Ultrasound training in med school

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streetdoc

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My school is looking at adding ultrasound to the cirriculum (all 4 years) since it seems to be the wave of the future and I hope to get some help from all of you wise folks-

First, i'm curious if anyone knows of a school that may already have this set up.
If not, what are some suggestions or things that may be helpful. SAEM has power points available and a bank of images (currently offline), but I thought that may be a good start.

For those of you that are residents, what is the typical way that you receive training? Is practice/ experience the only way? or have you come aross helpful resources that you could suggest for med students?
Thanks guys,
streetdoc

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As an echocardiographer, I have to say that because U/S skills are so, well, skill dependent, that yes, practical experience is the only way to become practically competent at anything beyond reading the images.
 
DropkickMurphy said:
As an echocardiographer, I have to say that because U/S skills are so, well, skill dependent, that yes, practical experience is the only way to become practically competent at anything beyond reading the images.

i assume you went to school for your skills...what did your training consist of? classroom/experience/shadown... fill me in, it may help us out.
thanks
streetdoc
 
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Well, I was trained as one in the Air Force. 3 months of classroom followed by a few months of clinical experience (I want to say 2 months, but I don't recall precisely since that was 5 years ago).
 
From a resident perspective, our training is mostly hands on in the department.

We get some training every couple of months during conference but we use the ultrasound all the time in the ED. I used it today to get a feel for an abscess I was going to I&D. Did I need the U/S? No way. I used it anyway because the more I use it, the more comfortable I'll get. I'm trying to find as many ways to use it as I can.

Take care,
Jeff
 
DropkickMurphy said:
As an echocardiographer, I have to say that because U/S skills are so, well, skill dependent, that yes, practical experience is the only way to become practically competent at anything beyond reading the images.

Haha, nice new avatar there, Dropkick. :thumbup:
 
streetdoc,

FWIW I hear UC Irvine has a kick butt US elective that is 2 weeks long. I didnt do it but know someone who did and they really enjoyed it..
 
EctopicFetus said:
streetdoc,

FWIW I hear UC Irvine has a kick butt US elective that is 2 weeks long. I didnt do it but know someone who did and they really enjoyed it..

i did a month of it and was definitely well worth it. you can probably gain a lot of experience with the machines in 2 weeks too, but I really felt like I learned a lot that last few weeks too. And the schedule was easy, you can schedule 4 hour shifts pretty much whenever (usually 3-4 students per rotation so have to watch out for everyone's schedule).

most of the attendings there are pretty cool about helping out when you are doing them, and of course dr. fox the ultrasound director was one of the best to schedule shifts with.
 
EctopicFetus said:
streetdoc,

FWIW I hear UC Irvine has a kick butt US elective that is 2 weeks long. I didnt do it but know someone who did and they really enjoyed it..

it's four weeks now.
 
leviathan said:
Haha, nice new avatar there, Dropkick. :thumbup:
Thanks....it was my girlfriend's creation. It's even funnier when you realize I'll have to put a ring on her finger to get her to live up to that admonition. "Sorry honey, no ring, no riding." Damn her and her virgin morality..... :smuggrin:
 
JackBauERfan said:
i did a month of it and was definitely well worth it. you can probably gain a lot of experience with the machines in 2 weeks too, but I really felt like I learned a lot that last few weeks too. And the schedule was easy, you can schedule 4 hour shifts pretty much whenever (usually 3-4 students per rotation so have to watch out for everyone's schedule).

most of the attendings there are pretty cool about helping out when you are doing them, and of course dr. fox the ultrasound director was one of the best to schedule shifts with.

Thanks for the good info, guys.
JackBauERfan, how is the rotation set up? is there a lecture the first day or two and then you just go at it?
I agree experience is key, our machines should be here this summer and students will be able to "check them out" after basic training. We are just trying to figuere out what the basic training should be. Keep the suggestions coming.
Thanks
streetdoc
 
Ceez said:
it's four weeks now.
I guess the old "you learn something new everyday" thing holds true yet again!! :smuggrin:
 
I was at UCI two weeks ago for second look weekend, and the school put on a "day in the ER" workshop with various clinically related activities, such as intubating, and of course, using ultrasound to guide procedures. Dr. Fox was insane, in a good way - I've never seen an attending with such enthusiasm for his work. He really couldnt stop talking about ultrasound, even after the presentation was over... I think he may even sleep with a portable ultrasound machine... ;)
 
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We (Ohio State) were taught the "fast scan" this year (first year). We have a doc in the ER who has been pushing it bigtime. He calls it "the stethescope of the future". We just did it on each other in our clinical skills lab over 4 or 5 one hour meetings. The same ER doc is in charge of the 4th year ultra sound elective...they learn a ton of different uses of it...I think they get a month or so to do the elective....then teach the "fast" scan to 1st years.
 
