Hocus POCUS or Crucial Tool? Attitudes of General Practice Training Scheme Program Directors to Point of Care Ultrasound

Abstract

Introduction: Point of care ultrasound is used in several medical specialties but has not yet been widely adopted in primary care in Ireland. This study explored the attitudes of GP training scheme program directors towards POCUS. This included views on clinical use and implications for postgraduate GP training.Methods: This was a mixed methods study. A survey was distributed to all GP training scheme program directors in the Republic of Ireland. The survey included questions regarding clinical use and current provision of education in point of care ultrasound to GP trainees in individual schemes. A focus group examining similar themes was also done.Results: 50% of PDs responded to the survey. No scheme had an established training program in POCUS, and only one was considering starting one. Reasons cited included perceived lack of trainee interest, lack of faculty expertise, and lack of time and resources, including equipment. Potential uses for POCUS included basic obstetric examinations for detection of foetal heart activity, and right upper quadrant ultrasound for investigation of biliary colic. Facilitators to the use of ultrasound included rapidity of diagnosis and patient satisfaction, while barriers included lack of expertise and equipment, and concerns about clinical indemnity. The focus group corroborated these findings. PDs participating in the focus group also raise concerns about time and resource constraints both in practice and in training programs, the lack of a critical mass of expertise in the GP training community, the risk of over diagnosis, and concerns around quality assurance. The potential for “creep” effect was recognized. The group saw POCUS as having a limited potential role in a small number of clinical scenarios. Facilitators to use included patient satisfaction and increasing miniaturization and affordability of equipment.Conclusions: There are currently no established training programs in POCUS for GP trainees in Ireland and there are no immediate plans to establish any. There is limited interest in its use in clinical practice, with multiple barriers identified.