Many doctors stop using point-of-care ultrasound (POCUS) shortly after training due to workplace barriers that prevent it from becoming routine, new research suggests.
POCUS devices allow rapid bedside imaging and can identify conditions such as heart failure, fluid in the lungs, and internal bleeding — all of which may be treatable if caught early.
Although thousands of UK doctors have received POCUS training, studies show many do not continue using it in clinical practice. Missed use has been noted in Prevention of Future Deaths reports as a factor in avoidable harm.
Researchers from the Universities of Cambridge and Exeter, and Royal Papworth Hospital in Cambridge, have identified six self-reinforcing cycles that explain why the technology is often left unused despite training and available equipment.
The study found that cultures discouraging junior staff from scanning, combined with limited expert support, create patterns of behaviour that make it difficult for POCUS to become part of routine care.
Lead author Professor Riika Hofmann from the University of Cambridge, said: “POCUS is being underused internationally, but it still feels like a problem that many people are unaware exists.
“A lot of time and money is being spent on training, but if the working culture of hospitals doesn’t support it, that investment risks being wasted.
“Our study is the first to explain why POCUS is not being integrated into everyday medical care.
“Unless we address this at the level of underlying culture, it won’t be used as intended, and lives could be lost.”
The call for wider POCUS use has come from several sources. Shock to Survival, a clinical framework supported by the British Cardiovascular and Intensive Care Societies, highlights its role in managing cardiogenic shock — a condition where the heart cannot pump enough blood to meet the body’s needs.
Dr Nicola Jones, co-author from Royal Papworth Hospital, said: “Failure to utilise POCUS in the assessment of critically ill patients may contribute to missed opportunities for timely, potentially life-saving intervention.
“This has led to growing calls for a deeper understanding of the barriers to its use. Our study seeks to address those concerns directly.”
The research team spoke with clinicians involved in the national Focused Intensive Care Echocardiography (FICE) programme, which supports healthcare professionals to use ultrasound to assess heart function in patients with serious circulatory compromise.
Participants included beginners, experienced practitioners, and those supporting clinical use of the technology.
Although some practical barriers were identified — such as scanning difficulties with certain patients — the study found that these issues were often interconnected.
Six “closed loop problems” were described, in which challenges reinforced one another and contributed to ongoing underuse.
One loop involved the low quality of early scans produced by trainees, which led to scepticism among senior clinicians.
This reduced trainee confidence and discouraged further use.
Another cycle concerned a lack of expert feedback.
With few trained supervisors and limited protected learning time, trainees had little opportunity to improve — and a larger expert pool failed to develop.
A third loop related to workplace norms. In departments where scanning was not part of standard care, senior clinicians often resisted its use.
Trainees were reluctant to scan for fear of overstepping, which reinforced the same norms that discouraged them in the first place.
To help break these cycles, the researchers suggest three practical steps that could improve POCUS uptake without increasing pressure on healthcare services.
Firstly, they suggest that trainees should have access to a wider variety of scan images, rather than relying only on repeated exposure to similar cases.
An international shared image bank could help develop their ability to identify abnormal findings.
Secondly, Consultants should look for opportunities during ward rounds or clinical discussions to review scans briefly, building skills and confidence over time.
The researchers also said that hospitals could use existing forums, such as quality assurance meetings where scan results are discussed, to help trainees understand expert reasoning and interpretation.
