Point-of-care Ultrasound in Internal Medicine Residency: A Multicenter Survey in Mexico

Point-of-care Ultrasound in Internal Medicine Residency: A Multicenter Survey in Mexico | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Point-of-care Ultrasound in Internal Medicine Residency: A Multicenter Survey in Mexico Fernando González-Valdivia, Gonzaga-López Teresa Ivonne, Arce-Salinas César Alejandro, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7437773/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Point-of-care ultrasound (POCUS) is increasingly recognized as an essential tool in Internal Medicine, its structured integration into residency programs remains still limited, particularly in low- and middle-income countries. In Mexico, the specific barriers to its implementation are not well characterized. This multicenter study was designed to assess current practices and perceived barriers to its integration. Methods: We conducted a multicenter cross-sectional survey of Internal Medicine residents and faculty in seven PEMEX hospitals (two tertiary, five secondary). Of 182 invited participants, 158 completed the questionnaire (response rate, 86%). The survey, pilot-tested and validated by experts, assessed perceived applicability, self-reported skill, knowledge, and frequency of POCUS use. Results: Overall, 96% of participants supported incorporating POCUS into Internal Medicine training and practice. Structured curricula were reported in 45% of tertiary and 41% of secondary hospitals. The most frequently taught applications were ascites, pleural effusion, and inferior vena cava assessment. Commonly performed procedures included central venous catheter placement, thoracentesis, and paracentesis; arterial blood gas analysis; arterial line placement were rarely performed. Thoracentesis training was more frequent in secondary than in tertiary hospitals (59% vs. 30%, P=0.001). The main barriers were lack of equipment (65.8%), shortage of trained instructors (57.5%), and insufficient institutional support (35.4%); equipment shortages were significantly higher in tertiary centers (40% vs. 8%, P<0.001). Conclusions: Although POCUS is widely valued among internal medicine residents and faculty in Mexico, its adoption is constrained by limited training, inadequate resources, and weak institutional support. These findings underscore the need for structured, competency-based curricula and national strategies to ensure equitable access, skill development, and safer patient care. Point-of-care ultrasound internal medicine perceived barriers medical education survey Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Since its introduction in the early 1990s, ultrasound has become an essential diagnostic and procedural tool across multiple medical specialties. In Internal Medicine, point-of-care ultrasound (POCUS) has been shown to improve diagnostic accuracy and guide clinical decision-making, yet its structured incorporation into residency programs remains inconsistent worldwide.¹ Although its benefits are well recognized, measuring its impact remains challenging given heterogeneous populations, absence of standardized protocols, and variability in training.² Evidence indicates that POCUS performed by internal medicine residents influences diagnostic and therapeutic decisions in up to 25% of cases.³ However, its broader adoption is hindered by persistent barriers, including limited access to ultrasound devices, lack of formal curricula and supervision, time constraints, and inadequate quality assurance systems.⁴ In Mexico, the challenges limiting the implementation of POCUS in Internal Medicine residency programs have not been systematically evaluated. This study was conducted to address this gap by assessing perceived barriers, applicability, interest, and self-reported skill levels among internal medicine residents and faculty within the Petróleos Mexicanos (PEMEX) Hospital’s health system. These findings aim to provide a foundation for the development of a national core curriculum to support standardized training and competency in POCUS across Internal Medicine programs in Mexico. Methods Study Design This study employed a multicenter cross-sectional design and was conducted in seven hospitals affiliated to the Petróleos Mexicanos (PEMEX) health system. The study sites included two tertiary care hospitals in Mexico City and five second-level care hospitals located in the states of Veracruz, Tamaulipas, Guanajuato, and Tabasco. All participating institutions provided accredited residency programs of Internal Medicine. Participants All Internal Medicine residents and faculty members from the participating institutions were invited to participate in the study (n = 182). Of these, 158 individuals (86%) provided electronic informed consent and were included in the final analysis. The sample consisted of 46 faculty members and 112 residents. Survey Development The questionnaire was developed following a comprehensive review of the literature and encompassed four main domains: 15 diagnostic applications, 9 procedural items, 18 knowledge-based questions, and demographic information. Perceived utility and self-reported skills were assessed using a 5-point Likert scale, while frequency of use was captured through numerical input. Prior to deployment, a pilot test was conducted in July 2024 with 10 participants (5 residents and 5 faculty). Based on their feedback, revisions were made, and the final version was validated by an expert panel. The survey was subsequently