Ultrasound Training Rant

For the emergency medicine and critical care physician competency in ultrasound is becoming essential.

The people I truly look up to in my specialties all recognise that bedside ultrasonography is an integral part of patient assessment.

However, the hows and whos of learning and teaching bedside ultrasonography remain a murky quagmire.

This is how I think it should be.

Every training scheme should have specialists skilled in the day-to-day use of bedside ultrasound who are equally adept in teaching these skills to others. Trainees should be expected, and should in turn demand, that they use ultrasound in their day-to-day practice and by the end of their training be proficient in diagnosing AAAs, performing eFAST scans, performing ultrasound-assisted procedures and using it to differentiate undifferentiated shock patients. Sonography skills will be meaningfully tested in Fellowship exams.

Trainees should not have to dip into their own pockets to attend expensive courses. They should not have to obtain superfluous additional certificates and qualifications. They should not have to complete meaningless logbooks (unless such logbooks are used effectively for reflection and meaningful discussion with a mentor).

In the future you won’t be an emergency medicine or critical care doctor unless you can inspect, palpate, percuss, auscultate, ultrasound and cogitate. Taking histories is integrated into our training. Examining patients is integrated into our training. Mastering ECG interpretation is integrated into our training. So must bedside sonography, and in the same way.

The real challenge is perhaps in teaching the teachers…

Perhaps FOAM can help to some extent: Ultrasound in EM.

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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