streetdoc said:
Thanks for the good info, guys.
JackBauERfan, how is the rotation set up? is there a lecture the first day or two and then you just go at it?
I agree experience is key, our machines should be here this summer and students will be able to "check them out" after basic training. We are just trying to figuere out what the basic training should be. Keep the suggestions coming.
Thanks
streetdoc

Orientation includes like 5-6 different CD's/DVD's they have prepared for you. It pretty much goes through the right way to hold the probes, the reasons why you're doing the studies, and particular stuff about the machine they have. The videos included FAST scanning, evaluating the aorta, ob/gyn stuff, hmm, pretty much just trying to get good 'windows' of most of the organs. The FAST scan is pretty good to learn with because it gets you a lot of the anatomy too. Oh, also using it to put lines and stuff in. But I think I learned the most just actually doing it on normal folks while in the ED.

After you watch the orientation stuff on your own, you pretty much stick to the schedule you set up before you got there. You can change it around though with the other students, or if no one is scheduled during a certain time you can just be there. They try to not have more than 2 folks scheduled at the same time, because there are other students from other services taking up space too, and it can get pretty crowdy (just like most places I've been haha).

So in short the basic training included FAST, ob/gyn, basic physics/terms in US, knobs and how to use them; and the hours at uci were really flexible.
 
SanDiegoSOD said:
I was at UCI two weeks ago for second look weekend, and the school put on a "day in the ER" workshop with various clinically related activities, such as intubating, and of course, using ultrasound to guide procedures. Dr. Fox was insane, in a good way - I've never seen an attending with such enthusiasm for his work. He really couldnt stop talking about ultrasound, even after the presentation was over... I think he may even sleep with a portable ultrasound machine... ;)

haha yeah, that's pretty funny, but its great learning from folks that really enjoy it.
 
JackBauERfan said:
Orientation includes like 5-6 different CD's/DVD's they have prepared for you. It pretty much goes through the right way to hold the probes, the reasons why you're doing the studies, and particular stuff about the machine they have. The videos included FAST scanning, evaluating the aorta, ob/gyn stuff, hmm, pretty much just trying to get good 'windows' of most of the organs. The FAST scan is pretty good to learn with because it gets you a lot of the anatomy too. Oh, also using it to put lines and stuff in. But I think I learned the most just actually doing it on normal folks while in the ED.

After you watch the orientation stuff on your own, you pretty much stick to the schedule you set up before you got there. You can change it around though with the other students, or if no one is scheduled during a certain time you can just be there. They try to not have more than 2 folks scheduled at the same time, because there are other students from other services taking up space too, and it can get pretty crowdy (just like most places I've been haha).

So in short the basic training included FAST, ob/gyn, basic physics/terms in US, knobs and how to use them; and the hours at uci were really flexible.

Oh and every friday they have a QA review session from the scans you did (you tape the important parts of it) and that was pretty cool too see how off you were haha. They are pretty good about informing you when someone in the ED needs an US evaluation (for gallstones, kidney stuff, aorta), but when there's down time, you're free to just find a normal person and tell them that you need practice using the ultrasound machine, and you can give them a chance to look at their kidneys and stuff. Most of the time I didnt' even record those (would have been boring friday material.
 
The attendings at my institution are great at teaching ultrasound. I am a third year medical student and we had an EMIG workshop where they went over how to do the FAST exam and how to use ultrasound for lines and such. The EM residents at my school have several workshops throughout their intern year where they use paid patients and go over all sorts of clinical uses. For example, for Ob day they pay a couple of the pregnant nurses for their time to act as practice subjects. The interns take turns doing the full Ob exam on the patients (I don't think they do the transvaginal though). I believe they also had paid patients come in for the eye exam (looking for detached retina), and for the testicular exam (looking for torsion). Also, each intern gets a dedicated month as the "ultrasound resident." Basically, when they are scheduled they just float around the ED doing any exams that might be required. They also use this time to help the surgery consult resident with anything they may need. When the U/S intern is not on, there is an upper level resident that will go around and do the job, so they can get enough exams for certification. Almost everyone from the program graduates with enough exams for certification. Of course, it is not just the dedicated U/S residents who get to do exams. Anyone who feels like it can use the machine if they want to.

I have seen the residents use ultrasound for a number of things. Any pregnancy under 20 weeks gets looked at. Suspected DVTs, biliary disease, renal disease, pelvic pain, and vascular procedures all get the probe. Just yesterday the U/S intern put an iv in a deep brachial vein on this guy who wasn't sick enough for a central line, but had lost all pokable peripheral veins. I think that pretty much everyone at that programs gets great ultrasound training and leaves well-prepared.
 
Code:
[QUOTE=turtle,md]I'm surprised Peski hasn't chimed in...

Paul, you out there ... ?


Turtle, just back from SF and SAEM as you know...anyway

I know Fox very well, and I think I want to do a rotation out at UCI, but I think I'll wait for the winter! :D Chris does a great job there and i know the students really love his rotation.

