A groundbreaking study has revealed why a cutting-edge medical imaging technique known as Point-of-Care Ultrasound (POCUS) often fails to become a staple in many doctors’ daily practice despite its promise for saving lives. POCUS, which involves bedside ultrasound scanning using portable devices, offers clinicians rapid diagnostic insights into critical conditions such as heart failure, pulmonary edema, or internal bleeding—ailments that frequently demand immediate intervention. Yet, the technology’s clinical integration remains alarmingly limited, with systemic obstacles obstructing widespread adoption.
Although thousands of UK doctors receive formal training in POCUS, researchers have found that most abandon its use shortly after completing their courses. The study, involving a collaborative effort by experts from the Universities of Cambridge and Exeter alongside Royal Papworth Hospital, delves into this puzzling phenomenon. Their findings unpack six interlinked “vicious cycles” that trap practitioners, hindering the routine use of POCUS even when equipment and instructional opportunities abound.
At its core, the problem stems not from the technology itself but from entrenched workplace cultures and inadequate expert support systems. Junior clinicians often face environments where experienced colleagues dismiss or undervalue bedside ultrasonography, thereby sowing doubt about its relevance. This skepticism is intensified by early difficulties novices encounter while conducting scans, which leads to poor-quality images and erodes confidence. Consequently, trainees hesitate to incorporate POCUS into clinical assessments, perpetuating the cycle of underuse.
The absence of a robust network of ultrasound specialists with protected time for mentoring exacerbates this issue. Without timely feedback and guided practice, novices find their progression stunted, limiting the pool of capable educators needed to sustain and grow POCUS expertise. Feedback loops like these manifest repeatedly, reinforcing barriers instead of dismantling them.
Moreover, deep-rooted professional hierarchies and norms create additional resistance. In numerous hospital departments, scanning remains the domain of senior staff, whose gatekeeping tendencies discourage junior doctors from “overstepping” traditional roles. This dynamic not only marginalizes trainees eager to hone their skills but also institutionalizes a stagnation that curtails technological innovation in patient care processes.
These cultural and organizational constraints strike at a critical juncture in healthcare, where timely diagnosis can differentiate between life and death. As highlighted in the “Shock to Survival” framework, developed collectively by the British Cardiovascular and Intensive Care Societies, POCUS has the potential to revolutionize the management of cardiogenic shock by enabling swift, bedside decision-making. Yet, missed opportunities persist, evidenced by Prevention of Future Deaths reports pinpointing underutilization of cardiac POCUS when evaluating severely ill patients.
Beyond the clinical challenges, the study underscores practical impediments inherent to the scanning process itself, such as anatomical variability among patients and difficulties obtaining clear images under pressure. However, these technical hurdles are subordinate to, and often compounded by, the negative cultural milieu surrounding POCUS implementation.
To counteract this inertia, the research team advocates specific strategic interventions aimed at breaking entrenched cycles without placing additional demands on an already overstretched healthcare workforce. First among these is diversifying trainees’ exposure beyond repetitive encounters with homogenous patient presentations. By leveraging an international repository of varied ultrasound images, novices could develop nuanced pattern recognition skills, enhancing diagnostic accuracy even in complex scenarios.
Another proposed approach encourages clinicians at advanced levels to capitalize on spontaneous “teachable moments” during clinical rounds or multidisciplinary discussions. These brief, context-rich educational interactions can progressively build scanning proficiency and foster confidence without requiring dedicated training sessions. Finally, integrating POCUS learning within existing institutional structures—such as quality assurance meetings where scan findings are routinely reviewed and debated—could create sustainable learning environments that nurture skill acquisition organically.
The implications of these recommendations extend beyond POCUS, highlighting how deeply embedded systemic factors govern the uptake of medical technologies. Unless hospitals confront and remodel the cultural dynamics and support mechanisms around emerging tools, investments in training risk underdelivering on their promise.
Lead author Professor Riika Hofmann remarks that the study represents the first comprehensive effort to elucidate why POCUS remains marginalized despite its known benefits. She emphasizes that without addressing the underlying cultural impediments, efforts to expand POCUS use may not yield improvements in patient outcomes. Co-author Dr Nicola Jones warns of the tangible consequences of this neglect, noting that refusal or failure to employ bedside ultrasound can mean lost chances for lifesaving interventions.
By illuminating the complex interplay between individual skills development, expert mentorship, and organizational attitudes, the study offers a roadmap for transforming POCUS from a sidelined innovation into a frontline diagnostic standard. The publication in Advances in Health Sciences Education invites healthcare leaders and policymakers to consider these findings as a call to action.
If these identified vicious cycles can be effectively disrupted, a new generation of medical practitioners might emerge, confident and capable in the use of POCUS. This would not only enhance individual clinical decision-making but also elevate the overall quality of acute medical care, ultimately improving survival rates for the most vulnerable patients.
The study’s thorough exploration of the obstacles facing POCUS adoption sets a precedent for tackling similar challenges in the integration of other emergent technologies within complex healthcare systems. It underscores the necessity of fostering supportive learning environments and evolving workplace cultures to realize the full potential of medical innovation.
Subject of Research: Barriers to the utilization and integration of Point-of-Care Ultrasound (POCUS) in clinical practice.
Article Title: A theory-informed approach to identify barriers to utilising Point-of-Care Ultrasound (POCUS) in practice: from vicious cycles to sustainable solutions.
News Publication Date: 23-Jun-2025
Web References:
Shock to Survival report, British Cardiovascular and Intensive Care Societies
DOI link to the article
Keywords: Health and medicine, Clinical medicine, Health care, Emergency medicine, Health care delivery, Health care policy, Education, Clinical imaging, Medical diagnosis