administered online via Microsoft Forms between August and September 2024. Participant recruitment was carried out using convenience sampling. The study protocol was reviewed and approved by the PEMEX Institutional Review Board, as well as by the corresponding local Ethics and Research Committees. Written informed consent was obtained from all participants. No external funding was received. Outcomes The primary outcomes were perceived applicability, self-reported skill, knowledge, and frequency of POCUS use. Applicability and skill were assessed using 5-point Likert scales (1 = very poor to 5 = very good), whereas knowledge was evaluated through structured multiple-choice questions. Statistical Analysis Statistical analyses were performed using SPSS software, version 25.0 (IBM Corp., Armonk, NY, USA). The normality of data distributions was evaluated with the Kolmogorov–Smirnov and Shapiro–Wilk tests. Continuous variables were summarized using measures of central tendency and dispersion, while categorical variables were presented as frequencies and percentages. Pearson’s correlation test was applied to explore associations. Statistical significance was defined as a two-tailed p-value < 0.05. Results Participation and demographics A total of 158 physicians participated in the study, comprising 46 faculty members and 112 residents, with an overall response rate of 86%. The mean age of residents was 29.0 ± 3.1 years, while faculty members had a mean age of 45.0 ± 9.4 years. Overall, 96% of respondents expressed support for integrating POCUS into internal medicine practice. No significant differences were observed between hospital levels or professional roles (Table 1 ). Table 1 Demographic characteristics. faculty members n = 46 29.1% Resident n = 112 70.9% Central Hospital n = 71 55,1% Regional Hospital n = 87 44.9% Resident Ages (media). 29 years old SD (3.1) faculty members Ages (media). 45 years old SD (9.4) Training and teaching Ninety-six percent of participants agreed that POCUS should be incorporated into both clinical practice and medical education in Internal Medicine. No significant differences were observed by level of care (p = 0.38) or professional role (faculty vs. resident). Structured POCUS training was reported in 45% of tertiary hospitals and 41% of second-level hospitals. The most frequently taught procedures were ascites evaluation, pleural effusion assessment, and inferior vena cava examination. In contrast, the procedures most commonly performed in practice included central venous catheter placement, thoracentesis, and paracentesis, whereas arterial blood gas sampling, peripheral intravenous cannulation, and arterial line placement were rarely performed (Table 2 ). Table 2 Time spent on teaching (training). Training Median (IQR) POCUS training (lectures, practices, sessions, etc.) 1 (IQR 4) Visual teaching of POCUS (ultrasound images or videos) 1 (IQR 4) POCUS training with simulators 0 (IQR 1) POCUS teaching with real-patients 1 (IQR 4) A significant difference was found in thoracentesis training, which was more frequently reported in second-level hospitals compared with third-level centers (59% vs. 30%, p = 0.001) (Figs. 1 and 2 ). Perceived barriers The most frequently reported barriers were lack of ultrasound equipment (65.8%), shortage of trained instructors (57.5%), and limited institutional support (35.4%). Financial constraints were cited by 24% of participants, whereas opposition from other professionals was infrequent (6.3%). Of note, a significantly higher proportion of respondents from tertiary care hospitals reported a lack of ultrasound equipment compared with second-level care centers (40% vs. 8%, p < 0.001) (Figs. 3 and 4 ). Applicability and self-perceived skill Participants identified central venous catheter placement (94.3%), ultrasound-guided thoracentesis (93.7%), and pericardial effusion assessment (92.4%) as the procedures most applicable to Internal Medicine practice. Importantly, all procedures evaluated received perceived applicability ratings above 54%. The highest self-reported skill levels were reported for ultrasound-guided paracentesis (44.3%), ascites detection (40.5%), and pleural effusion detection (39.3%). In contrast, the lowest skill levels were noted for ultrasound-guided arterial blood gas analysis (6.3%), peripheral arterial cannulation (7.0%), and both hydronephrosis and joint effusion assessments (12.6% each). Interest and frequency of use The highest levels of interest in learning POCUS procedures were observed for ultrasound-guided paracentesis (91.1%), left ventricular contractility assessment (90.6%), and both pneumothorax and pleural effusion assessments (89.9%). Although ultrasound-guided arterial blood gas analysis received the lowest interest rating, it was nevertheless considered relevant by more than two-thirds of participants (68%). The procedures most frequently performed within the previous six months were right ventricular dilation assessment and inferior vena cava measurement (Figs. 4 and 5 ). Discussion This multicenter survey demonstrates that point-of-care ultrasound (POCUS) is widely regarded as clinically relevant by internal medicine residents and faculty in Mexico, yet its structured implementation within residency training remains limited. Despite near-universal enthusiasm for POCUS integration, structured training programs were reported in fewer than half of the participating hospitals—underscoring a critical disconnect between perceived utility and actual implementation. Our results are consistent with studies from North America and Europe, which have documented strong interest in POCUS but uneven curricular adoption across residency programs. In the United States and Canada, structured curricula have expanded over the past decade, although variability persists across institutions.