Link To And Excerpts From Point of Care Ultrasound – Recommended Curriculum Guidelines for Family Medicine Residents* [Link is to the PDF] endorsed by The American Academy of Family Physicians.
*Developed 12/2016 by Contra Costa Family Medicine Residency Program, Martinez, CA.
Here are excerpts from the document:
Competencies
At the end of residency training, a family medicine resident should be able to:
• Know the indications, benefits, and limitations of POCUS (Patient Care)
• Assess anatomy, physiology, and pathology with POCUS (Medical Knowledge)
• Advance POCUS knowledge with appropriate precepting, electives, and use of
website resources (Practice-based Learning and Improvement)
• Communicate the results of a POCUS scan to the patient and treatment team, and
document the results appropriately in the medical record (Interpersonal and
Communication Skills)
• Talk to the patient about the risks and benefits of POCUS and alternatives to
POCUS, and obtain verbal consent prior to a POCUS scan (Professionalism)
• Utilize POCUS to decrease time to diagnosis, decrease procedure complications,
and expedite medical care (Systems-based Practice)Knowledge
2. Basic core applications of POCUS:
a. Obstetrics and gynecology (OB/GYN)
b. Cardiac
c. Trauma
d. Aorta
e. Biliary
f. Urinary tract
g. Deep venous thrombosis (DVT)
h. Soft tissue/musculoskeletal
i. Thoracic/pulmonary
j. Ocular
k. Procedural guidance
l. Clinical protocolsNOTE: “Basic” and “advanced” applications of POCUS are based on consensus opinion and are not meant to be all-inclusive or exclusive. It is anticipated that a family medicineresidency will utilize this document to create their own POCUS curriculum based on their specific needs, clinical focus, and credentialing process. Other than the OB/GYN section, ultrasound skills/competencies listed below are only described for the basic
applications of POCUS.Skills
[See pages 6 through 12 of the PDF for the detailed list of skills to be acquired during residency.]
Clinical protocols
POCUS clinical protocols are systematic exams that serve as an adjunct to improve diagnostic acumen. Clinical protocols do NOT substitute for an appropriate history, physical exam, or other tests, such as ECG, blood tests, and other appropriate
radiographic modalities.1. FAST/E-FAST: Focused assessment with sonography for trauma
2. RUSH: Rapid ultrasound for shock and hypotension
3. BLUE: Bedside lung ultrasound in emergency
4. CLUE: Cardiac limited ultrasound exam
5. FEEDS criteria (see OB/GYN section)[Please note that there are numerous excellent YouTube videos available on each of the above protocols.]
Competency assessment:
Competency assessment is utilized to provide the
resident with summative feedback and determine recommendations for privileges upon graduation. Each family medicine residency program should develop its own criteria to quantify the number of precepted scans needed to assess their learners for POCUS competency. In general, the number of precepted ultrasounds performed correlates with a resident’s competency level. Family medicine residency programs with well-established POCUS curricula have used 150 to 300 total scans for general point-of-care ultrasound competency, 25 to 50 supervised exams for a specific diagnostic exam, and 5 to 10 supervised scans for ultrasound-guided procedures.These numbers are consistent with recommendations from other specialty societies, such as the American College of Emergency Physicians (ACEP). 12,13 Programs and residents should understand recommendations for training, skill performance, and documentation from other organizations, such as the American Institute of Ultrasound in Medicine (AIUM) and the American College of Obstetricians and Gynecologists (ACOG), and how those are similar to, and differ from, protocols utilized in POCUS. Consideration should be given to utilizing a summative knowledge exam and skill assessment in this process. In the end, residents must be deemed to be competent by the ultrasound faculty and program director on a caseby-case basis.
[For clinicians who did not have the opportunity to get sufficient numbers of procedures during residency or fellowship, there is an excellent alternative.
The physician can hire an ultrasound technician to supervise the learning physicians examinations.
Ultrasound technicians’ ultrasound scanning and interpretation skills often greatly exceed those of the interpretating radiologists, and other interpreting clinicians (Cardiology, Ob-Gyn, etc],
