Beyond awareness: analyzing the incomplete integration and barriers to POCUS implementation: a nationwide study

Abstract

Point-of-care ultrasound (POCUS) is increasingly recognized as an essential tool in internal medicine; however, its real-world adoption remains variable. This study aimed to evaluate the current landscape of POCUS use, training, and barriers among internal medicine physicians in Türkiye. We conducted a nationwide, cross-sectional survey between January and June 2025, including 1678 physicians across diverse healthcare settings. The questionnaire assessed POCUS availability, training, clinical use, perceptions, and barriers. POCUS was perceived as necessary by 98.7% of participants; however, 73.4% reported no personal implementation, and only 50.3% reported any lifetime POCUS experience. Prior training was reported by 12.8% and was associated with higher self-reported competency (median score 3 [2-5] vs. 1 [1, 2], p < 0.001). A substantial perception-practice gap was observed across all domains, particularly in abdominal (- 62.7%) and thyroid applications (- 58.0%). Clinical observation was limited, with 54.4% of participants never having witnessed POCUS being performed. When present, it was positively correlated with both personal implementation (r = 0.500, p < 0.001) and self-reported competency (r = 0.450, p < 0.001). The most frequently reported barriers were lack of qualified trainers (65.8%), limited access to equipment (56.4%), and time constraints (41.5%). Multivariable analysis linked prior training and career stage to integration readiness, whereas actual implementation was associated with clinical observation, prior training, equipment availability, and inversely with seniority. These findings suggest that similar gaps may exist in other healthcare systems undergoing POCUS integration, highlighting the importance of structured education and system-level support.