⁵˒⁶ Similarly, European initiatives have been endorsed by specialty societies, yet heterogeneity remains a challenge.⁷ In contrast, the barriers identified in Mexico more closely resemble those of other middle-income countries, particularly limited access to equipment, shortage of trained faculty, and insufficient institutional commitment. By situating these findings within the Mexican healthcare system, this study contributes to the global understanding of POCUS adoption and underscores the importance of tailored, context-specific solutions Although resource constraints were the most frequently cited obstacles, the survey also highlighted a more structural barrier: lack of institutional support. More than one-third of participants reported insufficient administrative commitment, indicating that financial investment alone will not guarantee sustainable integration. This observation aligns with international consensus, which emphasizes that long-term success requires accreditation pathways, inclusion in certification standards, and robust quality assurance mechanisms.⁷ Without these structural supports, even widespread enthusiasm may fail to translate into meaningful clinical practice. Participants rated central venous catheter placement, thoracentesis, and pericardial effusion assessment as the most applicable POCUS procedures, consistent with international literature that identifies these as core competencies for internists.⁶ Diagnostic applications such as ascites and pleural effusion detection were associated with higher self-reported skill levels, whereas procedural competencies lagged behind. This discrepancy highlights the limitations of informal or self-directed training models ⁶ and raises concerns about patient safety, as inadequate training in ultrasound-guided procedures may increase the risk of complications and diagnostic delays. ³ Thus, failing to implement structured, competency-based curricula may undermine both the quality of care and patient outcomes.⁴ This study has limitations. The reliance on self-reported data introduces potential response bias, and the use of convenience sampling within a single healthcare system (PEMEX) may limit generalizability to other institutions in Mexico. Nevertheless, the multicenter design, high response rate, and inclusion of both residents and faculty strengthen the validity of the findings and provide valuable insights into current practices and barriers. Future research should include more diverse healthcare settings across Mexico, assess patient-level outcomes related to POCUS integration, and evaluate the effectiveness of structured educational interventions. Such efforts will be critical for informing national policies and developing sustainable frameworks that promote equitable access to ultrasound training, enhance clinical competency, and improve patient care. Conclusion This study demonstrates not only the strong willingness of Mexican internal medicine residents and faculty to adopt point-of-care ultrasound (POCUS), but also the systemic barriers that limit its full integration into training programs. Both groups identified POCUS as highly applicable to internal medicine practice—particularly for central venous access, ultrasound-guided thoracentesis, and the evaluation of cardiac abnormalities. Despite this consensus, substantial gaps in knowledge and procedural skills persist, highlighting the urgent need for structured, competency-based curricula within residency programs. Future efforts to standardize internal medicine training in Mexico should build on these findings, while considering the study’s limitations, to ensure equitable access, skill development, and ultimately safer patient care. Declarations Conflicts of Interest and Funding The authors declare no conflicts of interest and received no external funding. Author Contribution F.G. he wrote the main text of the manuscript, prepared all figures, created the database, and contributed to the survey with the other authors.T.I.G. disseminated the survey through institutional channels and helped oversee its proper application.M.C. conducted the final online survey, contributed extensively to the writing of the manuscript, and performed all statistical analysis.C.A.A. contributed to the abstract and contributed to the survey.All authors reviewed the manuscript. Acknowledgement We extend our sincere gratitude to all the internal medicine residents and faculty members who participated in the survey and contributed to this study. Data Availability Data is provided within the manuscript References Lichtenstein D, Axler O. Intensive use of general ultrasound in the intensive care unit. Intensive Care Med . 1993;19(6):353–5. Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med . 2021;385(17):1593–602. Andersen GN, Graven T, Skjetne K, Mjølstad OC, Kleinau JO, Dalen H. Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. J Ultrasound Med . 2015 Apr;34(4):627–36. Wong J, Montague S, Wallace P, Etchells E, Khalid Z, Swaminathan S, et al. Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. Ultrasound J . 2020;12:19. Ma IWY, Arishenkoff S, Wiseman J, Desy J, Ailon J, Martin L, Otremba M, Halman S, Willemot P, Blouw M ; Canadian Internal Medicine Ultrasound (CIMUS) Group*. