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FiNorman

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About FiNorman

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  1. My comment wasn't made to insult you or sonographers. I have a great deal of admiration of their skills and abilities, and I certainly have learned a great deal from them over the years. I also support ARDMS and SDMS regulating sonographers in any way they see fit, as this is their profession. With that being said, PAs have the ability to work with our collaborating physician organizations to create the standards which we see fit, and having a profession outside of our profession dictate how we should train our own profession, educate our selves and attain competency is not how we determine the future of our profession. ARDMS is well aware of how ACEP and other organizations view their attempt at professional misappropriation, and it is an official policy. In fact ACEP has called this policy "ludicrous." APCA/RDMS policy ACEP policy on Merit badge certification The ARDMS position is as inappropriate as nursing stating that PAs can't decide what standards are needed to place an IV in a patient, and if they would like to do so they should take a course created by nurses, so they can get a certificate created by nurses, and in the future nurses will decide what education requirements are needed to attain this certification.... and all the proceeds from this endeavor will go to a nursing association. If nurses want to decide how nurses put in IVs, then I support their societal aspirations, as long as it doesn't harm my patients or interfere our ability to care for patients. My position isn't intended to offend you or sonographers, so I do apologize if that was the case.
  2. "Is there any device analogous to the Butterfly system for Android phones?" Yes, The Philips Lumify Series runs from certain (not all android devices). The Lumify has the best image quality of all the hand held devices, and approximates the images produced by quality cart system. The Lumify system is inside each of the probes, and since the probes derive their power from the android device they will not work with the iPhone systems (iPhone only has the lightning and speaker ports which do not have enough electricity to power the Lumify probe. The advantage is you only have to charge one device (the tablet/phone). The disadvantage is you will need a different probe for different applications (high frequency probe for superficial scanning, low frequency for deeper structures). Each probe costs about $8k, or your could lease each for about $200/month. My understanding is Butterfly will eventually have an android version, but I don't have a time line or verification.
  3. In reference to RDMS and other certifications..... I support what every journey a clinical takes to attaining their goal. However I would remind clinicians that certification is not needed for the performance or billing of bedside ultrasound studies, nor is it needed for the credentialing, or privileging. In fact, ACEP, SEMPA, SPOCUS, and many other provider centric societies oppose "merit badge testing by external entities". This policy specifically refers to ultrasound, but also includes opposition to courses like ACLS and PALS. The reasoning is that requesting permission from outside entities to treat our patients surrenders our profession's right to self determination. ARDMS and Intelios run a business. We learn, master and perform many tests which have higher stakes than ultrasound, without taking a certification exam... EKG comes to mind. SPOCUS has published ultrasound competency guidelines, which mirror the ACEP competency based guidelines. The guidelines suggest a short CME ultrasound course, 25 scans in each application, and a total of a minimum of 150 ultrasounds to apply for credentialing.
