SECTON REPORT EMERGENCY ULTRASOUND
Why an Ultrasound Fellowship Might Be Right for You Joshua Guttman, MD FAAEM FACEP FRCPC and Lekha A. Shah, MD
The COVID-19 pandemic in combination with the reduced demand for emergency medicine attendings and greater supply of EM residency graduates exacerbates the difficulty of obtaining a desirable position. Finding an emergency medicine position in your chosen location was once a virtual guarantee. But it has become increasingly difficult for some EM graduates to find a satisfactory position these days. Completing a fellowship gives you expertise beyond that of a general EM graduate. ED directors and chairs are more likely to hire a fellowship graduate and preferentially retain those graduates in the event of a layoff if your fellowship background provides value to the ED.
WHILE EDS MIGHT HAVE A “POCUS CHAMPION” FILL THAT ROLE, AN ED DIRECTOR MAY RATHER HIRE QUALIFIED FELLOWSHIPTRAINED EPS THAT HAVE COMPLETED FORMAL US TRAINING RATHER THAN A GENERAL EP WHO HAS TO FIGURE OUT THESE ANSWERS IN REAL-TIME.” ED ultrasound fellowships have enjoyed a steady increase in popularity over the past two decades. The first fellowship was founded in 1994; in 2020, there were 135 fellowship programs accepting 212 fellows. While there are many fantastic fellowship opportunities through emergency medicine, the breadth of an ultrasound fellowship makes it a great choice for those with a wide range of intended practice. The use of POCUS is generally popular among emergency physicians (EPs), especially among those trained in its use during residency. Most emergency physicians recognize the value of this tool for both diagnostic and procedural performance. The ability to quickly “look inside” a patient to answer a focused clinical question
expedites care without subjecting them to ionizing radiation or expensive comprehensive imaging. With POCUS, you no longer need to wonder whether a patient has a pericardial effusion based on EKG, physical exam and X-ray; you can simply know the answer in mere seconds. For this reason, virtually all EDs have POCUS machines in the clinical area. For EPs interested in an academic career with a focus on education, ultrasound fellowships provide significant opportunities to hone teaching skills. POCUS is popular with all levels of learners who are keenly receptive to ultrasound teaching. All POCUS fellowships provide the opportunity to improve bedside teaching skills and deliver formal didactics (e.g., lectures, workshops, curriculum development, etc.). All EM residencies have a mandatory POCUS rotation that necessitates teaching by POCUS experts. These experts are generally given protected time as faculty. For POCUS faculty looking to advance beyond resident education, an ultrasound fellowship graduate may easily transition to become a POCUS educational lead for a medical school and other clinical departments (e.g., critical care, hospitalist, primary care, etc.). Some graduates have chosen to transition to roles within residency leadership (e.g. program director). Even those who simply prefer to teach a variety of learners (from first year medical students to seasoned faculty) benefit from POCUS education. There will be a role for you at an academic program.
manufacturers, these companies provide grants and equipment for research purposes. As a fellowship-trained POCUS expert, you would be an instinctive choice for developers to assist with product development. While research experience in ultrasound fellowships varies, all fellowships require mentored scholarly work.
FOR EPS INTERESTED IN AN ACADEMIC CAREER WITH A FOCUS ON EDUCATION, ULTRASOUND FELLOWSHIPS PROVIDE SIGNIFICANT OPPORTUNITIES TO HONE TEACHING SKILLS.” For those interested in community emergency medicine or administration, there is ample opportunity to lead an ultrasound program. The goals for a community EM group is usually to credential the group for POCUS, improve patient safety, and provide ongoing quality assurance. Revenue generation from POCUS studies is a key driver for these EDs. Community EDs hire ultrasound fellowshiptrained EPs to fill this role, often giving paid administrative time for those tasks. Some community health systems additionally hire
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For EPs interested in an academic career in research, POCUS provides unlimited scope since novel POCUS applications are constantly emerging. Some widely used POCUS applications require a stronger body of evidence to validate their current usage. Aside from diagnostic accuracy, POCUS provides other benefits to ED flow – reduced length of stay, time to diagnosis and cost savings. As artificial intelligence (AI) becomes more common, private companies are looking to integrate AI with POCUS. They need POCUS researchers to provide feedback as they refine their products for the market. Along with ultrasound COMMON SENSE JANUARY/FEBRUARY 2021
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