Emory St. Francis Internal Medicine

Curriculum: Each month the ultrasound curriculum will focus on a specific POCUS exam. This exam will be the focus of the online as well as in-person didactic lectures and scanning sessions. You will have a greater understanding of the topic of the month if you view the online didactic material before the scanning session. Most of the didactic material can be reviewed within 30 minutes.

Competency POCUS Exams: During your residency, you are expected to achieve competency in performing, interpreting and clinically integrating the POCUS exams below.

1. Evaluation of the Aorta
2. Evaluation of the Heart and IVC (Shock Assessment and RUSH Exam)
3. Evaluation of the Liver and Gallbladder (Focused Evaluation)
4. Evaluation of the 3^rd Trimester OB Patient (AFI, FHR, Presentation, Placental Location)
5. Ultrasound Guided Procedures (US guided needle placement)

Assessments: Online interactive ultrasound-based case scenarios will be posted on MCGultrasoundEducation.com under “Ultrasound Interactive Cases”. These interactive cases aid in assessing your POCUS integration skills. These cases will be assigned during the academic year. Completion of these assignments is expected to take about 15 minutes. These assessments along with the US practicum will be reported to the Residency Curriculum Competency Committee. Completion of these interactive cases and practicum is a required component for Proficiency Certification.

Ultrasound Practicum: During June 2020, you will be tested on your ultrasound skills in an ultrasound practicum. The practicum will include testing on ultrasound knowledge as well as scanning ability. You will be given more information prior to the ultrasound practicum.

Scanning Sessions: Each month there will be open scanning sessions in the Center for Ultrasound Education (CJ3101 – Pavilion 3) and at the locations listed below. These sessions will have instructors and ultrasound models for you to scan to improve your image acquisition skills. During these sessions, we will review the key components of the ultrasound exam of the month. These are not mandatory sessions, but these sessions give you an opportunity to ask questions and practice your skills. Your residency will have an assigned time (listed below), but you may attend one or more of the other sessions if you have the desire.

Scanning Numbers: You will need to document your ultrasound scans during the year using the Clinical Ultrasound Documentation System (i.e. by ordering the appropriate POCUS exam in Powerchart as described below). Alternatively, you can document your scans in One45. Scans can be done at any time on any patient. However, your scans are educational scans unless you are performing them with an ultrasound credentialed faculty member.

If the ultrasound scan is for education, follow the Educational Ultrasound Guidelines below.

• Ultrasound exams cannot be used for medical decision making.
• Educational scans may not be done on patients with complaints related to the exam (e.g. an educational FAST exam may not be done on a trauma patient or an educational gallbladder ultrasound may not be done on a patient with right upper quadrant pain). The exception is that an education ultrasound exam related to the patient’s complaint may be done if a complete study (CT scan or an ultrasound exam performed by Radiology) has already been done or will be done after the educational ultrasound exam. Educational exams may be done unrelated to their medical complaint (e.g. a gallbladder ultrasound exam can be done on a patient with pneumonia).
• The patient must be informed that the ultrasound exam is for educational purposes only and that they will not be charged for the exam and the results will not be placed in the patient’s medical record.
• Permission must be given by the patient for the scan. (Guidelines Subject to Revision)

POCUS Proficiency Pathway: The purpose of this pathway is to provide graduating residents documentation of POCUS skills at the end of GME training that can be used for hospital and practice credentialing of skill. This pathway is optional, but all requirements are mandatory to obtain the certification.

• Knowledge of the clinical indications for each POCUS exam
• Adequate skill to obtain ultrasound images for interpretation for each POCUS exam (Image Acquisition)
• Adequate skill in interpreting images for specified pathology involved with POCUS exams (Image interpretation)
• Understanding of goal-directed ultrasound in clinical care (Clinical Integration)

Participants must complete a total number of “reviewed” exams as well as a specified number of individual exams to complete the POCUS Proficiency Pathway. 

Ultrasound Orders: All ultrasound examinations must be “ordered” through Powerchart using any of the POCUS orders. If a POCUS exam is to be used clinically, use any of the clinical orders such as POCUS Echo, POCUS Abdomen, etc. Use the “task list” to document the findings of the exam. This documentation is part of the clinical documentation and will be part of the medical record. If a POCUS examination will be used only for educational purposes, use POCUS Teaching. POCUS Teaching orders will not result in the result section of Powerchart. However, these images will be available in PACS for quality assurance.

 POCUS Proficiency Pathway Proficiency Certification Requirements:

1. 300 total examinations documented with at least 150 “Reviewed” Ultrasound Exams.
2. Evidence of participation in educational / teaching sessions (scanning rounds)
3. Successful completion of all Interactive Modules
4. A minimum of 5 POCUS exams (performed prior to advanced imaging) correlated with CT or other confirmatory studies
5. Successful completion of the Ultrasound Practicum
6. Portfolio Completion in BOX

Ultrasound Machines: Almost any ultrasound machine can be used for educational ultrasound practice. You may use the machines at the Center for Ultrasound Education while practicing on fellow residents or models. The Center is generally open weekdays from 8am to 5pm. The ultrasound machines in the ED, MICU, STU, CCU and 8S can be used for educational ultrasound practice at any time. Should you move these machines from their assigned location, you need to “sign out” the machine from the location and return it when you are finished. It is your responsibility to clean the ultrasound machine according to the posted guidelines as well as assure the machine is returned to the storage location.

 Ultrasound Text: An iBook, pdf text, and an online ultrasound text with ultrasound videos is available for your smart phone and computer.