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Ultrasound Rotation HELP

Discussion in 'Emergency Medicine' started by Midwest Medic, Jan 7, 2009.

  1. Midwest Medic

    7+ Year Member

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    I am in the process of setting up an ultrasound rotation as the director of it. Quick question for those of you who have went through one or are the directors of it... What are some of the guidelines that you have for this? We have some basic ones down, like # of exams, QA, reading, and administrative stuff. Also, any surprises come up when you were on the rotation or as the director of one that I should be aware of?
     
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  3. Seaglass

    Seaglass Quantum Member
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    How much time do you have to devote to it, and how many people on the rotation at a time?
     
  4. oldManDO2009

    oldManDO2009 Senior Member
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    For what is worth as a forth year student I will have completed 10 weeks of ultrasound (really like US!) by the time I graduate in May, I have trained with the US techs and it has made a huge difference. The techs have taken the time to help me refine my probe techniques and they have taken time to review sonograms (normals and pathology). SO when I review sonograms in the afternoon I have a better feel for the blob of black and grey...

    So, if it is possible, I think initial training with techs is very helpful to get you past the initial confusion of the various views and get comfortable with the probe.

    After that it is a matter of getting probe time and for me, checking my conclusions with an experienced operator.

    my 2 cents....


    old man
     
  5. Bigbaitbigfish

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    I think you are supposed to have 20 scans of each by the time you finish residency to be 'certified', whatever that means:

    Cardiac
    Aorta
    FAST
    Renal
    Gallbladder
    r/o ectopic either transvag or abd
     
  6. Midwest Medic

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    Seaglass,
    Starting off planning on one person rotating at a time until I know how much time is involved then expanding to the max of 3 at a time. I do have a moderate amount of time to devote to this, and will not let it go downhill. There are also 2 other attendings in our group who are excited about it as well, and are planning on doing a lot for it too.
     
  7. Seaglass

    Seaglass Quantum Member
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    The most effective approach I have seen uses one month of one on one time. At CMC the director or I would spend afternoons with the resident on the rotation monday-friday. The resident spent only a few days scanning alone. We would also go over the core lectures with each of them - eventually we put them online and gave about half of them that way and half in person. The other requirement was having them keep a log with goals and going over it weekly so we could redirect them to spend more time getting scans that were being missed. If you have limited time then spending some time with techs might be OK of the techs are willing. We also gave a pre- and post-test that helped to see how much the resident was actually learning.
     
  8. doctor7

    doctor7 Member
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    Having done an US elective while a student and now helping to organize one as a senior resident, here are some thoughts:

    1. a readable text (not too long or even just some excerpts on basic concepts and EM oriented scans)
    2. a couple of 1 on 1 sessions to start...instructors should know the machine inside out: how to scan, switch probes, record, export to USB; then go through all the basics scans a few times and what to look for; e.g. RUQ and measuring CBD thickness or transvag while measuring FHR using M-mode
    3. solo sessions and method of reviewing studies...it's 2009 and all the new machines take USB or some type of flash drive; maybe try digital reports if you have a long-term goal of creating an efficient review process; most places still use a form stapled to the fax paper print-outs...pick your poison (bumpty frontier vs. old tech)
    4. organize resources into a digital format...a basic website with links to the machine manuals, recommended texts, documentation forms vs. digital documentation, blog element to add notes about quirks at your institutions (e.g. where the sterile probe covers are located)
    5. the more you invest in 4, the less time you'll spend repeating yourself
     
  9. Midwest Medic

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    Thanks to all who have replied. So far what we have developed is a folder of information similar to what doctor7 was implying with #4. I am planning on spending an entire shift with them the first day, going over the ins and out of the machine, setting up the flash drive for them, going over a few basic scans, and getting all the administrative crud out of the way. The residents who will be rotating with me will have a basic understanding of ultrasound, so that should help with the start up. We are then going to let them be on their own for the most part, with frequent meetings going over their scans on the comnputer with critiques. I am them going to give another shift with them after about 3 days of being on their own to get their bad habits fixed before they get too ingrained in them.

    Right now the only thing that we don't have set in stone is how many of each scan. We do not do transvag scans (radiology turf war, plan on fighting it once some of the other wars have been settled) here. Any ideas on how many of each should be done? Thanks again for all the input.
     
  10. Seaglass

    Seaglass Quantum Member
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    How long are the residents on rotation with you? A half day for a month, all day for 2 weeks . . . I would say off the cuff that 15 of each is a good starting point. It also depends how busy your ED is and how much OB you see.
     
  11. docflanny

    docflanny Senior Member
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    Midwest-

    I haven't been to SDN in a while but noticed your post we should talk. BTW- congratuatations!

    Most one month resident elective ultrasound months ask you to do 250-350 scans, usually you can accumulate 5 scans per patient. This also takes into account that you should be reading quite a bit during the month to understand ultrasound technology, the latest research, etc.

    If you're trying to teach your group...most of our attendings have taken a 16 hour basic course, sometimes multiple times. They are getting a lot of benefit from having small group tutor sessions: 3 attendings at a time spending ~4 hours going over exams and the machine at the bedside. Lot of bang for your buck. Once again, we should talk.

    Matt
     

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