From Pilot to Practice: A Checklist Approach to POCUS Training in Family Medicine.

Abstract

Background and objectives: Point-of-care ultrasound (POCUS) is increasingly used in primary care and is now an Accreditation Council for Graduate Medical Education training expectation for family medicine residents. However, standardized methods for teaching, observing, and assessing POCUS skills in clinical settings remain limited.

Methods: The University of Hawai'i Family Medicine Residency Program developed direct-observation checklists for obstetric (OB) and musculoskeletal (MSK) POCUS. OB assessments included first- and third-trimester scans, while MSK assessments focused on knee and shoulder examinations. Checklist content was adapted from existing validated tools and refined through Plan-Do-Study-Act cycles. The checklists were designed for use before, during, and/or after patient encounters to guide observation and feedback. Faculty and residents completed surveys to evaluate usability, workflow integration, and educational impact.

Results: From March to October 2025, 39 checklists (28 OB, 11 MSK) and 60 surveys were collected from faculty and residents at two clinical sites. Most attending physicians reported checklist completion and feedback delivery in less than 5 minutes. Faculty most frequently used the tools postencounter. Perceived utility was high: 76% of OB and 88% of MSK attending responses rated the checklist as very useful, and nearly all residents (95% OB; 100% MSK) reported that the checklists supported a systematic approach and reinforced learning. Time constraints and certain indirectly observable checklist items were identified as implementation challenges.

Conclusions: Structured POCUS teaching checklists are feasible and well-received in family medicine residency training. These tools support direct observation, structured feedback, and standardizing expectations during supervised scanning encounters.