Developing a POCUS-Focused Inpatient Wards Team with Mixed Faculty Expertise

Despite national endorsements from the Society of Hospital Medicine, the American College of Physicians, and the Alliance for Academic Internal Medicine recognizing point-of-care ultrasound (POCUS) as an essential skill, and while there have been recent Delphi studies establishing what core applications should be taught and how to teach and evaluate POCUS skills, program-level curriculum adoption remains inconsistent.^1-4

One program highlighted its use of “gel rounds” as part of its longitudinal curriculum. This program encourages, but does not require, the use of bedside ultrasounds during routine rounding on inpatient wards. However, the literature has not adequately described how POCUS should be integrated into inpatient ward practices.⁵

In April 2025, an internal needs assessment evaluating residents’ knowledge, attitudes, and perceptions regarding POCUS within our internal medicine residency program revealed a critical need for expanded training opportunities. Nearly 70% of surveyed residents expressed dissatisfaction with the current curriculum. Furthermore, approximately 50% felt that two to four hours per month should be dedicated to POCUS training, while 25% desired more than four hours of structured education monthly. Residents identified limited access to ultrasound machines and a shortage of trained attendings as primary barriers to learning. Suggestions for improvement included dedicating rotation time to POCUS practice, prioritizing active learning over passive modules, providing real-time feedback and mentorship, and increasing the availability of dedicated ultrasound devices for rounding teams.

This prompted the idea of creating a formalized, inpatient, POCUS-focused rotation with expectations requiring that a POCUS study be performed daily.

A POCUS wards workgroup was formed to design and implement this initiative. Stakeholders included a POCUS expert and POCUS novice faculty, an associate program director, internal medicine chief residents, the vice section chief of education, and the section chief of hospital medicine. It was decided that the current inpatient medicine workflow should not deviate significantly for realistic implementation. It has been shown that the streamlined integration of POCUS into the existing clinical workflow is essential for increasing the use of POCUS.⁶ For this reason, one pre-existing inpatient teaching team out of four was decided to be the target of implementation, and its call cycle, learner staffing, and patient population would not change.

Key team expectations include that the team performs at least one POCUS exam per day, at least one POCUS exam is performed on a new admission or transfer on admitting days, and image review takes place in the afternoons on non-call days.

Barriers and Solutions

Access to ultrasound machines was the most significant barrier to implementation. The division, including the teaching teams, only had access to two handheld ultrasounds located in the supervising physicians’ workroom, which is not immediately adjacent to the inpatient units or resident workrooms. Additionally, these handheld ultrasounds did not have a vascular preset, which POCUS faculty identified as inadequate. As there was insufficient equipment funding, the workgroup requested that faculty donate their unused FDF (Faculty Development Funds) for the year towards purchasing a cart-based ultrasound machine. Enough funds were collected to allow for the purchase of a machine that is physically located in the hallway of the unit assigned to the POCUS-focused wards team via geographical cohorting.

The lack of trained POCUS faculty is another common and well-established barrier to successful integration of POCUS training.^7,8 To staff the team, attendings were required to have access to QPath E (Telexy, Inc.)—the hospital’s POCUS archiving system for image storage, review, and quality assurance—and to perform at least one type of POCUS exam competently. Formal POCUS expertise was not required. Faculty were encouraged to practice scanning standardized patients at our monthly POCUS Club—a low-stress, open-house session facilitated by the division’s POCUS expert faculty. These two-hour sessions offer hands-on, supervised scanning with POCUS expert faculty and a standardized patient, structured as an informal drop-in open house. One hope was that POCUS novice faculty who signed up would be motivated to deepen their POCUS knowledge over time. The majority of attendings are on service for seven days at a time, so most residents would be on service with a POCUS expert for at least one to two weeks of their three-week rotation.

Another barrier was a lack of awareness of how to use and access QPath E. In December 2025, QPath E was made accessible via the university hospital intranet and as an application on the hospital Citrix Storefront, through the efforts of a workgroup faculty member. Two internal medicine residents created two nine-minute educational videos as part of a quality improvement project. The first teaches POCUS fundamentals: basic physics, knobology, modes, artifacts, indicator orientation, image optimization, and probe movements. The second demonstrates a step-by-step guide to using QPath E. There are pre- and post-intervention surveys. Residents rotating on the service are encouraged to watch these videos and are sent emails and direct messages with reminders at the beginning and throughout the three-week rotation.

