Canadian national survey of family medicine residents on point-of-care ultrasound training.

OBJECTIVE: To assess the quality of point-of-care ultrasound (POCUS) training in family medicine residency programs and to obtain the opinions of current family medicine residents on the role of ultrasound in primary care. DESIGN: A 23-question online survey conducted using SurveyMonkey between March 15 and June 30, 2017. SETTING: Canada. PARTICIPANTS: All family medicine residents of the 17 Canadian family medicine residency programs were included in the study but all enhanced skills residents were excluded. MAIN OUTCOME MEASURES: The quality and relevance of POCUS to primary care as perceived by residents and reported in the survey. RESULTS: A total of 854 Canadian family medicine residents responded, for a national response rate of 32.3%. Most respondents (94.3%) believe that POCUS training should be included in family medicine residency programs; however, only 18.4% of respondents currently receive formal training within their residency. Among those without POCUS training, 91.7% are interested in receiving formal training and 29.7% resorted to taking external POCUS courses. Most (77.5%) would consider using ultrasound in their future practice if they were competent in POCUS. The most useful applications for family medicine were considered to be the FAST (Focused Assessment with Sonography in Trauma) examination for free fluid and ascites (95.1%), procedural guidance (92.4%), and identifying an intrauterine pregnancy (88.6%). CONCLUSION: This is the largest survey identifying the perceived needs of family medicine residents for POCUS. Very few Canadian family medicine residents currently receive POCUS training. Consistent with our recent family medicine program director survey, there is overwhelming interest by family medicine residents to begin incorporating POCUS training into the family medicine curriculum.

Canadian national survey of point-of-care ultrasound training in family medicine residency programs.

OBJECTIVE: To assess the current state of point-of-care ultrasound (POCUS) training in Canadian family medicine residency programs. DESIGN: Cross-sectional survey to evaluate POCUS education in accredited Canadian family medicine residency programs; only 1 completed survey was accepted per residency program. SETTING: Seventeen accredited Canadian family medicine residency programs. PARTICIPANTS: Fourteen directors of family medicine programs across Canada. MAIN OUTCOME MEASURES: Opinions of program directors in family medicine education on the relevance of POCUS in family medicine, and the role of POCUS training in family medicine residency programs. RESULTS: The Web-based, anonymous survey, which was completed during the months of March and April 2016, achieved a response rate of 82% (14 out of 17 program directors). About one-fifth (21%) of program directors reported having an established ultrasound curriculum. Almost all directors (93%) believed that POCUS teaching should be integrated into family medicine residency curricula. Barriers to establishing training included the following: lack of adequate equipment (57%), lack of instructors (57%), lack of available time in the curriculum (57%), and lack of funding available to support training (71%). Seventy-one percent of respondents believed that POCUS could be used in outpatient family medicine clinics to alter clinical decision making. Some potential benefits associated with POCUS in primary care include more rapid diagnosis, improved patient outcomes, and potential to reduce health care costs. CONCLUSION: Although only a few Canadian family medicine residency program directors reported actually having an established ultrasound curriculum, most of them believed that POCUS training should be offered to family medicine residents and that its use could positively affect primary care. A growing number of family medicine residency programs are considering incorporating ultrasound training into their curricula, but resource availability remains a considerable barrier to implementation.

Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system.

INTRODUCTION: Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system. METHODS: Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients' pre-pathway implementation was compared with 99 consecutive patients' post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups. RESULTS: Length of hospital stay decreased from a median of 3 (inter-quartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design. CONCLUSIONS: The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.