I am happy to say I think the CCHS has some killer pathology that makes EUS really hit home for our residents and faculty.

I have someone out from the west coast with me now and in the past 2 days she has scanned and seen 2 AAA, 1 popliteal Artyery Aneurysm, an ectopic, free fluid X 4 pts, liver mets, pericardial effusion X 2, pleaural effusion, central line placed, dilated ONS in a ICH, gallstones, and calculated an EF of 4%, and this was really over 2 days in the ED, why....volume baby...turn UP the volume. :thumbup: :thumbup: :thumbup:

This is a powerful technology, with almost no limits, we really just scratching the surface now of our collective specialty potential. For eg we are now running a TCD/microbbuble stroke study, which is just so cool.

I often reflect and laugh when I think of how many attendings and program directors around the country chuckled and scoffed when i said i wanted to use and specialize in ultrasound as a resident when interviewing back in 1995......whose laughing now baby!!! :smuggrin:
Oh yeah, many of them also said there would be NO academic jobs by 2000!

I am glad the medical students really embrace the technology it IS here to stay.

"Gell'in in Delaware"

Paul
 
Anyone have recommendations on good books (esp with images) to use in preparation of an ultrasound elective rotation (and any other time it comes in school/residency/future)?

I'm not talking massive texts -- Like a few days of reading, maybe even a pocket book. Thoughts?

-K
 
kalico said:
Anyone have recommendations on good books (esp with images) to use in preparation of an ultrasound elective rotation (and any other time it comes in school/residency/future)?

I'm not talking massive texts -- Like a few days of reading, maybe even a pocket book. Thoughts?

-K


There is a book by Dr. Sierzenski!! umm, Dr. Fox recommended it (also an author haha). I actually like it though, really concise and I like the setup of it.
 

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JackBauERfan said:
There is a book by Dr. Sierzenski!! umm, Dr. Fox recommended it (also an author haha). I actually like it though, really concise and I like the setup of it.

oh and its definitely a fast readable and reference one.
 
Since I last posted, someone recommended:
"A Practical Guide to Emergency Ultrasound" by Kendall.

Anyone have experience with this? Is the other one better?
 
Alright as a true EUS geek, i have to admit i have all the above and others. the issue is budget and what to get out of the book. our book is "protocol heavy" reviewing multiple positions to place the transducers and associated images, including those that get you into trouble. Our book is for the true "introduction to bedside US" but is pretty comprehensive. I really think the best thing to do is sit down with any of these and review them. I have written several chapters in many of these texts therefor I AM biased. but I have 4 primary EM US texts.

Sorry I realize not much help, but I don't want to hock my own goods on SND...poor form in my opinion.

Paul
 
Anyone going to this Ultrasound in Critical Care (World Congress on Ultrasound- www.wcu2006.com) June 11-14? Just curious.
 
I will be there.

Paul
 
I will hock them then! Having bought it from ACEP last month, the new book by gaspari, fox, and our very own peski is great. It's focus as peski said is protocols. It will tell you what images are needed and how to get them for the most common exams. It's an easy read with great accompanying images. What it is not though is path. heavy. It's not chock full of images of pathology and it's various appearances on u/s. This fact makes this book a great starter u/s resource IMO but not a definitive text. I imagine the reason peski owns many u/s books (besides having contributed to them) is because there is no such thing as a definitive EM U/S text. If you want a good FIRST EM U/S text though their new one is a great choice.
 
colforbinMD said:
I will hock them then! Having bought it from ACEP last month, the new book by gaspari, fox, and our very own peski is great. It's focus as peski said is protocols. It will tell you what images are needed and how to get them for the most common exams. It's an easy read with great accompanying images. What it is not though is path. heavy. It's not chock full of images of pathology and it's various appearances on u/s. This fact makes this book a great starter u/s resource IMO but not a definitive text. I imagine the reason peski owns many u/s books (besides having contributed to them) is because there is no such thing as a definitive EM U/S text. If you want a good FIRST EM U/S text though their new one is a great choice.

I agree, its very good for protocols and how to acquire the images. Not a lot of path, but really good for anyone starting, and I think the best is to just practice with an US on normal folks to get a good feel of it. Remember it is a SKILL that takes time to get good with.
 
does anyone have a copy of the ultrasound CD from UCI? I heard it has good stuff for med students.. I was wondering if Dr Fox and company keep the data on the web somewhere for independent study and for those that don't get a chance to do a rotation.
 
RayF said:
does anyone have a copy of the ultrasound CD from UCI? I heard it has good stuff for med students.. I was wondering if Dr Fox and company keep the data on the web somewhere for independent study and for those that don't get a chance to do a rotation.

Na, I asked them as of 8 months ago and they had not moved it to the web yet. I then asked if I can get copies of the CDs and was going to do it, but forgot and left without getting them. So sorry, pretty much useless response on the CD issue.
 
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