To support the content development of our survey, key texts and articles on POCUS were reviewed [31 (link)–35 ]. An initial survey was drafted with input from two researchers (KW and IM) in July 2015, containing a list of 15 diagnostic applications, 10 procedures, and 80 basic knowledge items. For each survey item on diagnostic applications and procedures, two questions were asked: 1) How applicable is the application/procedure to patient care in internal medicine? 2) What is the participant’s skill in that area? For knowledge items, only self-reported level of knowledge was asked.
This survey was then piloted with 8 non-internal medicine residents in order to obtain input on survey length, content, and clarity. Based on feedback from the pilot data, in particular with respect to the length of the initial survey, we substantially revised the survey. For diagnostic applications, items on A-lines and Z-lines were removed, as they were felt to be too specific. The addition of two diagnostic applications was suggested: deep vein thrombosis and hydronephrosis. For procedures, incision and drainage was removed as the skills involved were felt to be redundant with the skills involved in abscess aspiration. Lastly, many of the 80 items on POCUS knowledge [26 (link)] were felt to be too specific, resulting in a survey that was unacceptably long. Ultimately, knowledge items were grouped into broader categories. The final survey included 15 diagnostic applications, 9 procedures, and 18 knowledge items, in addition to questions on baseline demographic data (see Additional file 1).
Using an online survey tool (SurveyMonkey Inc. San Mateo, California, USA; www.surveymonkey.com), the final survey was distributed to the trainees between April and June 2016. Up to two reminder emails were sent between two and 8 weeks to maximize participant response rate. As this study was unfunded, no incentives were used in this study at any study site.
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