Advanced Ultrasound Rotation

Rotation Goals:

This rotation is a four-week rotation, with two weeks of PTO, in point of care ultrasound (POCUS). The goal of this rotation is to provide residents with an advanced knowledge base, bedside image acquisition/interpretation skills, and a framework for clinical integration, to allow residents to use bedside ultrasound in their daily practice of Emergency Medicine.

Overview:

Residents are expected to attend weekly ultrasound didactics sessions where they will have the opportunity to hear ultrasound faculty and fellows present lectures on various core ultrasound topics. During these sessions, they will also participate in our quality assurance process, where they will partake in an active discussion regarding the scans that they have submitted that week. The quality assurance process allows faculty the opportunity to provide constructive feedback as well as ensure that associated pathology is documented, and patients are notified.

To promote hands on learning, residents on this rotation will spend time scanning patients in the Emergency Department. This experience allows residents the opportunity to practice their image acquisition and interpretation skills. Residents are expected to complete a minimum of 25 intrauterine pregnancy, biliary, renal/urinary, soft tissue/musculoskeletal, thoracic/airway, ocular, bowel, and procedural guidance scans. In combination with scans completed on their basic ultrasound rotation, this will ensure that they have meet the clinical competency criteria as outline by ACEP, for all 13 ACEP approved POCUS applications. Scan sessions will be performed independently, with Registered Diagnostic Medical Sonographers, and with direct oversight from ultrasound faculty/fellows. Goal directed feedback will be provided in real time at the bedside.

Residents on this rotation will be expected to serve as a resource for more junior learners on their ultrasound rotation. Through teaching fundamental POCUS applications, residents will further solidify their personal understanding of core POCUS knowledge. This will strengthen their ability to integrate ultrasound findings clinically and better prepare them to enter the emergency medicine workforce.

Other educational opportunities for this rotation are tailored toward individual resident’s areas of interest. Some potential opportunities include advanced education in:

  • US guided regional anesthesia

  • Advanced cardiac imaging (Simbionix TEE simulation)

  • Novel curriculum development (ex. POCUS escape room)

  • Ultrasound research and quality improvement projects

During this rotation, a combination of didactics, experiential learning and proficiency assessments will be employed. The following clinical ultrasound application topics will be covered:

  1. Intrauterine Pregnancy (transabdominal and transvaginal)

  2. Biliary

  3. Renal/Urinary Tract

  4. Soft-Tissue/ Musculoskeletal

  5. Thoracic/Airway

  6. Ocular

  7. Bowel

  8. Procedural Guidance

  9. Additional advanced topics including: Advanced echo (TEE), testicular, ovarian, thyroid, liver, transthoracic echo, ultrasound-guided regional anesthesia

Methods for Evaluation of Residents:

Observation and MedHub form completed by the EUS Director at the conclusion of the rotation.

Methods for Evaluation of Rotation/Attendings:

Evaluations are completed on MedHub anonymously by the residents at the conclusion of the rotation.

Goals:

  1. 1. Introduce administrative components of running an emergency ultrasound program, including IT, Biomed, local ultrasound representatives and national meeting opportunities such as the ACEP and SAEM General Assembly.

  2. Enhance bedside teaching skills by supervising medical students and junior residents learning the basic applications of POCUS. Additionally, taking part in the Quality Assessment process of reviewing ultrasound exams on Qpath.

  3. Understand issues related to patient privacy, comfort, & patient education related to emergency ultrasound.

  4. Understand the clinical utility & limitations of emergency bedside ultrasound.

  5. Become facile in communicating with other clinicians regarding the clinical implications & significance of ultrasound findings.

Objectives:

  1. Attend weekly ultrasound didactics sessions

  2. Adequately perform and interpret POCUS and meet the minimum benchmark for the 12 core applications as defined by ACEP.

  3. Discuss the clinical utility of bedside emergency ultrasound with reference to the common conditions for which scans are used; as well as some advanced techniques. Discussion should emphasize diagnostic utility with reference to pre & post test probability, sensitivity & specificity, positive & negative predictive value.

  • Gallstones/Cholecystitis

  • Intraperitoneal Blood/Fluid

  • Normal/Abnormal Pregnancy

  • Hydronephrosis

  • Pleural Fluid

  • Pneumothorax

  • Soft Tissue Fluid Collection & Foreign Bodies

  • DVT

  • Cardiac Arrest

  • Pericardial Fluid Collections

  • Major Cardiac Wall Motion Abnormalities

  • Retinal Detachment

  • Venous Cannulation

  • Intestinal Pathology

CLINICAL EXPERIENCE AND SCHEDULE:

  1. Supervised scanning shifts - please refer to the Google calendar (linked here and under Rotation Logistics column above) for dates/times to meet faculty in the ED for bedside scanning and teaching. An Ultrasound faculty member will meet with you on the first day of the rotation for orientation and introductory scanning shift. Please refer to the email sent by Dr. Ho-Gotshall. As an adult learner, the rest of your time is independent and you must meet rotation requirements.

  2. Independent scanning shifts - during times when there is no supervised scanning, the resident should be scanning independently in the ED. In general, the PGY-2/3 should be in the ED from Monday-Friday for scanning. At least 5 hours a day should be devoted to bedside US scanning to be able to meet rotation requirements. Patients scanned independently should have a confirmatory study as a gold standard (e.g. CT abdomen, CXR, confirmatory US performed by radiology). If there is not a scheduled activity on a given day, you should see if any Ultrasound Faculty are working clinically and join them on shift.

  3. Weekly education/QA meetings - these take place every Thursday at 9am the GME/Ocean View Building in Classroom 5. You must attend all Thursday meetings during your rotation.

  4. PTO - Your 5 days of PTO must be submitted and approved at least 6 weeks in advance.  If MORE than 1 Thursday QA session will be missed, you will be responsible for making this up in the block before or after your rotation.