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med. 2017 Sep;32(9):1052-1057. LoPresti CM, Schnobrich DJ, Dversdal RK, Schembri F. A road map for point-of-care ultrasound training in internal medicine residency. Ultrasound J. 2019 May 9;11(1):10. Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, et al ; International Liaison Committee on Focused Cardiac UltraSound (ILC-FoCUS); International Conference on Focused Cardiac UltraSound (IC-FoCUS). International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014 Jul;27(7):683.e1-683.e33.. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7437773","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":506550805,"identity":"8c41f4d8-edf2-46bb-81b6-c6d5eecebff3","order_by":0,"name":"Fernando 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care.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7437773/v1/4a7258a39995e272bfafc42c.png"},{"id":90463603,"identity":"5e8f8b8d-ce5b-424a-83e3-d5d53dce3940","added_by":"auto","created_at":"2025-09-03 05:05:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":71209,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerceived barriers to the adoption of ultrasound in Internal Medicine.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7437773/v1/aa18df6ab4b744a95153005b.png"},{"id":90463613,"identity":"05f2d06b-df7f-4bae-a295-da23f8f14471","added_by":"auto","created_at":"2025-09-03 05:05:03","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":78153,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eperception of usefulness, interest and frequency of ultrasound-guided procedures. 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Part 2\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7437773/v1/cccded7a2c7a7f832bc1db83.png"},{"id":90463594,"identity":"851ca522-f34e-4840-aad2-80cb34ba7fba","added_by":"auto","created_at":"2025-09-03 05:05:02","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":82615,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eperception of usefulness, interest and frequency of ultrasound-guided procedures. 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In Internal Medicine, point-of-care ultrasound (POCUS) has been shown to improve diagnostic accuracy and guide clinical decision-making, yet its structured incorporation into residency programs remains inconsistent worldwide.\u0026sup1; Although its benefits are well recognized, measuring its impact remains challenging given heterogeneous populations, absence of standardized protocols, and variability in training.\u0026sup2;\u003c/p\u003e\u003cp\u003eEvidence indicates that POCUS performed by internal medicine residents influences diagnostic and therapeutic decisions in up to 25% of cases.\u0026sup3; However, its broader adoption is hindered by persistent barriers, including limited access to ultrasound devices, lack of formal curricula and supervision, time constraints, and inadequate quality assurance systems.⁴\u003c/p\u003e\u003cp\u003eIn Mexico, the challenges limiting the implementation of POCUS in Internal Medicine residency programs have not been systematically evaluated. This study was conducted to address this gap by assessing perceived barriers, applicability, interest, and self-reported skill levels among internal medicine residents and faculty within the Petr\u0026oacute;leos Mexicanos (PEMEX) Hospital\u0026rsquo;s health system. These findings aim to provide a foundation for the development of a national core curriculum to support standardized training and competency in POCUS across Internal Medicine programs in Mexico.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis study employed a multicenter cross-sectional design and was conducted in seven hospitals affiliated to the Petr\u0026oacute;leos Mexicanos (PEMEX) health system. The study sites included two tertiary care hospitals in Mexico City and five second-level care hospitals located in the states of Veracruz, Tamaulipas, Guanajuato, and Tabasco. All participating institutions provided accredited residency programs of Internal Medicine.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eAll Internal Medicine residents and faculty members from the participating institutions were invited to participate in the study (n\u0026thinsp;=\u0026thinsp;182). Of these, 158 individuals (86%) provided electronic informed consent and were included in the final analysis. The sample consisted of 46 faculty members and 112 residents.\u003c/p\u003e\n\u003ch3\u003eSurvey Development\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was developed following a comprehensive review of the literature and encompassed four main domains: 15 diagnostic applications, 9 procedural items, 18 knowledge-based questions, and demographic information. Perceived utility and self-reported skills were assessed using a 5-point Likert scale, while frequency of use was captured through numerical input.\u003c/p\u003e\u003cp\u003ePrior to deployment, a pilot test was conducted in July 2024 with 10 participants (5 residents and 5 faculty). Based on their feedback, revisions were made, and the final version was validated by an expert panel. The survey was subsequently administered online via Microsoft Forms between August and September 2024. Participant recruitment was carried out using convenience sampling.\u003c/p\u003e\u003cp\u003e The study protocol was reviewed and approved by the PEMEX Institutional Review Board, as well as by the corresponding local Ethics and Research Committees. Written informed consent was obtained from all participants. No external funding was received.