Brian Shian, MD,George Bergus, MD Department of Family Medicine University of Iowa College of Medicine

Transcription

1 Brian Shian, MD,George Bergus, MD Department of Family Medicine University of Iowa College of Medicine

2 Both Dr. Shian and Dr. Bergus report no conflict of interest related to this presentation

3 Share our experience of starting a training program for our Family Medicine Residents Promote point-of-care ultrasound in the primary care setting Model the author's approach to establish a point-of-care ultrasound training program Integrate point-of-care ultrasound into daily practice

4 It is the use of portable ultrasonography at patient s bedside for diagnostic and/or therapeutic purpose. Characteristics: Exam is for a well-defined purpose linked to improve patient outcomes Exam is focused and goal directed Exam findings are easily recognizable Exam is easily learned Exam is quickly performed at the patient s bedside. Kendall JL, etc. History of Emergency and critical care ultrasound: the evolution of a new imaging program. Critical care 2007 May;35 (5 suppl):s126-s130

5 Ocular Thyroid Pulmonary Cardiac Gallbladder Liver Kidney AAA & IVC Bladder & PVR Obstetrics IUD check DVT Shoulder Knee Soft tissue Foreign body Paracentesis Thoracentesis LP IV access Joint injection Etc.

6 A technology that can potentially: make a more rapid diagnosis lower health care costs improve patient satisfaction and outcomes An essential skill to have for future physicians The new stethoscope

7 Ultrasound is not only in radiologist s hands any more Currently many specialties employ ultrasound Several medical schools have formal ultrasound curriculum Ultrasound is coming to primary care fast Did you know that our POCUS pre-course sold out way before I was able to register?

8 A 27 year-old Caucasian male with a 2 year history of intermittent epigastric pain treated as GERD presents on a Friday at 3:30 pm with a 3 day history of epigastric and RUQ pain with nausea. No fever or jaundice. Traditional evaluation would take a couple of hours to get labs done, then possible RUQ US the following week.

9 Instead, a bedside ultrasound was done, and it showed the picture at right. Surgery was called right away, the patient was taken to the operating room 3 hours later. Thickening Gallbladder Wall SIN Sign: Stone in the Neck

10 Hall JW, Holman H, Bornemann P, etc. Point of Care Ultrasound in Family Medicine Residency Programs: A CERA Study. Fam Med 2015;47(9):

11 Point of Care Ultrasound Survey to the clinical faculty in the Department of Family Medicine at University of Iowa College of Medicine

12 A retired Siemens Acuson US machine A faculty with POCUS experience New standard of care for inpatient procedural support Basic need for OB assessment Guidance for MSK procedure

13 An intradepartmental survey in 2014: 57% had no POCUS training at all 46% thought it was an indispensable skill to have 78.5% were interested or strongly interested No preference regarding training schedule

14 Supportive leadership Expertise available in the same institution A dedicated core faculty Radiology engineering available

15 A 2-year process Borrowed machines from ETC and MICU Old Siemens Acuson machine The new SonoSite Edge Additional GE VScans

16 Modeled the Curriculum from UC-Irvine A year-round curriculum Include 24 applications Didactic and hands-on sessions Participation is not mandatory for Family Medicine residents

17 A one hour session In the 2 nd and 4 th Tuesday morning each month Half hour for didactic on a topic or an app Followed by 30 minute of hands-on exercise Open to faculty, residents and students Simulated patients, self-mode models

18 A one-hour session Every 2 nd and 4 th Thursday from 5 pm- 6 pm No didactic component No given topic or application assigned A core faculty available for any app trainee would like to practice on Open to faculty, residents and students Simulated patients available

19 A core faculty provide majority of the teaching for the didactic part and all review sessions EM staff for initial efast scan OB ultrasound tech for initial basic OB scans ICU attending for initial pulmonary ultrasound Echo lead tech for initial echocardiography

20 Utilized COM simulated patient pool Paid about $20.00 per hour No separate contract needed Always difficult to find OB cases Certain exams are done on trainees Self-made model for foreign bodies and IV access

21 The program has been running for 14 months 1/3 of residents and 6 faculty members were involved Several residents transitioned their skills to clinic An in-house grant is awarded by the GME office

22 All positive from every party involved Residents would like more flexible hours and extended availability Faculty would like more focused training Both simulate and real patients are impressed with our POCUS capability

23 Additional faculty are needed Residents are not fully taking advantage of our existing POCUS training OB ultrasound models Difficult applications have not been explored Reimbursement Privileging and credentialing?

24 A year-round curriculum consists of 24 applications. didactic sessions every other week review sessions with hands-on experience on simulated patients the other weeks Ultrasound boot camp for residents and faculty: twice a year scheduled. Non-invasive cardiac vascular assessment using ultrasound for M2.

25 Support from the leadership One or more dedicated faculty Readily available ultrasound machines Flexible training schedules

26 Let s WAIT! It is GREAT!

27 V S Solomon SD, Saldana F. Point-of-Care Ultrasound in Medical Education Stop Listening and Look. N Engl J Med 2014;370:

28 Thank You!