A Longitudinal and Multimodal Simulation-Based Curriculum Improved Internal Medicine Residents' Confidence in Procedures, Point-of-Care Ultrasound, and Clinical Decision-Making.

Introduction Internal medicine training has historically relied on classroom-based lectures, typically delivered through morning and noon conferences, which offer broad content coverage but limited experiential learning. Simulation-based education improves resident confidence, procedural ability, and clinical reasoning; yet it is often delivered in brief, standalone activities that lack longitudinal structure or integration within the broader curriculum. Few programs have a longitudinal simulation curriculum that spans the academic year and incorporates multiple modalities and topics. We developed a novel simulation-based curriculum intentionally integrated into the existing resident academic schedule to provide structured hands-on learning across multiple domains. Sessions focused on procedural and point-of-care ultrasound (POCUS) training, as well as separate high-fidelity clinical cases. The curriculum includes four fundamental procedures: POCUS instruction on cardiac, pulmonary, abdominal, genitourinary, and vascular applications, and 14 high-fidelity clinical triage cases. In total, 50 of approximately 150 annual didactic hours were redesigned into simulation-based sessions. Materials and methods The longitudinal curriculum spanned nine months (August 2024 to April 2025) and was divided into two components: procedural and POCUS training, and clinical simulation scenarios. Procedural training included central venous catheterization, thoracentesis, intubation, and paracentesis. POCUS training included cardiac, pulmonary, abdominal/genitourinary, and vascular ultrasound. Four residents were assigned to the procedural station and another four to the ultrasound station, with groups rotating between stations every 30 minutes. Eight residents were assigned to clinical scenarios that ran concurrently, consisting of a 10-minute simulation followed by a 20-minute debrief. Outcomes The Phillips return on investment (ROI) framework (levels 0-3) guided evaluation through post-session resident surveys and an end-of-year faculty survey assessing curriculum effectiveness. Outcomes were analyzed using mean Likert scores and response frequencies. Results Thirty-six first-year residents participated. A total of 288 surveys were collected: 89 for procedures, 87 for POCUS, and 112 for clinical simulations. Across all domains, 284 of 288 responses (98.6%) agreed or strongly agreed that the sessions provided new information or clarified existing knowledge. Specific findings included the following: all participants (89/89) agreed or strongly agreed that they felt more confident in their procedural ability; 98.9% (86/87) agreed or strongly agreed that they were more confident in distinguishing normal from abnormal sonographic images; and 94.7% (106/112) agreed or strongly agreed that clinical simulation improved their diagnostic skills. Five critical care attendings who supervised interns throughout the year reported observable improvements compared to prior cohorts. All five noted stronger POCUS skills, and four reported improved triaging skills. Both improvements were attributed to the simulation curriculum. Conclusions A longitudinal simulation curriculum that integrates POCUS, procedures, and high-fidelity clinical cases improves resident confidence, procedural competence, and diagnostic decision-making. This multimodal model offers a scalable approach for strengthening experiential learning in internal medicine training.