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcomes were perceived applicability, self-reported skill, knowledge, and frequency of POCUS use. Applicability and skill were assessed using 5-point Likert scales (1\u0026thinsp;=\u0026thinsp;very poor to 5\u0026thinsp;=\u0026thinsp;very good), whereas knowledge was evaluated through structured multiple-choice questions.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using SPSS software, version 25.0 (IBM Corp., Armonk, NY, USA). The normality of data distributions was evaluated with the Kolmogorov\u0026ndash;Smirnov and Shapiro\u0026ndash;Wilk tests. Continuous variables were summarized using measures of central tendency and dispersion, while categorical variables were presented as frequencies and percentages. Pearson\u0026rsquo;s correlation test was applied to explore associations. Statistical significance was defined as a two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eParticipation and demographics\u003c/h2\u003e\u003cp\u003e A total of 158 physicians participated in the study, comprising 46 faculty members and 112 residents, with an overall response rate of 86%. The mean age of residents was 29.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 years, while faculty members had a mean age of 45.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 years. Overall, 96% of respondents expressed support for integrating POCUS into internal medicine practice. No significant differences were observed between hospital levels or professional roles (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003efaculty members\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.1%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55,1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegional Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResident Ages (media).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efaculty members Ages (media).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD (9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTraining and teaching\u003c/h3\u003e\n\u003cp\u003eNinety-six percent of participants agreed that POCUS should be incorporated into both clinical practice and medical education in Internal Medicine. No significant differences were observed by level of care (p\u0026thinsp;=\u0026thinsp;0.38) or professional role (faculty vs. resident). Structured POCUS training was reported in 45% of tertiary hospitals and 41% of second-level hospitals.\u003c/p\u003e\u003cp\u003eThe most frequently taught procedures were ascites evaluation, pleural effusion assessment, and inferior vena cava examination. In contrast, the procedures most commonly performed in practice included central venous catheter placement, thoracentesis, and paracentesis, whereas arterial blood gas sampling, peripheral intravenous cannulation, and arterial line placement were rarely performed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTime spent on teaching (training).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTraining\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOCUS training (lectures, practices, sessions, etc.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (IQR 4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual teaching of POCUS (ultrasound images or videos)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (IQR 4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOCUS training with simulators\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (IQR 1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOCUS teaching with real-patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (IQR 4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA significant difference was found in thoracentesis training, which was more frequently reported in second-level hospitals compared with third-level centers (59% vs. 30%, p\u0026thinsp;=\u0026thinsp;0.001) (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePerceived barriers\u003c/h2\u003e\u003cp\u003eThe most frequently reported barriers were lack of ultrasound equipment (65.8%), shortage of trained instructors (57.5%), and limited institutional support (35.4%). Financial constraints were cited by 24% of participants, whereas opposition from other professionals was infrequent (6.3%). Of note, a significantly higher proportion of respondents from tertiary care hospitals reported a lack of ultrasound equipment compared with second-level care centers (40% vs. 8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eApplicability and self-perceived skill\u003c/h2\u003e\u003cp\u003eParticipants identified central venous catheter placement (94.3%), ultrasound-guided thoracentesis (93.7%), and pericardial effusion assessment (92.4%) as the procedures most applicable to Internal Medicine practice. Importantly, all procedures evaluated received perceived applicability ratings above 54%.\u003c/p\u003e\u003cp\u003eThe highest self-reported skill levels were reported for ultrasound-guided paracentesis (44.3%), ascites detection (40.5%), and pleural effusion detection (39.3%). In contrast, the lowest skill levels were noted for ultrasound-guided arterial blood gas analysis (6.3%), peripheral arterial cannulation (7.0%), and both hydronephrosis and joint effusion assessments (12.6% each).