The Stethoscope of the 21st Century: Are We Ready for the POCUS Revolution?

For centuries, we’ve relied on the stethoscope and physical exam to guide management. Today, point-of-care ultrasound (POCUS) is emerging as the modern analogue—a “21st-century stethoscope” that clinicians can use at the bedside. POCUS allows physicians to visualize the heart, lungs, abdomen, and vessels in real time, augmenting or even outpacing traditional exam techniques (1). Major internal medicine organizations now recognize its value: The American College of Physicians (ACP) has formally acknowledged POCUS’s diagnostic power and plans to develop guidelines and curricula to train all internists (2). Likewise, the Society of Hospital Medicine (SHM) endorses POCUS training for hospitalists (3). If POCUS is indeed this era’s stethoscope, our residency programs must rapidly adapt. 

Evidence for POCUS’s utility is mounting. In one trial of patients with chest pain or shortness of breath, adding POCUS within 24 hours of admission dramatically shortened time to correct treatment: The median time to appropriate therapy fell from 24 hours to just 5 hours (P = 0.014) when POCUS was used (4). In emergency settings, POCUS also outperformed the stethoscope: One study showed that POCUS diagnosed heart failure or pneumonia with 90% accuracy, versus about 86% with auscultation (5). By building on history and exam, ultrasound instantly narrows differentials. Of note, POCUS also enhances safety. Procedures like thoracentesis, paracentesis, and line placement become safer when performed under ultrasound guidance, reducing complications and improving patient outcomes. 

The effect of POCUS on health systems is equally compelling. Studies show that POCUS can cut costs and unnecessary tests. In a large multicenter study of hospitalized patients, availability of POCUS was linked to a meaningful reduction in hospital costs: about $4,000 less per admission on average, driven by fewer chest radiographs and radiology procedures (6). Despite these advantages, POCUS training is far from universal in internal medicine. Unlike emergency medicine, which mandates POCUS proficiency, many internal medicine residencies have no consistent curriculum. A recent review noted widespread interest among trainees, but training remains “not standardized” across programs (7). The ACP and SHM similarly call for consensus curricula and training standards. In other words, experts argue, it is time to embed POCUS into the core of our training—not as an elective, but as an essential skill just like using a stethoscope. 

Barriers remain—limited faculty expertise, machines, and time in the schedule—but they are surmountable. Early adopters report needing to train faculty and secure portable machines, but these investments quickly pay off. National certification pathways (for example, SHM’s certificate of completion) can validate skills. Ultimately, patient care dictates this shift: The cost of not teaching POCUS is delayed diagnoses, extra tests, and missed pathology. 

The POCUS revolution is here, and internal medicine cannot afford to lag behind. By integrating ultrasound into the physical exam, we give residents a powerful diagnostic extension—the modern stethoscope that sees. Residency programs, educators, and certifying bodies should act now to standardize POCUS training across the board. Making POCUS training mandatory in internal medicine residency is not just about keeping up with technology; it’s about delivering faster, safer care and training internists who can navigate the 21st-century clinic. 

References 

1. Wang L, Harrison J, Dranow E, et al. Accuracy of ultrasound jugular venous pressure height in predicting central venous congestion. Ann Intern Med. 2022;175:344-351. [PMID: 34958600] doi:10.7326/M21-2781 
2. American College of Physicians. ACP statement in support of point-of-care ultrasound in internal medicine. Accessed at www.acponline.org/meetings-courses/focused-topics/point-of-care-ultrasound-pocus-for-internal-medicine/acp-statement-in-support-of-point-of-care-ultrasound-in-internal-medicine on 8 May 2025. 
3. Soni NJ, Schnobrich D, Mathews BK, et al. Point-of-care ultrasound for hospitalists: a position statement of the Society of Hospital Medicine. J Hosp Med. 2019;14:E1-E6. [PMID: 30604779] doi:10.12788/jhm.3079 
4. Ben-Baruch Golan Y, Sadeh R, Mizrakli Y, et al. Early point-of-care ultrasound assessment for medical patients reduces time to appropriate treatment: a pilot randomized controlled trial. Ultrasound Med Biol. 2020;46:1908-1915. [PMID: 32430108] doi:10.1016/j.ultrasmedbio.2020.03.023 
5. Özkan B, Ünlüer EE, Akyol PY, et al. Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial. Eur J Emerg Med. 2015;22:440-3. [PMID: 25715019] doi:10.1097/MEJ.0000000000000258 
6. Tierney DM, Rosborough TK, Sipsey LM, et al. Association of internal medicine point of care ultrasound (POCUS) with length of stay, hospitalization costs, and formal imaging: a prospective cohort study. POCUS J. 2023;8:184-192. [PMID: 38099159] doi:10.24908/pocus.v8i2.16791 
7. Ramgobin D, Gupta V, Mittal R, et al. POCUS in internal medicine curriculum: quest for the holy-grail of modern medicine. J Community Hosp Intern Med Perspect. 2022;12:36-42. [PMID: 36262489] doi:10.55729/2000-9666.1112

Apurva Popat, MD

Dr. Apurva Popat is a chief resident in internal medicine at Marshfield Clinic and will be pursuing a fellowship in cardiology. He has a strong interest in bedside ultrasound, cardiac arrhythmias, medical education, and improving patient care through evidence-based approaches.