INTRODUCTION:Point-of-care ultrasound (POCUS) inclusion in physician assistant (PA) program curricula is increasing. Research has shown that preceptors' readiness to teach POCUS on rotations is limited. The purpose of this research is to describe PA students' self-reported opportunity to practice POCUS on rotations, to quantify the number of POCUS examinations completed on rotations, and to analyze data to provide insights into which rotations might be most amendable to POCUS training for PA students. METHODS:Students were surveyed about their preceptors' willingness to allow the practice of POCUS on rotations. Students were required to complete POCUS examinations during rotations. The number of examinations performed was extracted from the Butterfly Network software and paired with the students' rotation information. Descriptive statistics were completed. RESULTS:A survey response rate of 71.4% was noted. The student reported opportunities to practice POCUS were the highest on Family Medicine, Cardiology, Hospital Internal Medicine (HIM), and Emergency Medicine (EM). Students completed 778 POCUS examinations on rotations. A higher objective number of examinations were completed on EM and HIM rotations. DISCUSSION:EM and HIM rotations afforded the most opportunity to convert the reported opportunity to practice POCUS to the objective act of obtaining POCUS images. Most rotations had proportionally similar number of POCUS examinations completed per organ system, however, Cardiology had a disproportionately higher number of cardiac examinations. This rotation and application-specific understanding of PA students' ability to obtain POCUS examinations on rotations should be used by PA programs while developing POCUS curriculum.

At the time this article was written, Ellie Gertner was a student in the PA program at the Mayo Clinic in Rochester, Minn. She now practices in internal medicine at the Mayo Clinic. Michael Breunig is clinical skills co-director in the PA program at the Mayo Clinic and practices in the Division of Hospital Internal Medicine at the Mayo Clinic. The authors have disclosed no potential conflicts of interest, financial or otherwise. Michael Breunig, PA-C, and M.F. Winegardner, MPAS, PA-C, department editors

Purpose Point-of-care ultrasound (POCUS) inclusion in medical education is increasing, and understanding of clinical educators' perceptions and use patterns is needed. The purpose of this research project was to explore current use, interest, knowledge, perceptions, and readiness to teach POCUS from the perspectives of clinical preceptors for physician assistant (PA) students. Methods A survey research study was completed on previously identified preceptors. Descriptive statistics outlined the frequencies of responses. Bivariate analysis with Chi-Square or Fischer Exact Testing was used to identify statistically significant differences between groupings. Results Most preceptors (87.1%) believe POCUS adds clinical value, but a minority received POCUS training (37%), are familiarity with its use (37.4%), and currently use POCUS (23.4%). Two-thirds (66.1%) of preceptors stated they would allow PA students to practice POCUS skills on clinical rotation; however, few (31%) felt comfortable with this and even fewer (22.6%) felt comfortable findings on POCUS into their clinical decision making. Conclusions Despite support of incorporation of POCUS into PA education, clinical preceptors' readiness to teach POCUS on clinical rotations is limited. This study shows that preceptors are neither comfortable with student use nor incorporating student findings into clinical decision making. A lack of sufficient clinical preceptors to support POCUS education has not been previously reported. PA programs attempting to incorporate POCUS into their curricula will need to be intentional providing opportunities to continue POCUS on clinical rotations.

ABSTRACT:Point-of-care ultrasound (POCUS) has been demonstrated to improve students' medical knowledge and clinical exam skills and advances patient care through numerous diagnostic and therapeutic applications. Despite the growing use of ultrasound in medical education and clinical practice, few physician assistant (PA) programs have successfully integrated POCUS education into their curricula. This manuscript describes an evidence-based approach for integrating POCUS education throughout a 2-year PA curriculum, with the goal of serving as a useful guidepost for other PA programs as they strive to incorporate this valuable skill into their curricula.

Point-of-care ultrasound (POCUS) has been demonstrated to improve students' medical knowledge and clinical exam skills and advances patient care through numerous diagnostic and therapeutic applications. Despite the growing use of ultrasound in medical education and clinical practice, few physician assistant (PA) programs have successfully integrated POCUS education into their curricula. This manuscript describes an evidence-based approach for integrating POCUS education throughout a 2-year PA curriculum, with the goal of serving as a useful guidepost for other PA programs as they strive to incorporate this valuable skill into their curricula.

