C56-09 Guiding the Needle: A Competency-Based Ultrasound Peripheral IV Curriculum, for Medicine Residents

Abstract Introduction Hands-on procedural training in internal medicine has declined in recent years, reflected by the removal of procedure-specific logs from ACGME graduation requirements. Yet, many residents pursue procedurally-intensive fellowships such as critical care, where ultrasound needle guidance is foundational for central venous and arterial access. To address this gap, we designed and implemented an ultrasound-guided peripheral IV (pIV) curriculum, used as a proxy skill for needle guidance, by using Kern’s Six-Step approach to improve residents’ technical performance and confidence. Methods Program evaluation of our MICU rotation consistently identified limited procedural exposure. A targeted needs assessment revealed two key themes: (1) residents lacked confidence and practice with ultrasound-guided procedures, and (2) fellows had low confidence in residents’ procedural ability when experience was limited. Residents specifically identified needle-tip tracking on ultrasound as the most challenging aspect of the procedure. We developed a curriculum with the goal of improved ultrasound needle-guidance skill and first-year resident self-confidence. The training consisted of a brief, standardized didactic session on ultrasound physics, probe handling, and needle visualization, which was followed by a hands-on practicum using phantom arms with IV tubing to simulate a single peripheral vein. Performance was assessed with a modified Peripheral Ultrasound-Guided Venous Access (P-UGVA) scale which is a validated scoring tool for ultrasound pIV placement. For simulation appropriateness, we removed elements unrelated to the task (anatomy identification and hygiene), retaining domains for image optimization, needle visualization, dynamic tip control, and successful cannulation. Interns completed a pre-practicum assessment, received one-to-one coaching during deliberate practice, and underwent a post-practicum assessment one week later on the same simulator and rubric. Primary endpoints were change in modified P-UGVA scores (both with needletip coordination score and modified total score, analyzed using Wilcoxon Signed-Rank test and paired t-test test respectively) and self-reported confidence in ultrasound needle guidance. Results Nineteen residents completed the practicum before and after curriculum delivery, and 16 residents completed surveys. After curriculum delivery, the mean needle-tip coordination score improved by 0.63 points (p = 0.01), with a trend towards higher overall modified P-UGVA score (mean +1.31 points, p = 0.15). Twelve participants (75.0%) reported greater confidence in ultrasound-guided pIV placement after curriculum delivery. Conclusion A focused simulation-based curriculum significantly improved residents’ ultrasound needle-guidance abilities and self-reported confidence. Even brief structured interventions can meaningfully enhance procedural competence in early trainees and bridge the gap created by reduced procedural exposure during residency. This abstract is funded by: None