Ultrasound Fellowship

General medicine point-of-care ultrasound fellowship

ultrasound

For clinician users of Point-of-care ultrasound (POCUS) almost everyone can share their "lightbulb moment", where using ultrasound at the bedside changed the way they thought about a patient, and opened their eyes to the potential benefit for future care.

The Division of General Internal Medicine and the Division of Hospital Medicine support a POCUS Fellowship with the Point-of-care Ultrasound Group at Oregon Health & Science University. The fellowship was created in 2016, when it was the second of its kind in the nation. The fellowship aims to train physician-leaders in POCUS who are keen to share knowledge with their communities. Like similar Emergency Medicine Ultrasound Fellowships, this fellowship is non-ACGME accredited.

This fellowship focuses on developing expertise in POCUS knowledge, technical performance, and clinical integration, while simultaneously preparing the fellow to be a leader in POCUS. The curriculum develops a framework for knowledge building through weekly ultrasound conferences focusing on image review, literature review, and both faculty and fellow led didactics. Technical performance expertise is enhanced by regular mentored scanning with POCUS physician faculty and/or an educational sonographer, in a variety of settings including the emergency department, cardiovascular and medical ICUs, medical wards, and various outpatient settings. Fellows additionally work with procedure teams in the hospital and the clinic to obtain POCUS-guided procedural training.

Our team believes that the quality patient care is the driver for learning this technique, and the fellow will have either a valued clinical role in the Internal Medicine Clinic or as a nocturnist at OHSU. In this setting the fellow is encouraged to utilize POCUS skills to guide patient care and practice clinical integration when POCUS is indicated. Fellows receive formative evidence-based feedback of their incorporation of their POCUS into their clinical decision-making.

Finally, our fellowship aims to shape and prepare the trainee for future leadership opportunities. We provide additional training in developing expertise in bedside teaching, developing effective lectures, leadership, and acquiring the know-how to build a POCUS program. Fellows additionally have the opportunity to participate in the OHSU’s novel Education Scholars Program with other educators from around the institution.

Sample image

Curriculum

Fellows learn a broad set of POCUS applications over the fellowship year. Every fellow will learn a core curriculum, but we also develop an individual-driven curriculum plan tailored to the fellows’ specific interests and career goals.

Core Curriculum

  1. Ultrasound Operation and Physics
    1. Spectral Doppler
  2. Cardiac
    1. Basic
      1. Left ventricular function
      2. Right ventricular function
      3. Pericardial fluid
      4. Tamponade physiology
    2. Advanced
      1. Cardiac Output
      2. Diastology
      3. Endocarditis
  3. Lung
    1. Basic
      1. Pleural Fluid
      2. Pneumothorax
    2. Advanced
      1. Consolidations
      2. Alveolar interstitial syndrome (B-lines)
      3. Pleural disease
      4. Diaphragm function
  4. Genitourinary
    1. Basic 
      1. Hydronephrosis
      2. Bladder volume assessment
    2. Advanced
      1. Cysts
      2. Renal Doppler
      3. Renal parenchymal assessment
      4. Stone Assesment
  5. Hepatobiliary
    1. Basic
      1. Cholelithiasis
    2. Advanced
      1. Ductal Assessment
      2. Masses
      3. Polyps
      4. Sludge
      5. Wall Assessment
      6. Pericholecystic fluid
      7. Porcelain gallbladder
      8. Liver cysts, abscesses, and masses
      9. Fatty liver
      10. Cirrhosis
      11. Portal vein Doppler
      12. Portal venous thrombosis
  6. Abdomen
    1. Basic
      1. Free fluid assessment
      2. Splenic assessment
    2. Advanced
      1. Pancreas
      2. Pneumoperitoneum
  7. Intestinal
    1. Basic
      1. Gastric antrum assessment
      2. Small bowel obstruction
    2. Advanced
      1. Diverticulitis
      2. Appendicitis
      3. Inflammatory bowel disease
      4. Ileus
  8. Musculoskeletal and Soft Tissue
    1. Basic
      1. Cellulitis
      2. Abscess
      3. Joint Effusion
      4. Baker’s Cyst
    2. Advanced
      1. Tendinopathy
      2. Crystal Arthropathy
      3. Injection
      4. Ligament injury
      5. Carpal tunnel
  9. Vascular
    1. Basic
      1. IVC
      2. IJV
      3. DVT (upper and lower extremity)
    2. Advanced
      1. Arterial flow
      2. Pseudoaneurysm
      3. VEXUS evaluation
  10. Head and Neck
    1. Basic
      1. Thyroid size
      2. Lymph nodes
    2. Advanced
      1. Thyroid cysts and masses
      2. Thyroiditis
  11. Procedures
    1. Basic
      1. Paracentesis
      2. Thoracentesis
      3. Lumbar puncture
      4. I&D
      5. Arthrocentesis (small and large joint)
  12. Education Skills
    1. Curriculum Development
    2. Lecture construction
    3. Oral presentation and speaking skills
    4. Bedside instruction
    5. Competency Assessment
  13. Research Skills
    1. Critical Analysis of Medical Literature
    2. Project Design
    3. Literature review and assessment
    4. Research methodology, data collection, and manuscript preparation
    5. Institutional Review Board submission
  14. Administration Skills
    1. Program management
    2. Quality assurance
    3. Competency, certification, and credentialing
    4. Billing/Coding
    5. Documentation
    6. Return on investment
    7. POCUS managers (image archival)
    8. Local, regional, and national policies
    9. Administrative oversight
    10. Risk management
    11. Peer review
    12. Equipment purchase
    13. Equipment maintenance and cleaning
    14. System networking
    15. National organizations

POCUS

Clinician career development is a critical focus of our team. We believe that creating excellent POCUS clinician's educators is enhanced when we support the fellow's academic and professional development. We have several methods for supporting this development.