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eInterest and frequency of use\u003c/h2\u003e\u003cp\u003eThe highest levels of interest in learning POCUS procedures were observed for ultrasound-guided paracentesis (91.1%), left ventricular contractility assessment (90.6%), and both pneumothorax and pleural effusion assessments (89.9%). Although ultrasound-guided arterial blood gas analysis received the lowest interest rating, it was nevertheless considered relevant by more than two-thirds of participants (68%).\u003c/p\u003e\u003cp\u003eThe procedures most frequently performed within the previous six months were right ventricular dilation assessment and inferior vena cava measurement (Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicenter survey demonstrates that point-of-care ultrasound (POCUS) is widely regarded as clinically relevant by internal medicine residents and faculty in Mexico, yet its structured implementation within residency training remains limited. Despite near-universal enthusiasm for POCUS integration, structured training programs were reported in fewer than half of the participating hospitals\u0026mdash;underscoring a critical disconnect between perceived utility and actual implementation.\u003c/p\u003e\u003cp\u003eOur results are consistent with studies from North America and Europe, which have documented strong interest in POCUS but uneven curricular adoption across residency programs. In the United States and Canada, structured curricula have expanded over the past decade, although variability persists across institutions.⁵˒⁶ Similarly, European initiatives have been endorsed by specialty societies, yet heterogeneity remains a challenge.⁷ In contrast, the barriers identified in Mexico more closely resemble those of other middle-income countries, particularly limited access to equipment, shortage of trained faculty, and insufficient institutional commitment. By situating these findings within the Mexican healthcare system, this study contributes to the global understanding of POCUS adoption and underscores the importance of tailored, context-specific solutions\u003c/p\u003e\u003cp\u003eAlthough resource constraints were the most frequently cited obstacles, the survey also highlighted a more structural barrier: lack of institutional support. More than one-third of participants reported insufficient administrative commitment, indicating that financial investment alone will not guarantee sustainable integration. This observation aligns with international consensus, which emphasizes that long-term success requires accreditation pathways, inclusion in certification standards, and robust quality assurance mechanisms.⁷ Without these structural supports, even widespread enthusiasm may fail to translate into meaningful clinical practice.\u003c/p\u003e\u003cp\u003eParticipants rated central venous catheter placement, thoracentesis, and pericardial effusion assessment as the most applicable POCUS procedures, consistent with international literature that identifies these as core competencies for internists.⁶ Diagnostic applications such as ascites and pleural effusion detection were associated with higher self-reported skill levels, whereas procedural competencies lagged behind. This discrepancy highlights the limitations of informal or self-directed training models ⁶ and raises concerns about patient safety, as inadequate training in ultrasound-guided procedures may increase the risk of complications and diagnostic delays. \u0026sup3; Thus, failing to implement structured, competency-based curricula may undermine both the quality of care and patient outcomes.⁴\u003c/p\u003e\u003cp\u003eThis study has limitations. The reliance on self-reported data introduces potential response bias, and the use of convenience sampling within a single healthcare system (PEMEX) may limit generalizability to other institutions in Mexico. Nevertheless, the multicenter design, high response rate, and inclusion of both residents and faculty strengthen the validity of the findings and provide valuable insights into current practices and barriers.\u003c/p\u003e\u003cp\u003eFuture research should include more diverse healthcare settings across Mexico, assess patient-level outcomes related to POCUS integration, and evaluate the effectiveness of structured educational interventions. Such efforts will be critical for informing national policies and developing sustainable frameworks that promote equitable access to ultrasound training, enhance clinical competency, and improve patient care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates not only the strong willingness of Mexican internal medicine residents and faculty to adopt point-of-care ultrasound (POCUS), but also the systemic barriers that limit its full integration into training programs. Both groups identified POCUS as highly applicable to internal medicine practice\u0026mdash;particularly for central venous access, ultrasound-guided thoracentesis, and the evaluation of cardiac abnormalities.\u003c/p\u003e\n\u003cp\u003eDespite this consensus, substantial gaps in knowledge and procedural skills persist, highlighting the urgent need for structured, competency-based curricula within residency programs. Future efforts to standardize internal medicine training in Mexico should build on these findings, while considering the study\u0026rsquo;s limitations, to ensure equitable access, skill development, and ultimately safer patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest and Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest and received no external funding.