Internal Medicine Ultrasound Curriculum Outline. Mike Wagner, MD, FACP,
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1 Internal Medicine Ultrasound Curriculum Outline Mike Wagner, MD, FACP,
2 Before Curriculum Implementation Bolus Training No Image QA outside of the ED No formal requirements Competency not assessed Ultrasound use on wards (outside of procedures) sporadic/undocumented
3 Core/Basic Curriculum 1. INTRODUCTION TO ULTRASOUND Applications, Strengths/Limitations, General Principles, Modes, Probes and Artifacts, Key Home Screens, and Scanning Tips 2. LUNG Pleural Effusion (PLEF) Pneumothorax (PTX) Interstitial Syndrome / B-Lines 3. HEART Cardiac Motion (vs Standstill) Pericardial Effusion and Size Systolic Fxn/Gross Assessment of Contractility Chamber Size/Proportions/LVH Basic Valvular Disease (MR/AI/AS) 4. IVC CVP Estimate/Intravascular Volume Assessment IVC Size, Respiratory Variation 5. KIDNEY/BLADDER Hydronephrosis Renal Size/Echogenicity Bladder Volume/Post-void Residual Ascites (pelvic) 6. VASCULAR Proximal Lower Extremity DVT
4 Core/Basic Curriculum 7. LIVER/GALLBLADDER/SPLEEN Liver Size/Hepatomegaly GB tenderness/gallstones Spleen size/splenomegaly Ascites (RUQ/LUQ) 8. AORTA/PERIPHERAL ARTERIES AAA Peripheral pulse identification Doppler review 9. MSK/NERVES/SOFT TISSUE Abscess vs Cellulitis Foreign Body Localization Rib Fracture/Long Bone Fracture Joint Effusions (Knees, Elbows) Edema vs Adipose 10. PROTOCOLS FOR SICK PATIENTS FAST exam, RUSH protocol, POCUS in Codes 11. INTEGRATED HEART/LUNG/IVC CLUE Protocol, FATE Protocol 12. GUIDED PROCEDURES CVL Thoracentesis Paracentesis Knee arthrocentesis PIV
5 Core/Basic Curriculum: Expected Milestones by Year End of PGY1 Homescreen acquisition + basic interpretation PLAX Lung -2 nd ICS IVC/Aorta- transverse/long RUQ (PLEF/Ascites) IJ/carotid or femoral vein End of PGY2 2/4 cardiac views Renal-Hydronephrosis AAA Joint Effusion Procedures (CVL, Thora, Para) End of PGY3 4/4 cardiac views + valves DVT Gallstones 8-zone Lung Protocol RUSH protocol/codes
6 Ultrasound Equipment Wards Pocket-sized Ultrasounds (for each Ward Team) Laptop-sized Ultrasound for Procedures/Detailed Exams Outpatient Clinic Laptop-sized Ultrasound MICU/SSU/CCU/ED Cart-Based Ultrasounds
7 Resident Ultrasound Didactic Training (>30 hours) Noon Conference Didactics (45 min, 1/block) Covers core curriculum May move towards online lectures Morning Report (5-10 min, 2-4x/block) Multiple Small Feedings Interesting cases Optional topics Repetition of core content Supplemental FOAMed and Just-in-time Resources
8 Hands-on Training Popular POCUS elective (2-4 weeks) Weekly Bedside Gel Rounds Standardized Patients and Simulator Practice 2 hours, 3x/year during ambulatory block Milestones (by PGY level) assessed by OSCE each year Procedure Phantom Lab 3 hours, 1x/year
9 Image Log/QA
10 Imaging Requirements All scans should be SAVED and LOGGED Need 25 scans in an application to be eligible for sign-off. Once >150 total ultrasound scans logged/signed off, can request an assessment for any application when ready (even if <25 scans). Sign-off includes adequate: Images obtained/number of views/correctly interpreted Score (80% or higher) on knowledge assessment Performance on bedside OSCE
11 Challenges Low Utilization of Equipment Solutions: Increased training, pocket-sized devices Faculty Training Solutions: Scanning vs non-scanning track Logging Solutions: Smartphone use, Team Competition Successes Increased Participation in Research Numerous Ultrasound for the Win Cases
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