Rotation Overview and Goals

The primary goal of the emergency ultrasound (EUS) rotation will be to provide a practical and didactic experience that will enable participating residents to become proficient with routine EUS applications as specified by ACGME requirements. Residents will gain an understanding both of the indications and limitations of EUS such that they will be able to incorporate EUS in their future practice. At the completion of the rotation residents will be expected to demonstrate competency in basic ultrasound physics, image generation and interpretation. Residents should complete the rotation feeling confident in their ability to utilize EUS in caring for patients.

Educational Objectives

1. Demonstrate proper technique and utilization of ultrasound equipment in the ED
2. Understand the principles of ultrasound physics and use them to enhance their image acquisition
3. Demonstrate competency in the routine emergency ultrasound applications:
   1. FAST
   2. AAA
   3. Cardiac
   4. Gallbladder
   5. Renal
   6. DVT
   7. First Trimester
   8. Soft tissue
   9. Central and peripheral IV access
   10. Procedural
4. Demonstrate ability to recognize and differentiate adequate from inadequate studies of recorded images for CQI
5. Demonstrate ability to correctly interpret EUS findings
6. Complete and document (in a database) 150 scans and should try to include at least 10 scans for each indication
7. Complete a pre and post rotation examination

Interpersonal and Communication Skills

1. Develop and consistently demonstrate listening skills to address patients' concerns respectfully and effectively
2. Ensure that patients (and their families) understand the nature of the studies being performed
3. Develop effective methods for communicating with colleagues in the emergency department.

Professionalism

1. Demonstrate empathy and compassion toward patients and their families
2. Emulate the role of the emergency physician as a patient advocate
3. Incorporate sensitivity for the patient's age, gender, sexual orientation, religious beliefs, and socioeconomic background in providing them care in the ED
4. Respect patient autonomy, comfort and modesty as you perform sonographic studies

Practice Based Learning and Improvement

1. Effectively use the educational resources available in the ED, including on-line texts and databases
2. Identify areas for self-improvement and implement strategies to enhance sonographic knowledge, skills, and processes of care
3. Demonstrate willingness to acquire new knowledge and skills specific to emergency medicine ultrasound
4. Accept and integrate feedback given by other members of the health-care team, including faculty, senior residents and nursing staff

Systems Based Practice

1. Demonstrate appropriate use of ED resources
2. Integrate sonographic findings into the care of patients appropriately

Description of Clinical Experience

Residents will be expected to spend eight (8 hour) shifts in the OHSU ED performing EUS scans on appropriate patients. Four of these shifts will be spent together with rotation directors who will provide hands on education and supervision. The remainder of the shifts should be scheduled at times when EUS facile faculty are available. Exams should be performed largely on patients who will be undergoing confirmatory studies such as X-rays, CT scans or radiology performed US.

Description of Didactic Experience

Residents will have 2 didactic days during the rotation during which they will receive lectures, participate in video review and CQI and discuss recent EUS literature. During the course of the rotation residents will be expected to complete required reading from the Ma and Mateer, Emergency Medicine Ultrasound textbook. They will also have access to additional educational resources including instructional videos and didactic handouts. Residents will also be responsible for teaching one 4th year medical student ultrasound lab.

Evaluation Process and Feedback to Residents

Residents will be evaluated both in real time by the rotation directors during scanning shifts as well as retrospectively at the end of the rotation. The directors will provide direct feedback when scanning with the residents to enhance technique and image enhancement. Directors will also complete standard resident evaluations at the end of the rotation. Furthermore, residents will complete a pre and post rotation written examination.

Evaluation of Faculty and the Rotation by Residents

Residents will evaluate the rotation directors and the rotation using standard rotation evaluations. Furthermore, residents will be encouraged to provide the directors with direct feedback at the end of the rotation based on their experience.