Welcome to the Ultrasound/POCUS Curriculum!
Overview of POCUS
Basic point-of-care ultrasound (POCUS) skills are an important competency for the family physician (AAFP, 2017). With ultrasound now available as a hand-held unit, POCUS is considered to be one of the most important developments in the medical physical exam since the invention of the stethoscope. Additionally, ultrasound is a helpful, often critical, competency for physicians practicing in low resource settings. (Here’s a helpful overview of POCUS in family medicine.)
The residency Ultrasound/POCUS curriculum is an asynchronous, longitudinal "rotation" geared at helping our residents graduate with competency in a variety of ultrasound applications, including in outpatient, inpatient, obstetrics, and underserved and international global health settings.
Residents are advised to download (“join”) the POCUS Evernote Notebook for point-of-care reference throughout residency. The Notebook also includes a POCUS Procedures Checklist of recommended scans to complete by the end of residency.
For any questions, please contact the POCUS Curriculum faculty oversight. For inpatient POCUS questions, you can also contact Dr. Putnam (POCUS Inpatient Faculty Lead). To schedule “bonus” 1:1 training, see #5 below for Dr. Henkel’s contact info.
POCUS Curriculum Components
The Ultrasound/POCUS curriculum is built around the following core components:
R1 Orientation to POCUS during R1 pre-July Orientation (2 hours), with a focus on inpatient POCUS procedure applications
R1 1:1 Orientation to Outpatient POCUS during R1 FMC 2-week block early in the R1 year (1 hour)(Scheduled portion of Module 1).
R1 POCUS Workshop (Scheduled on two 2nd-Thursday PM slots) featuring interactive didactics mixed with live-model lab time, reviewing ultrasound basics/knobology and practicing common inpatient and outpatient family medicine applications (7 hours total)
Online learning modules (20 hours total) completed during designated rotations (BELOW)
POCUS 1:1 precepting: 2-4-hour sessions scheduled with residents during various rotation slots (Surgery, TCH ER, Ortho). Our goal is for each resident to have a minimum of 4 of these sessions in residency and to utilize TCH ER, IP, and/or FMC for the location of these sessions. Scheduled sessions include:
Surgery: 2-hour session in the FMC focused on abdominal POCUS applications.
Orthopedics: 2-hour sessions in the FMC based on simulated cases that integrate some MSK POCUS applications.
Emergency Medicine, Adult (TCH R3): 2-hour sessions in the TCH ER focused on ER POCUS applications (CLUE, DVT, Ocular)
Emergency Medicine, Peds (CCHMC): 3-hour session with Dr. Jamie Nong at CCHMC ER focused on pediatric EM POCUS applications (Pyloric stenosis, Intussusception, Hip joint synovitis, and Pneumonia)
Bonus! If you would like more 1:1 teaching, Dr. David Henkel in the TCH ER is willing to schedule volunteer 2-4 hour teaching sessions with residents for ER/hospital scans as schedules allow; please contact Dr Henkel directly to arrange (email/cell).
Inpatient POCUS precepting on B Team Wednesdays and on a case-by-case basis as the schedule allows, through the teaching of IP attendings and senior residents during rounds or admissions
Inpatient POCUS conference every 2 weeks to review key inpatient heart and lung applications (CLUE, etc)
Additional POCUS learning opportunities: Residents are encouraged to develop competency in the recommended procedures listed HERE and log them in the MedHub Procedures Log. It is anticipated that residents will get extra POCUS opportunities in the following rotations/curricular areas:
FMC Patient Care - Throughout residency, residents should utilize the FMC Ultrasound to enhance their physical exam in the FMC. Common applications are anticipated to include evaluation of cellulitis/abscess, evaluation of abdominal pain (RUQ and AAA scanning), post-void residual bladder volume calculation, obstetric evaluations (T1 pregnancy dating using CRL, T3 AFI in higher risk pregnancies), gynecologic evaluations (IUD placement confirmation), and guidance for musculoskeletal procedures/injections.