  4. Hello colleagues, I would like to start by stating I have no financial relationships with any of the parties involved. The only income I receive is from my hourly wage I earn. My name is Frank Norman and I am the Co-Founder of The Society of Point of Care Ultrasound. SPOCUS is a non profit, multidisciplinary medical society which is focused on integrating bedside ultrasound into practice and education. To my knowledge it is the first and only PA led society which is creating national standards of care, training and education for all of medicine. SPOCUS has recently partnered with ultrasound manufacturer Butterfly Network. The Butterfly Network has created a hand held, single probe ultrasound which plugs into an iPhone. However, instead of costing $20k for an ultrasound machine, The Butterfly is priced at $2k, unfortunately there is a waiting list to purchase the device. SPOCUS and Butterly are collaborating on a very unique opportunity. SPOCUS will offer very affordable ultrasound training workshops for PAs (flipping the classroom with pre-course video lectures and e-books, as well as live ultrasound training) , and Butterfly will offer the opportunity purchase one of their machines, skipping the wait list, to be delivered before the live conference, so the attendees can practice what they have learned through the videos. In addition, the attendees will also be able to save their practice images to the Butterfly Cloud, and used as a learning opportunity during the live workshop. The first of these opportunities will be at the AAPA 2019 in Denver, Co, on May 20th. SPOCUS will also mentor attendees on credentialing, billing, and medical-legal issues and PA Program curriculum integration, regardless the medical specialty (PA students, IM, FP, Peds, ortho, surgery and the subspecialties) I hope to see you all there, Thanks, Frank
  5. Hello friends, My name is Frank Norman, I am a fellow PA and heavily involved with integrating ultrasound into primary medical curriculum and Co-Founder of The Society of Point of Care Ultrasound. I would like to invite any PA students that are interested in this topic to attend the Yes, iScan Competition and Workshop at AAPA on May 20th. Yes, I Scan- Ultrasound Student Workshop and Competition - AAPA 2019.webloc. Pre-PA students can take part in the workshop by volunteering as ultrasound models, and it's an awesome way of gaining insight into the profession and meeting many of the faculty members you will encounter on your journey through the application process. To help teams prepare for the competition, SPOCUS will provide student teams with pre-competition study guides, video education and ebooks, as well as work to find a local mentor. Last year was the first year of the competition. AAPA agreed to allow 6 teams of 3 to 4 PA students per team to compete, but because of the overwhelming response we expanded the field to 15 teams. Between the competition and the workshops, one third of all PA programs had an opportunity to participate. This year the SPOCUS and AAPA partnership is expanding. There will be 36 teams competing, and we will be training 250 PAs and PA educators on POCUS at the surrounding workshops. The workshops are very affordable at $75 a piece. Even more exciting, is our partnership with the ultrasound manufacturer Butterfly Network. Butterfly has created a hand held, single probe ultrasound which plugs into an iPhone. However, instead of costing $20k for an ultrasound machine, The Butterfly is priced at $2k. Unfortunately there is a waiting list to purchase the device.However, our partnership with Butterfly Network has created a very unique opportunity. SPOCUS will offer very affordable ultrasound training workshops for PAs (flipping the classroom with pre-course video lectures and e-books, as well as live ultrasound training) , and Butterfly will offer the opportunity purchase one of their machines, skipping the wait list. The ultrasound devices will be delivered before the live conference, so the attendees can practice what they have learned through the videos. In addition, the attendees will also be able to save their practice images to the Butterfly Cloud, and used as a learning opportunity during the live workshop. SPOCUS will also mentor attendees on credentialing, billing, and medical-legal issues and PA Program curriculum integration, regardless the medical specialty (PA students, IM, FP, Peds, ortho, surgery and the subspecialties) Thanks we look Yes, I Scan- Ultrasound Student Workshop and Competition - AAPA 2019.webloc
  6. The list is building, but we are still looking for volunteers. Our response from schools has been overwhelming. Within 2 weeks we had 15 teams sign up for 12 slots (we expanded to 15 teams to accommodate.). Lots of schools will be present and we are expecting lots of faculty members.
  7. Good afternoon, my name is Frank Norman, I am a PA and president of the Society of Point of Care Ultrasound (SPOCUS.org). On 5/21/18 at AAPAs National Convention in New Orleans SPOCUS will be teaming up with AAPA to create the first ever Yes, iScan Ultrasound competition. This is going to be a yearly event where student teams from PA programs from across the country will compete for the champions cup, by performing more than 15 applications and 120 tasks like measuring the aorta, finding individual nerves, identifying cardiac valves, putting in IVs and much more. We are looking pre-pa students to act as ultrasound models, in several blocks from 8-4 with an lunch break. There will be plenty of opportunity to network with program directors, faculty, deans and PA leadership. If you have questions you can reach out to Kerb@aapa.com or sign up at Model sign up. I will also be following this post to get feedback.
  8. The Society of Point of Care Ultrasound (SPOCUS.org) has gotten a multitude of requests to host POCUS workshops, in a variety of clinical applications. We are establishing a cadre/speakers bank and are actively looking for clinicians who are POCUS competent, and wish to teach at local/national conferences. Are there any members on here interested?