Our POCUS Group is dedicated to the education of trainees across the institutions. These groups include, but are not limited to; medical students, physician assistant students, nursing students, residents, and post-graduate learners. Given our group's broad responsibility, the fellow will have ample opportunity to engage in teaching opportunities within the university and local community. To support the fellow's career development, we protect time and encourage the fellow to take part in the many educational scholarship offerings available through the university. This includes the opportunity to participate in the OHSU’s novel Education Scholars Program with other educators from around the institution where participants receive formal instruction in health professions scholarship.

We additionally believe that being involved in research is a critical component to the continued incorporation of POCUS into clinical care and the field of internal medicine, while simultaneously building a valuable skillset in the training physician. The fellowship requires the design and implementation of at least one novel research project, including institutional review board submission, and we encourage the involvement in ongoing research projects as well.

Lastly, the international POCUS community is remarkable in regards to its warmth and enthusiasm. Our fellows have the opportunity to attend ultrasound conferences to engage and network with this community.

Teaching Curricular Experiences

Our fellows get a broad exposure to numerous different learners allowing them to participate in different training models and obtain skills in curriculum design, delivery, and assessment. At OHSU our group supports a number of different learners, including:

  1. Health Professions Education
    1. MD students (electives, longitudinal experiences)
    2. PA students (longitudinal)
    3. NP students (elective)
    4. Nutrition students (elective)
  2. GME
    1. Internal Medicine (workshop, electives, procedural ultrasound team POCUS pathway)
    2. Family Medicine (Longitudinal ultrasound curriculum)
    3. Other associated GME programs (Surgery, anesthesia, IM subspecialty fellowships)
  3. CME
    1. Novel faculty development program

OHSU Skyline

Oregon Health & Science University is located in the beautiful and vibrant Pacific Northwest right in the heart of Portland. Ultrasound activities primarily occur at the University Hospital, Multnomah Pavilion Simulation Center, and at the state-of-the-art Robertson Life Sciences Building (RLSB). Fellows have access to a fleet of both cart-based and handheld ultrasounds and get exposure to up-and-coming technology during the fellowship year.

POCUS cart

Cart-based ultrasound

POCUS handheld

Handheld ultrasound

Leadership

Kevin Piro Program Director

Kevin Piro, MD, FACP
Associate Professor of Medicine
Medical Director, OHSU Point of Care Ultrasound
Director, General Medicine Ultrasound Fellowship

Associate Program Director Chrissy Schutzer

Chrissy Schutzer, BA, RDMS
Director of Operations, OHSU Point of Care Ultrasound
Educational Sonographer

Faculty

Renee Dversdal, MD, FACP
Professor of Medicine
Medical Director, OHSU Simulation

Michael Wollenberg, MD
Associate Professor of Anesthesiology and Perioperative Medicine
Director, Perioperative Ultrasound Education

Matt Chan, MD
Assistant Professor of Family Medicine
Director, Family Medicine Point of Care Ultrasound Curriculum

Nilan Schnure, MD
Assistant Professor of Medicine
Director, Outpatient Internal Medicine Ultrasound

Aaron Silver, MD
Assistant Professor of Medicine
Director, MD Continuity Elective

James Anstey, MD
Assistant Professor of Medicine
Director, OHSU Faculty Point of Care Ultrasound Education

Fellows

Kaahu Leite-Ah Yo, Michelle Beam, Arinea Salas

Michelle Beam, MD
Instructor of Medicine
General Medicine Ultrasound Fellow

Kaahukane Leite-Ah Yo, MD
Instructor of Medicine
General Medicine Ultrasound Fellow

Arinea Salas
Instructor of Medicine
General Medicine Ultrasound Fellow

Graduates

Our graduates have been remarkably successful post-fellowship and have taken a variety of career paths.

2016
Kevin Piro, MD (OHSU)

2017
Tim Flynn, DO (Abbott Northwestern, ambulatory clinic)

2018
Madiha Ahmad, MD (Rheumatology)

2019
Chad Ficek, MD (Sanford Medical Center, hospitalist)
Michael Northrop, MD (Legacy Health, hospitalist)
Florian Sattelmacher, MD (Queen’s Health System, ambulatory clinic)

2020
James Kornfield, MD (OHSU, Pulmonary and Critical Care Medicine)

2021
Scott Biggerstaff, DO (University of Minnesota, POCUS Director)
Paul Musgrave, MD (Legacy Health, hospitalist)
Aaron Silver, MD (OHSU, hospitalist)

2022

Michael Armstrong, DO (OHSU, Pulmonary and Critical Care Medicine)
Kelvin Ng, MD (OHSU, Family Medicine)

Member of the POCUS program

Candidates and Application

The application period will open starting September 1st with hiring decisions being made on a rolling basis.

In order to apply, our group requests a one-page letter of intent, two recommendations, and a CV. An interview will follow review of your application. Please send application materials to piro@ohsu.edu. We are also available to answer questions about the fellowship to interested candidates.

We look forward to hearing from you and having the opportunity to share our program!

Kevin Piro, MD, FACP
Associate Professor of Medicine
Medical Director, OHSU Point of Care Ultrasound
Director, General Medicine Ultrasound Fellowship

Division of Hospital Medicine, Division of General Internal Medicine
Oregon Health & Science University

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@Sono4Pyro
@ohsu_pocus