Teaching Our Residents POCUS
by Hemanckur Makker, MD and Matthew Jeranek, MD
Point-of-care ultrasound (POCUS) has become an integral part of the anesthesiologist and intensivist toolbox for the diagnosis and management of various disease states especially as ultrasound systems become more ubiquitous in our hospitals and increase in portability and ease of use1. This has been emphasized by the ABA in adding the application and interpretation of POCUS cardiac, lung, and abdominal imaging to the Applied Exam2. Working with residents and fellows, I often wonder about the most efficient and effective way to teach these skills in a busy clinical setting. How do we best integrate this into the trainee curriculum? How many exams are necessary for a trainee to become competent (independent)? Should residents strive for some sort of certification?
At the Medical College of Wisconsin (MCW), we have implemented a longitudinal curriculum starting from the resident’s PGY 1 year and continuing into the resident’s CA 3 year. This has integrated well within our existing simulation education. Given that each trainee has a different background and experience coming from medical school, we start with the basics. As an introduction, our PGY1 residents receive a didactic session followed by a hands-on course where we focus on cardiac and lung imaging on a standardized patient. Groups are small and limited to five residents per faculty member to allow sufficient personal instruction. Our CA 1 curriculum gives our residents exposure through our trauma simulation workshop where they practice and implement the EFAST exam, which is used routinely in our trauma bay. During the CA 2 and CA 3 years our residents receive a five-part curriculum. We increased this from 3 last year as a response to our residents' feedback. The curriculum goes through ultrasound basics/knobology, cardiac, lung, and abdominal imaging. Each session has a didactic portion followed by practical hands-on experience, keeping with small groups to allow sufficient instruction. These sessions have been rated as “extremely effective” by more than 80% of our residents. On our pre and post-test given to the residents before and after our POCUS course, self-reported knowledge scores increased from a mean of 4.67 SD 2.11 (out of 10) to 6.88 SD 1.86 (Table 1). The residents continue to practice their ultrasound skills as the opportunities arise either in the operating rooms or in our intensive care units.
Table 1. Self-reported knowledge scores before and after our POCUS course (out of 10).
Our CA3’s can choose to take a two-week long POCUS elective. They focus on imaging patients in our PACU and our CVICU, with the ICU providing great exposure to various pathologies. A faculty member is available daily to review exams with each trainee. Each exam is saved into our PACS system allowing for quality review, not to mention a log of each exam the resident has completed. It is here that our residents can practice more advanced techniques such as calculating cardiac output, measuring valve gradients, estimating severity of valvular lesions and quantification of ventricular function. This elective course has received a lot of positive feedback and has quickly become one of our most popular electives.
Regarding competency, Clunie et al recently published that their residents needed 36 exams to reach an entrustment score of greater than 4 (may use independently) for cardiac exams and 8 for lung exams3. However, not each trainee learns at the same rate and there should be a system to evaluate resident competence prior to them being “signed off” to perform and interpret exams independently. Certification can be obtained through The American Society of Anesthesiologists Diagnostic POCUS Certificate Program. This is a structured online program which requires 100 cardiac, 20 lung, 20 gastric, and 20 fast exams as part of their certification process and requires mentor attestation. A motivated resident can certainly meet those numbers and obtain the certificate during the tenure of their residency with proper opportunities and mentorship. Certification can also be useful for hospital privileges in the future and maintenance of quality of POCUS examinations.
POCUS continues to gain popularity into our daily practice in the operating rooms and the ICU. At MCW we have integrated our POCUS curriculum within our existing simulation curriculum with encouraging results and good feedback from residents. Competency and certification are both goals that our residents can reasonably achieve.
- Naji A, Chappidi M, Ahmed A, Monga A, Sanders J. Perioperative Point-of-Care Ultrasound Use by Anesthesiologists. Cureus. 2021 May 24;13(5):e15217.
- The American Board of Anesthesiology. (2022, February). APPLIED Exam Objective Structured Clinical Examination (OSCE) Content Outline. Retrieved February 1, 2023, from https://www.theaba.org/wp-content/uploads/pdfs/OSCE_Content_Outline.pdf
- Clunie, M., O’Brien, J., Olszynski, P. et al.Competence of anesthesiology residents following a longitudinal point-of-care ultrasound curriculum. Can J Anesth/J Can Anesth 69, 460–471 (2022).
