrasound simulation use. The control group consisted of students who received baseline POCUS education during teaching rounds but did not have access to the ultrasound simulator. The experimental group consisted of students who, in addition to baseline POCUS education, had access to a high-fidelity ultrasound simulator throughout the clerkship for a minimum of 1 hour per week. Students in both the control and experimental groups completed a pre- and post-intervention confidence survey and knowledge-based examination. RESULTS: Eighty-two percent (50/61) of students completed pre- and post-tests, with the control group demonstrating no significant difference in POCUS confidence or knowledge. After exposure to the ultrasound simulator, the experimental group demonstrated statistically significant improvement in POCUS confidence and overall POCUS knowledge (p < .01). CONCLUSION: The use of high-fidelity ultrasound simulation can improve POCUS confidence and knowledge among medical students while addressing common barriers to the implementation of a POCUS curriculum. Despite showing statistically significant improvement in overall knowledge, the results did not appear to hold educational significance. Additional POCUS educational methods are necessary to overcome cognitive bias and potential overconfidence. The next stage of curriculum development will include resident-led POCUS workshops to supplement simulation.

Quality of Diabetes Care Among Recent Immigrants to the USA.

BACKGROUND: This study investigated the relationship between immigration status and quality of care for patients with diabetes. METHODS: We used the Medical Expenditure Panel (MEPS) dataset between 2002 and 2011 to examine the association between quality of care and immigration status. Quality of care was measured by report of dilated eye exam, foot exam, A1C test, an annual doctor's visit, and having blood pressure checked. Immigration status was defined as US born, non-US born but living in the USA for less than 15 years, and non-US born but living in the USA for more than 15 years. Bivariate analyses were used to compare receiving quality of care and immigration status. Multiple logistic regression was used to examine the association of immigration status with quality of care, adjusting for demographic and medical variables. RESULTS: Bivariate analyses showed significant differences for all quality of care measures compared to immigration status. However, after adjusting for sociodemographic factors and comorbidities, the only quality of care measures that were significantly associated with immigration status was having blood pressure checked (OR = 0.37 for < 15 years and 0.90 for > 15 years compared to US born, p < 0.001) and having dilated eye exam (OR = 0.77 for < 15 years and 0.89 for > 15 years compared to US born, p = 0.046). CONCLUSIONS: After adjustment for socioeconomic and comorbidity factors, blood pressure testing and dilated eye exams were the only measures significantly associated with immigration status. The highest risk was in the first 15 years after entering the USA and should be a target for interventions.