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eF.G. he wrote the main text of the manuscript, prepared all figures, created the database, and contributed to the survey with the other authors.T.I.G. disseminated the survey through institutional channels and helped oversee its proper application.M.C. conducted the final online survey, contributed extensively to the writing of the manuscript, and performed all statistical analysis.C.A.A. contributed to the abstract and contributed to the survey.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe extend our sincere gratitude to all the internal medicine residents and faculty members who participated in the survey and contributed to this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eLichtenstein D, Axler O.\u003c/strong\u003e Intensive use of general ultrasound in the intensive care unit. \u003cem\u003eIntensive Care Med\u003c/em\u003e. 1993;19(6):353\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eD\u0026iacute;az-G\u0026oacute;mez JL, Mayo PH, Koenig SJ.\u003c/strong\u003e Point-of-Care Ultrasonography. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2021;385(17):1593\u0026ndash;602.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAndersen GN, Graven T, Skjetne K, Mj\u0026oslash;lstad OC, Kleinau JO, Dalen H.\u003c/strong\u003e Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. \u003cem\u003eJ Ultrasound Med\u003c/em\u003e. 2015 Apr;34(4):627\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWong J, Montague S, Wallace P, Etchells E, Khalid Z, Swaminathan S, et al.\u003c/strong\u003e Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. \u003cem\u003eUltrasound J\u003c/em\u003e. 2020;12:19.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMa IWY, Arishenkoff S, Wiseman J, Desy J, Ailon J, Martin L, Otremba M, Halman S, Willemot P, Blouw M\u003c/strong\u003e; Canadian Internal Medicine Ultrasound (CIMUS) Group*. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med. 2017 Sep;32(9):1052-1057.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLoPresti CM, Schnobrich DJ, Dversdal RK, Schembri F.\u003c/strong\u003e A road map for point-of-care ultrasound training in internal medicine residency. Ultrasound J. 2019 May 9;11(1):10.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVia G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, et al\u003c/strong\u003e; International Liaison Committee on Focused Cardiac UltraSound (ILC-FoCUS); International Conference on Focused Cardiac UltraSound (IC-FoCUS). International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014 Jul;27(7):683.e1-683.e33..\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Point-of-care ultrasound, internal medicine, perceived barriers, medical education, survey","lastPublishedDoi":"10.21203/rs.3.rs-7437773/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7437773/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePoint-of-care ultrasound (POCUS) is increasingly recognized as an essential tool in Internal Medicine, its structured integration into residency programs remains still limited, particularly in low- and middle-income countries. In Mexico, the specific barriers to its implementation are not well characterized. This multicenter study was designed to assess current practices and perceived barriers to its integration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a multicenter cross-sectional survey of Internal Medicine residents and faculty in seven PEMEX hospitals (two tertiary, five secondary). Of 182 invited participants, 158 completed the questionnaire (response rate, 86%). The survey, pilot-tested and validated by experts, assessed perceived applicability, self-reported skill, knowledge, and frequency of POCUS use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOverall, 96% of participants supported incorporating POCUS into Internal Medicine training and practice. Structured curricula were reported in 45% of tertiary and 41% of secondary hospitals. The most frequently taught applications were ascites, pleural effusion, and inferior vena cava assessment. Commonly performed procedures included central venous catheter placement, thoracentesis, and paracentesis; arterial blood gas analysis; arterial line placement were rarely performed. Thoracentesis training was more frequent in secondary than in tertiary hospitals (59% vs. 30%, P=0.001). The main barriers were lack of equipment (65.8%), shortage of trained instructors (57.5%), and insufficient institutional support (35.4%); equipment shortages were significantly higher in tertiary centers (40% vs. 8%, P\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eAlthough POCUS is widely valued among internal medicine residents and faculty in Mexico, its adoption is constrained by limited training, inadequate resources, and weak institutional support. These findings underscore the need for structured, competency-based curricula and national strategies to ensure equitable access, skill development, and safer patient care.\u003c/p\u003e","manuscriptTitle":"Point-of-care Ultrasound in Internal Medicine Residency: A Multicenter Survey in Mexico","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 05:04:57","doi":"10.21203/rs.3.rs-7437773/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38a501cd-04d1-4998-8ca5-b583446acc0a","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-01T13:53:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 05:04:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7437773","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7437773","identity":"rs-7437773","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}