Hemanckur Makker, MD
Department of Anesthesiology
Medical College of Wisconsin
Matthew Jeranek, MD
Department of Anesthesiology
Medical College of Wisconsin
SOCCA Reception at 2023 SCCM Critical Care Congress in San Francisco
Time: 5:00 PM – 7:00 PM PT
Location: Hilton Union Square (333 O’Farrell Street)
Room: Franciscan A
When: February 2, 2023 | 6:00 PM ET
Where: Register online
Description: Join us for our first Early Career Intensivist Group Meet and Greet of the year on February 2 at 6pm ET. We will have SOCCA board member Dr. Ashish Khanna joining us for a lively discussion about navigating through life as an Early Career Intensivist. We look forward to seeing you soon!
Mechanical Circulatory Support (MCS) / Extra Corporeal Membrane Oxygenation (ECMO) / Cardio Thoracic ICU (CTICU) Workgroup
Members who have a special interest in MCS are invited to join this workgroup. Our first meeting will be January 19, 2023, at 5PM CST. Please register in advance: SOCCA CTICU/ECMO Meetup Link.
This year, SOCCA is seeking committee volunteers for our communication, education, membership, and research committees—as well as the new clinical practice committee. To view committee descriptions and submit an application, visit https://socca.org/get-involved/.
You may submit an application for a SOCCA Committee between November 1, 2022 and December 31, 2022.
Learn more & review SOCCA’s Volunteer Selection Criteria.
This election cycle, SOCCA will be electing three members for the Board of Directors (3-year term). Further details about the governance structure of SOCCA are described in SOCCA’s Society Bylaws.
SOCCA members interested in serving in an elected positions on the SOCCA Board of Directors should submit a letter of interest, photograph, and curriculum vitae to Vivian Abalama, IOM, CAE ([email protected]) with subject line “2023 SOCCA Board of Directors Election.”
Review criteria by which Board of Directors and volunteer leaders are evaluated: Volunteer Selection Criteria.
You can apply via email only for a Board of Directors position between November 1, 2022 and December 5, 2022.
SOCCA Innovators Award: applications open 9/30/2022 – 12/31/2022.
Gender Equality in Critical Care
Major professional societies & organizations have the obligation to initiate & sustain strategies that support & enhance gender equality in critical care. WICC invites members of SOCCA to participate & discuss ways to advance these goals & values. Understanding & recognizing gender diversity challenges & carrying on the momentum gathered in recent years within SOCCA and outside it, will enable a positive environment for more women to enter & remain within ACCM.
SOCCA has a calendar/list of events. Visit it regularly & save essential dates.
The SOCCA Speakers Bureau has officially launched! As a SOCCA member, you may now:
Have you made any changes in 2022? It’s time to update your SOCCA demographic profile and / or renew your membership. Keep your SOCCA experience seamless & don’t miss out on any updates & member benefits. Visit: buff.ly/3sPMG6j
SOCCA would like to acknowledge the invaluable contributions of our female intensivists during this month and year-round. Throughout September, four of our members will be sharing their experiences as a woman in critical care.
Read: Burnout: No Easy Answers in a Post-Pandemic World, by Sarah Alber, MD
Read: Belonging to an Organization: Professional Advancement & Personal Gains, by Nazish Hashmi, MD
Read: Mentors and Mentees: A Powerful Connection, by May Hua, MD, MS
Read: Women in Critical Care: Where We Are & Where We Want to Be, by Shahla Siddiqui, MD, MSc, FCCM
Shahla Siddiqui, MD, MSc, FCCM, and Co-Chair of SOCCA’s Women in Critical Care recently edited a special issue of Journal of Critical Care featuring women as first and senior authors. Read Dr. Siddiqui’s introduction in Volume 71 | October 2022 issue.
The SOCCA Early Career Intensivists working group provides new members and members who are early in their careers with the resources needed to ease the transition from trainee to practicing intensivist. Learn more.
Have you read “SOCCA, the Pandemic, and the Future” by SOCCA’s Miguel Cobas, MD, FCCM, in this month’s ASA Monitor? Visit: https://socca.org/wp-content/uploads/2022/04/Cobas_SOCCA.pdf
As a SOCCA member, you are eligible to receive a discount on an IARS membership. IARS membership benefits include a subscription to Anesthesia & Analgesia, SOCCA’s official journal, A&A Practice e-journal, free journal CME, access to a member community and discounted registration to the IARS Annual Meeting. Click here to view a list of membership options.
Anesthesiology Critical Care Fellowship Programs
Have you visited SOCCA’s Anesthesiology Critical Care Fellowship Programs page? If you would like your organization’s program added to our site, let us know here: https://socca.org/new-socca-fellowship-listing/.