Maternity Care/OB - All residents are encouraged to utilize their maternity care experiences in the FMC, PNC, and on L&D to practice OB ultrasound applications with attending guidance as needed and available, including T1 IUP confirmation, fetal lie confirmation, T3 AFI measurement, and OB Limited Ultrasound scans (documenting 7 required elements for billing: indication, EGA, number of gestations in utero, fetal lie, AFI, placental location, and placental grade)
TCH ER/Urgent Care - During this 2-week senior rotation, residents are “on call” during their shifts in the TCH Emergency Room Ultrasound to provide POCUS scans for the TCH ER physicians when paged, including RUQ Ultrasounds, Cardiac and Lung (CLUE) for dyspnea, T1 US, and 2-zone DVT scanning.
ICU Rotation - Residents should perform or, at minimum, observe at least once, placement of a central line using ultrasound guidance.
Cardiology Rotation - Residents should observe one performed echocardiogram during their cardiology month and review the interpretation of one echocardiogram by a cardiologist.
Global Health Guatemala - Residents typically have opportunity to use POCUS during the Wuqu Kawoq Field Experiences throughout residency.
Finally, for those who want to deepen their POCUS skills and possibly move toward credentialing, a 2-week Ultrasound/POCUS elective (or mixed with Radiology elective) may be arranged. Please contact Dr. Rich before your elective if you are interested in building an Ultrasound/POCUS elective or a Radiology-plus-POCUS elective.
Independent Learning Modules
Please complete the following learning modules in your scheduled POCUS Learning Module times throughout residency. The total time to complete the modules should take 20 hours. Be sure to complete Module 1 before subsequent modules (Some modules will be completed out of order based on your rotation schedule, which is generally otherwise not a problem).
For each module, be sure to follow along in your TCH/UC Family Medicine POCUS/Ultrasound Evernote Notebook (See link above in Overview section or under Resources & References below); you may wish to add your own notes to your folder (or elsewhere) as you proceed through each module. Each module finishes with a Quiz and Feedback form that must be completed before the end of the designated rotation.
Click on each module below to open the learning module guide.
Module 1: Introduction to Ultrasound (Curriculum Location: R1 FMC Block (in 1st 3 months) / Total Time: 2h)
Module 2: Introduction to Obstetric Ultrasound (Curriculum Location: OB TCH#1 / Total Time: 2h) (NOTE: This module is accessed through Canvas as part of the OB curriculum. Please contact Dr. Lazaron if you have not yet received an email inviting you to access this module.)
Module 3: RUQ Abdominal Ultrasound (Curriculum Location: Surgery / Total Time: 2h)
Module 4: Bladder, Renal Ultrasound, & FAST Protocol (Curriculum Location: Surgery / Total Time: 2h)
Module 5: AAA Screening & IVC Ultrasound Ultrasound (Curriculum Location: Surgery / Total Time: 1.5h)
Module 6 Superficial Structures (Thyroid, SSTIs, SubQ Masses) Ultrasound (Curriculum Location: Surgery / Total Time: 2h)
Module 7: Cardiac Ultrasound (Curriculum Location: Cardiology / Total Time: 2h)
Module 8: Lung Ultrasound & CLUE Protocol (Curriculum Location: Cardiology / Total Time: 2h)
Module 9: Gynecologic Ultrasound (Curriculum Location: Gynecology / Total Time: 1h)
Module 10: MSK & MSK Procedural Ultrasound (Curriculum Location: Orthopedics & Sports Medicine R2 / Total Time: 2h)
Module 11: Hospital Procedural Ultrasound (Curriculum Location: FMC Procedure Clinic / Total Time: 1h)
Module 12: Emergency Medicine Ultrasound: FAST Protocol & DVT US (Curriculum Location: TCH Urgent Care/Emergency Medicine / Total Time: 1h)
Resources & References
TCH/UC Family Medicine POCUS/Ultrasound Evernote Folder (Click here)
TCH/UC Introduction to POCUS Evernote (Click here) - this file is included in the TCH/UC Evernote Folder
AAFP 2017 Recommended POCUS Competencies for Family Medicine (Click here)
SUSME (Society of Ultrasound in Medical Education) Learning Modules (Click here)
Introduction to Bedside Ultrasound Volumes 1 (Click here) and 2 (Click here) (FREE iBOOK)
Ultrasoundpaedia (Click here)
SonoAccess Sonosite Ultrasound App (Click here)
Sonoworld Case Portal (Click here)
AIUM (American Institute of Ultrasound in Medicine) (Click here) - for the POCUS passionate, requires annual membership (around $400/year)