Emergency Ultrasound

A vertical emergency ultrasound curriculum has been developed for the residency, with specific goals and objectives for each year of training. By the time of graduation, residents will have completed an extensive curriculum covering basic and advanced emergency ultrasound applications and will be able to fully integrate emergency ultrasound into their daily practice.

Objectives: 
  1. Understand the basic principles of point-of-care ultrasound.
  2. Recognize indications of point-of-care ultrasound and its impact on patient management.
  3. Develop proficiency in the performance and interpretation of basic and advanced point-of-care ultrasound examinations.
  4. Acquire skills in performing ultrasound guided procedures.
  5. Recognize common pathologic conditions in all of the basic and advanced point-of-care ultrasound examinations.

Goals:

  1. Develop skills in performing and interpreting point-of-care ultrasound examinations.
  2. Learn to integrate point-of-care ultrasound into clinical practice of emergency medicine.
Clinical Experience: 

Interns: The core ultrasound curriculum for interns begins during orientation month, with an intensive one-day course of didactic lectures and hands-on practice with human models and phantoms. During this course, residents learn the basic principles and physics of sonography and are introduced to various basic point-of-care ultrasound examinations. In their first year, residents are required to do a two-week ultrasound rotation and also scan in the ED during anesthesia rotation. During the ultrasound rotation, the residents learn by scanning ED patients under the supervision of emergency ultrasound section faculty with an emphasis on bedside teaching and hands-on practice. The rotation is tailored to provide a comprehensive introductory experience in emergency ultrasound to interns. The goals of the rotation are to understand the basic principles of point-of-care ultrasound, attain proficiency in performing basic point-of-care ultrasound examinations, and integrate bedside ultrasound into patient's diagnostic workup and management. Indications for ultrasound, knobology, image acquisition and interpretation are emphasized. Residents have access to ultrasound reference books, journal articles, multimedia resources online modules, question bank, and blue phantoms during this rotation. Additionally, residents have opportunities for scanning while working in the ED throughout the year. Residents are encouraged to perform at least one scan during every ED shift.

Junior Residents: Residents participate in emergency ultrasound lectures presented at weekly conferences. Residents also participate in hands-on workshop sessions to further improve their skills in image acquisition and interpretation. Residents are encouraged to perform both basic and advanced point-of-care ultrasound examinations during their ED shifts. Residents also have an option to do an emergency ultrasound selective during their second year. They spend their selective rotation time in the ED performing point-of-care ultrasound examinations under the supervision of emergency ultrasound section faculty. Residents are also encouraged to participate in or develop new research ideas in emergency ultrasound.

Senior Residents: Residents continue to participate in emergency ultrasound didactic and hands-on workshop sessions to further improve their skills in image acquisition and interpretation. Residents also have an option to do an emergency ultrasound selective during their third year. They spend their selective rotation time in the ED performing point-of-care ultrasound examinations under the supervision of emergency ultrasound section faculty. Residents also have an opportunity to teach point-of-care ultrasound to interns and junior residents, medical students and nursing staff.

Didactic Experience: 

The components of ultrasound education are spread over the entire course of residency training. The goal is to provide longitudinal, didactic, and hands-on instruction to EM residents throughout their residency training. Didactics are presented in a lecture series over 18 months covering both basic and advanced emergency ultrasound applications. The residents have opportunity to participate in a monthly ultrasound quiz. Additionally, refresher workshops using cadavers, human models and phantoms are offered to residents throughout the year.

During ultrasound rotation, residents receive didactic instruction in selected topics and hands-on practice using phantoms and human models. The residents are required to attend QA session held weekly by ultrasound section, at which time digital images and clips are reviewed. Residents are also required to participate in emergency ultrasound journal club. The recommended reading during ultrasound rotation includes:

Selected reading assignments in emergency ultrasound textbooks (listed below) and journals:

  1. Emergency Ultrasound by John Ma, James Mateer and Michael Blaivas.
  2. Emergency Ultrasound Pocket Reference by Matthew Lyon, Carl Menckhoff and Stephen Shiver.
  3. Review of online modules (lecture series), journal articles and multimedia materials.
  4. Practice questions in the Question Bank on Emergency Ultrasound applications.
Evaluation Process: 

At the end of ultrasound rotation, there will be formal testing of knowledge base and ultrasound image interpretation. Residents are required to take ACEP online Emergency Ultrasound examination. A written evaluation of resident is completed by emergency ultrasound section faculty.

Residents are required to perform at least 300 ultrasound examinations during their residency training. Ultrasound examinations performed by residents are archived in the web-based departmental ultrasound database. These examinations are reviewed on a regular basis to provide timely feedback to the residents on scanning technique, image acquisition, and interpretation. Information regarding total numbers of ultrasound examinations is made available to residents on a monthly basis.

Competency Assessment: 

Ultrasound competencies are assessed once yearly using human models, manikins and questionnaires. The goal of competency assessment is to ensure that all EM residents have a basic set of skills to allow for integration of ultrasound into their daily clinical practice after residency training is completed. Competency assessment includes two components:

  1. Assessment of scanning technique: A practical examination consisting of a direct assessment of the skills necessary to obtain and record appropriate ultrasound images for all the basic applications of emergency ultrasound is used. The practical examination includes assessment of proper machine settings, probe positioning, image acquisition, interpretation, documentation and communication of results. Ultrasound images obtained during the practical examination are assessed for technical merit including image quality, identification of landmarks, and completeness of imaging protocol. The practical examination may include various methods to assess for adequacy of skill, including but not limited to Objective Structured Clinical Examination, and Standardized Direct Observation Tool.
  2.  Assessment of Image Interpretation: Identification of sonographic anatomy, artifacts and recognition of normal and pathologic findings are assessed. The medical decision-making process based on sonographic findings is also assessed.
Resources: 

» Key Points for Ultrasound Training (PowerPoint file)

Required Images

» Click here for a document which details the required images which should be included in each exam. Faculty and residents should use this as a guide when performing scans in the department.

» Web Links

» News & Events