Implementation and Initial Feedback

Fourteen attendings with POCUS expertise ranging from novice to expert signed up to staff the team, which began in January 2026, nine months after the workgroup was created. Most attendings have completed at least one POCUS study daily, with time constraints cited as the primary barrier among those who have not, particularly POCUS novice faculty.

Informal feedback from residents:

• “POCUS wards teach POCUS the way it’s meant to be taught and used.”
• “It’s exciting to compare our reads to formal reads.”
• “We get to practice this skill so much more with this new opportunity.”
• “POCUS was less intimidating for me at the end of my rotation because I got to use it without the pressure of placing a line in the MICU [medical intensive care unit] or in a critical care scenario.”

Informal feedback from attending physicians:

• “Having clear expectations to utilize POCUS daily and easy access to a high-quality cart-based machine on the same unit as the majority of patients with geographical cohorting has made it feasible to use POCUS at least once daily, mostly during rounds to answer specific questions. One major challenge is the lack of interest among the majority of preliminary interns.”
• “As a POCUS novice, I had the team watch short videos online on high-yield POCUS topics. We were able to see elevated JVP [jugular venous pressure] and compare that to patients with normal JVP. We were also able to see B lines on a patient with pulmonary edema.”
• Preliminary survey data: Of nine residents who completed the pre-rotation survey, four completed the post-rotation survey, with three of four (75%) completing the educational modules.

Across all ultrasound confidence and knowledge domains—including probe selection, image optimization, ultrasound physics, and QPath E workflow—post-rotation respondents demonstrated meaningful improvement, with low confidence eliminated entirely.

Most notably, all four post-rotation respondents anticipated increasing their POCUS use to at least weekly in future clinical practice, compared to rarely or never before the rotation. Residents identified expert mentorship, protected scanning time, and organ-specific teaching as areas for growth.

Lessons Learned and Next Steps

This initiative demonstrated that the absence of POCUS expert faculty available 100% of the time need not be a barrier to launching a dedicated POCUS wards team. Early engagement of key stakeholders across both the division and residency leadership proved essential to successful implementation.

In practice, teams have been scanning at least once daily on most days; however, scanning is occasionally not completed, most often on busy days with POCUS novice faculty, with time constraints cited as the primary barrier. Preliminary interns have shown limited interest in POCUS participation, and we have requested that residency leadership schedule only categorical interns for the team going forward.

Several areas for continued development have been identified. A formal process for longitudinal support, supervision, quality assurance, and feedback for POCUS novice faculty remains to be established. Additionally, setting clear expectations at the start of rounds, including which patients will be scanned, what specific clinical questions will be addressed, and whether scanning will occur during rounds or in the afternoon, has emerged as a critical factor in ensuring POCUS is consistently integrated into the workflow on even the busiest clinical days.

Conclusion

With the implementation of the above, we were able to achieve a structured method to improve exposure to POCUS as well as the introduction of how it fits into the inpatient medicine wards’ workflow, even when staffed by POCUS novice faculty members. We were able to do this by having a dedicated ultrasound machine, cohorting interested POCUS expert faculty as attendings on this team, and setting clear expectations about when and where POCUS studies will be performed and reviewed. Integrating POCUS into current workflows, where possible, without significantly changing the structure of the rotation has also been a key element of success. 

Dr. Salas

Dr. Subramany

Dr. Goldstein

Dr. Shaw

Dr. Herrera

Dr. Inga

Dr. Salas is a hospitalist at the University of New Mexico (UNM) Hospital in Albuquerque, N.M. Dr. Subramany is co-director of simulation education and POCUS for the internal medicine residency program and associate professor of medicine at the UNM Hospital in Albuquerque, N.M. Dr. Goldstein is a hospitalist at UNM Hospital in Albuquerque, N.M. Dr. Shaw is an associate professor in the division of hospital medicine’s department of internal medicine, an associate program director of the internal medicine residency, an assistant clerkship director of the internal medicine clerkship, and the vice section chief of education for hospital medicine at the University of New Mexico in Albuquerque, N.M. Dr. Baron Herrera is a PGY-2 internal medicine resident at the UNM Hospital in Albuquerque, N.M. Dr. Inga is a PGY-3 internal medicine resident at the UNM Hospital in Albuquerque, N.M. 

References

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