Enhanced Skills Program: Emergency Medicine Residency Goals and Objectives

EMERGENCY ULTRASOUND ROTATION

LIAISON:

Rotation Coordinator: Dr. Dinesh Krishna: dkrish6@gmail.com Rotation Scheduling: Kerry McPartland: Kerry.McPartland@nygh.on.ca

GOALS:

The Emergency Medicine emergency ultrasound rotation focuses on the following main areas:

1. Understanding the role of and indications for basic emergency ultrasound in the care of the emergency medicine patient.
2. Completing 50 + supervised determinate scans of the following areas: cardiac, aorta, abdomen, pelvis
3. Achieving Independent Practitioner (IP) certification from the Canadian Emergency Ultrasound Society (CEUS)
4. Understanding the evidence supporting the use of emergency ultrasound
5. Appreciating the limitations of emergency ultrasound
6. Becoming comfortable and proficient at teaching others how to perform emergency ultrasound scans
7. Introducing advanced emergency ultrasound skills and laying the foundation for the future acquisition of advanced emergency ultrasound skills

OBJECTIVES:

Medical Expert

Upon completion of the rotation, residents will be able to:

1) Demonstrate an understanding of the basic knobology of the ultrasound machine
2) Demonstrate an understanding of the basic ultrasound physics principles and how they relate toimage generation
3) Utilize proper ultrasound technique, including probe manipulation and image optimization
4) Produce high quality images and correctly interpret the images in the following areas:

• Cardiac ultrasound, including the detection of pericardial effusion and cardiac standstill b) Aortic ultrasound including the detection of aortic aneurysm
• Abdominal FAST ultrasound, including the detection of free intraperitoneal fluid
• Female pelvic ultrasound, including the detection of intrauterine pregnancy

5) Reject indeterminate scans
6) Demonstrate an understanding of the emerging role for bedside ultrasound for advanced applications
7) Apply emergency ultrasound findings in clinical management of emergency patients
8) Demonstrate an understanding of the limitations of emergency ultrasound
9) Demonstrate up to date knowledge related to trauma FAST exams and basic POCUS image generation

Communicator

Upon completion of the rotation, residents will be able to:

1. Converse effectively and sensitively with patients and their families.
2. Ensure patients understand the differences between emergency ultrasound and radiology-performed scans
3. Communicate and document ultrasound findings appropriately

Collaborator

Upon completion of the rotation, residents will be able to:

1. Work effectively as part of a health care team
2. Recognize how emergency ultrasound contributes to the overall care of the patient
3. Collaborate appropriately with radiology to ensure that appropriate imaging standards are being met
4. Demonstrate understanding of how other specialties incorporate bedside ultrasound into their practice

Manager

Upon completion of the rotation, residents will be able to:

1. Complete proper documentation and archiving of ultrasound scans
2. Demonstrate an understanding of the importance of Quality Assurance system to monitor scans being performed
3. Schedule sufficient ultrasound scanning shifts to complete required scans
4. Manage time efficiently
5. Take appropriate care of the ultrasound equipment
6. Demonstrate an understanding of the background of emergency ultrasound and the role that it has played in changing the bedside diagnostic environment.

Health Advocate

Upon completion of the rotation, residents will be able to:

1. Act as an advocate for individual patients in the emergency department
2. Facilitate access to emergency ultrasound devices for all resuscitation and acute care areas of the emergency department
3. Demonstrate a recognition of the importance of informing patients and their MRP (most responsible physician) of any incidental findings identified on point-of-care ultrasound scans and ensures appropriate follow up
4. Demonstrate an understanding of the role of point-of-care ultrasound in reducing the amount of radiation exposure to certain emergency department patients

Scholar

Upon completion of the rotation, residents will be able to:

1. Critically evaluate the literature as it pertains to emergency ultrasound, in particular related to trauma FAST exams and basic POCUS image generation
2. Demonstrate an understanding of the evidence supporting the commonly performed emergency ultrasound scans
3. Demonstrate an understanding the limitations of emergency ultrasound literature and the need for further high-quality research in this area
4. Effectively teach ultrasound skills to others
5. Demonstrate commitment to lifelong learning
6. Demonstrate effective communication skills when teaching ultrasound skills to others
7. Demonstrate proficiency at training other practitioners how to perform emergency ultrasound

Professional

Upon completion of the rotation, residents will be able to:

1. Be sensitive to any discomfort caused by ultrasound scans, especially when performing training scans or when scanning volunteers
2. Adhere to the code of ethics of the CMA and the institution
3. Treat patients and colleagues with respect
4. Self-evaluate, including demonstrating insight into strengths and weaknesses
5. Be responsible, reliable, punctual, and accountable for one’s actions
6. Demonstrate an understanding of the medico-legal implications of emergency ultrasound in patient care and in physician certification process