Establishing a training program in focused point of care ultrasound is an exciting and rewarding experience. The impact of ultrasound on the clinical practice of medicine becomes so obvious that many clinicians, after acquiring basic ultrasound skills, wonder how they got along without this technology. This chapter outlines the process for developing a point of care ultrasound training program and addresses the common questions encountered when starting a new program. This chapter was written on the basis of our training experience in Emergency Medicine residency programs. The principles outlined could be applied to residencies in other specialties as well as to groups of practicing physicians who are interested in developing an ultrasound program for emergency and acute care settings.
Point of care ultrasound examinations are performed by the patient care provider to answer specific clinical questions in order to make patient care decisions in real time. “Comprehensive” examinations, generally done by imaging specialists, seek to completely evaluate a particular organ system or anatomical area. Point of care examinations, on the other hand, are focused in their scope and seek to answer only one or a few questions about an organ system or anatomical area (e.g., “are there gallstones or not?”). By virtue of their focused interpretations, point of care examinations require less training for proficiency.
The following are a set of steps for establishing a high-quality point of care ultrasound program. These steps should generally proceed in order. Early selection of the ultrasound director is preferable, as several of the steps are time consuming and would benefit by having a designated advocate to champion their completion.
Determine type of examinations to be performed.
Develop a program plan.
Select the point of care ultrasound director(s).
Obtain hospital approval of program plan.
Acquire an ultrasound machine.
Train the ultrasound director(s).
Train the group.
Perform problem solving and ongoing training.
This step seems like an easy task. However, the number of focused ultrasound applications continues to expand along with technological advances in ultrasound and individual operator expertise. It makes sense to start with applications that will get the most use in a particular practice setting. Some acute care, emergency, and critical care settings provide excellent diagnostic ultrasound service so training might be best focused on services that are not offered or not offered in a time frame that is acceptable. Examples include most of the procedural applications, as well as the critically emergent diagnostic applications such as the focused assessment with sonography for trauma (FAST) examination, evaluation of cardiac arrest states, evaluation of undifferentiated hypotension, and the abdominal aortic aneurysm (AAA) examination. One advantage to starting with procedural applications is that they require less training than diagnostic examinations so they can be put into use quickly. Further more, there will likely be less political resistance to procedural ultrasound, which is now widely supported and utilized by a variety of clinicians. For a list of potential applications, see Table ...