Emergency Medicine and Critical Care Ultrasound Fellowship Program
The SAUSHEC Emergency and Critical Care Ultrasound Fellowship is designed to be a 1 year advanced point of care ultrasound education program for clinicians interested in becoming experts and leaders in this growing subspecialty. The use of point of care ultrasound is now widespread at both community and academic hospitals (civilian and military) across a variety of medical specialties. It has been used extensively by emergency and critical care physicians to improve diagnostic accuracy at the bedside, safely guide invasive procedures, rapidly detect life threatening pathology, avoid unnecessary ionizing radiation for the patient, monitor the effects of an ongoing resuscitation, and improve ED and ICU throughput. It has also seen extensive use on the battlefield to facilitate triage decisions, justify utilization of scarce medical assets such as medical evacuation, and resuscitate critically wounded soldiers. The fellowship will adhere to the ACEP Emergency Ultrasound Fellowship Guidelines (ACEP 2008) and the American College of Chest Physicians Consensus Statement on Competence in Critical Care Ultrasonography (ACCP 2009). There are four primary components: sonologist training/procedural competency, teaching, research/scholarly activity, and administration. For sonologist training, there will be 2 tracks: one for emergency physicians and one for critical care physicians. These tracks have significant overlap but are tailored specifically for each physician’s primary focus.
The US fellow will become proficient in the primary as well as the extended applications for emergency and critical care ultrasound, including the extended focused assessment with sonography in trauma (E-FAST), focused echocardiography, hepatobiliary, aorta, deep venous thrombosis, genitourinary, thoracic, procedural guidance, musculoskeletal, soft tissue, obstetric, ocular, testicular, pelvic, pediatric, and intestinal examinations. The Emergency Department at SAMMC has state-of-the-art ultrasound machines for the fellow to use. Currently, there are 9 cart-based ultrasound units in the ED, allowing the fellow to perform a wide breadth of ultrasound applications and become proficient with any US machine in the future. Our current inventory includes 4 Sonosite M-turbos, 4 Sonosite S-FASTs, and one Zonare Z one ultra. All of these machines transmit images wirelessly to the Picture Archiving and Communication System (PACS) at SAMMC for later review. These images will be in video format, allowing the fellow to comprehend the dynamic nature of ultrasound scanning. There is also one Sonosite M-turbo with DICOM wireless connectivity currently reserved for the fellow's use upstairs in the ICU. A full complement of transducers are stationed on each cart, including linear, endocavitary, phased, microconvex, and curved arrays.
The US fellow is expected to personally perform at least 1000 ultrasound exams during the fellowship. This can be accomplished during scheduled clinical shifts or "scanning shifts." The Fellowship Director will review each of these exams, either at the bedside or during scheduled review/quality assurance (QA) sessions. QA sessions will be held on a weekly basis and will focus on providing the fellow feedback with regards to image acquisition, quality, and methods for improvement. The fellow will master the aforementioned applications of diagnostic and procedural emergency ultrasound prior to graduation, as outlined in the ACEP Emergency Ultrasound Imaging Criteria Compendium, the ACEP Emergency Ultrasound Guidelines (2008), as well as selected applications delineated by the American College of Chest Physicians Consensus Statement on Critical Care Ultrasonography (2009).
Along with traditional textbooks, the curriculum will consist of several web based ultrasound modules, replete with interactive learning tools, relevant journal reviews, and over 300 of the latest ultrasound articles from peer reviewed journals. The fellow will also have access to a massive archive of ultrasound pathology in video format for reference, along with a dedicated ultrasound simulation room in the ED.
As a primary teaching responsibility, the fellow will provide education to the Emergency Department attendings, residents, and students. The primary venue for this teaching will be during scanning shifts where the fellow will facilitate the staff in honing their skills on the primary applications of emergency and critical care ultrasound and expanding their knowledge in evolving applications. The fellow must be able to demonstrate 20 hours per month of hands on teaching at the end of each block.
The fellow will run the weekly ultrasound QA/review sessions. During these sessions, each ultrasound exam will be reviewed and critiqued. This includes studies done by the fellow, residents, or students during their ultrasound electives. The fellow will be responsible for educating the residents/students in this forum under the supervision of the director. This can count towards the 20 hour per month teaching requirement.
The fellow will also be integrally involved in the emergency medicine residency ultrasound curriculum. This involves a combination of pre-scheduled didactic and hands-on teaching sessions, scanning shifts during ultrasound elective rotations, teaching pearls given during clinical shifts, and assisting the fellowship director in leading journal review discussions.
Fellows will also be involved in medical student ultrasound education. This primarily takes the form of instructing students who are taking an ultrasound elective with lectures, hands-on sessions, and instruction during scanning shifts and video review sessions.
Fellows will also have opportunities to participate in ultrasound courses given locally, regionally, and nationally. As a faculty for these courses, the fellow is expected to evolve from solely providing instruction during hands-on sessions, to giving lectures, to ultimately being able to organize a course independently. The fellow will also serve as an instructor for Special Operator Clinical Ultrasound (SOLCUS) courses, which are taught traditionally at Ft Bragg and Ft Campbell and are designed to push ultrasound far forward on the battlefield to the 18 D level. Other courses include the Joint Forces Combat Trauma Management Course (JFCTMC), where ultrasound is taught to a variety of providers prior to their deployments.
Fellows will give a minimum of three Grand Rounds lectures during the course of the year on an advanced EUS topic.
Fellows will assist and facilitate residents during their ultrasound rotations in preparing video review clips and high-yield teaching points for Grand Rounds "US cases of the month."
Research and subsequent peer-reviewed publication is an integral aspect of academic emergency and critical care medicine practice and, therefore, it should comprise a significant portion of the fellow's non-clinical workload.
A minimum of two on-going IRB approved research projects are required for graduation. The fellow should be primary author on one project and co-author on a second project (the second project does not have to be one he/she designed and implemented from the ground up). The second project is usually turned over from the previous fellow, which only requires a change of primary investigator template from the IRB. These projects may be retrospective or prospective in design. Case reports, case series, expert opinions, letters to the editor, and textbook chapters are not eligible to satisfy this requirement.
At least one abstract should be submitted with the fellow’s name as first author and presented to a national meeting such as ACEP, SAEM, SCCM, ACCP, or AIUM during their fellowship.
The fellow must complete a minimum of one additional publication in the form of images in clinical medicine, case report, case series, expert opinion, letter to the editor, or textbook chapter.
The fellow must attend at least one national emergency ultrasound section meeting throughout the year. It is strongly recommended that the fellow be a member of the ACEP, ACCP, or SCCM ultrasound sections.
The fellow will learn how to set up, direct, and manage an ultrasound continuous quality improvement (CQI) program. This entails learning how to develop a data collection instrument, a database for storing CQI data, and a means of developing measures of quality.
The fellows will be responsible for the emergency medicine resident ultrasound rotation evaluations. These must be completed monthly on time.
The emergency ultrasound fellow must initiate and conduct at least one interdepartmental quality assurance work / project. Before the project is started, it must be approved by the Fellowship Director. Upon completion of the project, the data will be presented to the Emergency Department faculty.
The fellow will be come familiar with national recommendations for credentialing and how it is carried out in a hospital-based emergency medicine practice.
The fellow (and fellowship director) will attend inter-departmental and committee meetings throughout the hospital in relation to EUS
Registered Diagnostic Medical Sonographer certification or Registered Diagnostic Cardiac Sonographer certification is strongly encouraged.