Introduction The use of ultrasound as an educational technology in medical education to teach basic sciences, including anatomy and physical examination techniques, has become common. Multiple studies have demonstrated the benefits of using ultrasound to teach anatomy and physical examination skills; however, this has not been studied in physician assistant (PA) students. Methods This qualitative phenomenological research used 5 semi-structured interviews of first semester PA students to obtain a deeper understanding of students’ perspectives. Dominant coding categories were identified through open coding, and thematic analysis was completed to identify emerging themes of participants’ perspectives. Results Overall, the students positively perceived this use of ultrasound. Four themes emerged regarding PA students’ perspectives of ultrasound as an educational technology within their Clinical Anatomy and History and Physical Examination classes: solidifying the curriculum, desiring more, looking ahead, and burden of curriculum. Discussion This study supports the use of ultrasound as an educational technology to solidify prior learning; however, steps to ensure student commitment to the technology should be taken. Careful consideration for curricular sequencing and allocation of time should be utilized by programs attempting to integrate ultrasound in this manner. Hands-on experiences, rather than faculty demonstrations, and clinical correlation should be utilized whenever possible.

Taryn Ragaisis and Michael Breunig practice in the Division of Hospital Internal Medicine at the Mayo Clinic in Rochester, Minn. The authors have disclosed no potential conflicts of interest, financial or otherwise. Bryan Walker, MHS, PA-C, and Michael Breunig, PA-C, department editors

OBJECTIVE:Little is understood about what contributes to perceived workload for those providing overnight coverage to hospitalized patients overnight, which limits the ability to modify these factors or to proactively identify appropriate staffing levels. The objective of this study is to understand the major contributors to perceived overnight cross-coverage workload.METHODS:Cross-covering advanced practice providers (APPs) in a large academic hospitalist group completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) at the end of each night shift. Other shift characteristics were collected, including patient load, assigned action items, watcher/unstable patients, newly admitted patients, number of units covered, total pages, peak pager density, rapid response team (RRT) activations, and intensive care unit (ICU) transfers.RESULTS:For 14 APP participants, who completed 271 post-shift surveys, the mean (SD) patient load was 49.9 (6.4) patients per night, and providers received a mean (SD) of 40.8 (13.7) total pages per shift. Mean (SD) NASA-TLX score was 35.1 (19.0). In multivariate modeling, total pages, action items, and any RRT or ICU transfer were associated with significant increases in the mean NASA-TLX score, with estimated effect sizes of 0.5, 0.8, and 14.3, respectively, per 1-unit increase in each shift characteristic. The greatest cumulative contributor to perceived workload was total number of pages, followed by the presence of any RRT activation/ICU transfer, with estimated effect sizes of 20.4 and 14.9, respectively.CONCLUSIONS:Total number of pages was the greatest contributor to perceived workload. This study suggests that quality improvement initiatives designed to improve pager communication may considerably improve provider-perceived workload.

PURPOSE:The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs).METHODS:In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined.RESULTS:In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04).CONCLUSION:Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.

Ryan C. Kingsley practices in the Division of Hospital Internal Medicine, Department of Medicine, at the Mayo Clinic in Rochester, Minn. Sandeep Pagali practices in the Division of Hospital Internal Medicine, Department of Medicine, at the Mayo Clinic and is an assistant professor of medicine at the Mayo Clinic College of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise. Bryan Walker, MHS, PA-C, and Michael Breunig, PA-C, department editors

At the Mayo Clinic in Rochester, Minn., Michael Breunig is an instructor of medicine and an NP/PA assistant supervisor in hospital internal medicine and Deanne Kashiwagi is a consultant in the Division of Hospital Internal Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise. Bryan Walker, MHS, PA-C, department editor

ABSTRACTAtypical hemolytic uremic syndrome (HUS) is clinically difficult to distinguish from HUS and thrombotic thrombocytopenic purpura. Atypical HUS results from dysregulation of complement activation causing thrombotic microangiopathy affecting multiple organ systems. Atypical HUS is associated with high morbidity and mortality, making early recognition and appropriate therapy necessary to improve patient outcomes.

Thoracic aortic aneurysms often are asymptomatic or cause nonspecific symptoms such as cough, dyspnea, wheezing, or dysphagia. Acute onset of severe chest, neck, back, or abdominal pain may indicate an aortic rupture or dissection. Early identification and treatment, including optimized medical management and evaluation for surgical intervention, are necessary to improve patient outcomes.