PGY2 Basic Ultrasound Rotation

Rotation Goal:

This rotation is a four-week rotation, with one week of PTO, in point of care ultrasound (POCUS). The goal of this rotation is to provide residents with the core 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 echos, DVTs, aortas, and eFAST exams. They are also expected to complete 5 ultrasound guided peripheral IVs and they are required to perform a total of 150 exams during this month. 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.

Additionally, residents will independently complete the Core Ultrasound Curriculum (CoreUltrasound.com). This online curriculum was launched in 2021 and has been adopted by many emergency medicine residency programs, as an educational platform meant to provide a core foundation of knowledge for the 13 ACEP approved EUS applications. These modules are comprised of both educational videos and associated exams. This educational tool allows educators the ability to assess areas of individual weaknesses and provide individual feedback.

Some examples of topics include:

  • Basics/Physics

  • Cardiac

  • eFAST

  • Aorta/IVC

  • Lung

  • Vascular Access

  • Genitourinary

  • Nerve Blocks

  • Soft Tissue

  • Ocular

  • DVT

  • Pelvic

Methods for evaluating Residents:

A final rotation evaluation will be completed in Medhub at the conclusion of the rotation. Objective data to complete this evaluation will be compiled from direct observation, Core Ultrasound Curriculum examinations/completion, quality assurance of submitted scans, completion of all of the predefined required scans, and professionalism.

Methods for Evaluation of Rotation/Attending:

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

Goals:

  1. Become familiar with the basic physics & technology of bedside ultrasound.

  2. Understand the record keeping & documentation requirements for billing & medical records purposes as well as for clinical care.

  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. Develop the ability to obtain & interpret scans for common emergency conditions of the following anatomic areas.

    • Abdomen (including FAST)

    • Cardiac

    • Pelvis

    • Ocular (for retinal detachment)

    • Chest

    • Soft Tissue

    • Procedural Guidance

    • Vascular (DVT)

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

Objectives:

  1. Attend weekly ultrasound didactics sessions

  2. Complete 25 echos, aortas, DVTs, eFASTs, & 5 US guided peripheral IVs

  3. Complete a total of 150 scans

  4. Complete all Core Ultrasound Modules (CoreUltrasound.com)

  5. Discuss the clinical utility of bedside emergency ultrasound with reference to the common conditions for which scans are used. 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. Pope. 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. Patients scanned independently should have a confirmatory study as a gold standard (e.g. CT abdomen, CXR, confirmatory US performed by radiology). On days with unassigned activities, try and join POCUS faculty on clinical shifts. POCUS faculty include: Dr. Wilson, Dr. Pope, Dr. Ho-Gotshall, Dr. Purcell, Dr. Richardson, Dr. Hardin, and Dr. Pardue.

  3. Ultrasound tech scanning shifts - Wednesdays at 4:30 pm, meet in Whale Bay. On Wednesdays please contact Scott Mincey, cell number: 910-625-6755. You are responsible for communicating with Scott if you are not available to scan with them for any reason. They are RDMS and RVT certified and can serve as your guide for abdominal and DVT studies.

  4. 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.

  5. 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.