  9. I should have added... if anyone practices in another specialty and is having trouble getting credentialing use the generalist https://spocus.org/Practice-Guidelines. I would also ask that you please reach out to me and let's communicate.... the AAPA is looking for examples of PAs encountering barriers to practice and your situation can help out others.
  10. Great answer SN..... I apologize for the tardy reply, as I just noticed this post. My name is Frank, I am the President of SPACUS, which has now morphed into SPOCUS. http://SPOCUS.org. You should use the ACEP guidelines for credentialing. I would implore you to please reach out to me if you are refused credentialing because you are a PA. This is an issue we are diligently working on, and ACEP and AAPA are actively involved with. Privileging should be solely based on state law, documented experience, and demonstrated competence of clinical practice. Any other basis for refusing to grant privileges is contrary to JHACO standards. https://spocus.org/Credentialing-Statement If your group or the facility seems to be the ones not supporting your effort or that it is an issue of medical-legal liability I would politely point out that there have been ZERO studies, which ever demonstrated harm to patients from groups of professions performing POCUS. There are not even any case studies to demonstrate harm done. In fact, since there is no data on this subject, there are at least 3 studies which looked at the number of law suits filed in state and federal court related to POCUS. Over the 20 year period, these authors found 8 law suits.....in each of these cases the breach of duty was alleged to be "a failure to perform the bedside sonogram, thereby violating the standard of care." Therefore facilities and practices that think they are shielding themselves from liability by not having a program are sadly mistaken. Since 2007 the ACGME mandates procedural competency in EUS as it is a “skill integral to the practice of Emergency Medicine” as defined by the 2013 Model of the Clinical Practice of EM. If we practice by the principal that patients deserve the same standard of care, regardless of the provider seeing that patient. That means for the past 10 years every department in this country has had the time to incorporate this practice into a formalized program and POCUS is the STANDARD of care for every clinician practicing EM. Leadership will have a very long day in court explaining how they failed to incorporate this into the practice with a 10 year head start. As far as state law, I am not aware of any state law that prohibits PAs from performing ultrasound if delineated by their collaborating physician. Dirty secret... there are only 4 states that require licensure or certification for ultrasound techs to perform ultrasound studies. New Hampshire, New Mexico, North Dakota, and Oregon. None of these states require licensure or certification for physicians or PAs (however NM requires nurses, of which nurse midwives fall into the category... therefore NM in this state were forced to take a certification exam to perform ultrasound). These states allow physicians and PAs to perform POCUS, as they are exempted from the certification requirement as medical providers. SPOCUS would be happy to assist you with credentialing.
  11. Prima, If you were referring to USC, University of South Carolina Dr. Paul Bornemann, and Dr. Hoppmann have done an amazing job of integrating POCUS into the undergraduate medical education and into the residency program. As of today the American Academy of family practice is preparing standards by which every resident will have to learn ultrasound in order to complete the FM residency programs. Emergency medicine has already identified ultrasound as a skill integral to the practice of emergency medicine and has mandated training since 2007. I am pleased to hear that others are using ultrasound in their daily practice as well, and if you're interested in helping the cause please contact SPACUS.org and get involved.
  12. Are you faculty? What specialty are you in? You don't have to "almost anything". Join SPACUS and I will personally mentor you. All I ask in return is that you give back to the society and pay it forward by teaching someone else.
  13. Good news my friend, there are some misconceptions.... first, the greatest barrier is by far, the cost of the machine. And you are absolutely correct, is not an insurmountable barrier. The days of huge capital expenditures for machines is over. Let's do the math. $400 per student, in a class of 30 students is $12k. With academic pricing SPACUS.org can secure full Lumify machines for $3000/year. That's 4 machines per class, or 8 in a program of two classes. During the lab sessions, 8 machines- 4 students per station, accommodates all students. Now the Training-again not a problem. First SPACUS has a free Train the Trainer Program that is intended to teach faculty how to do the applications. We also offer a free Text book and may even come to the school to arrange live scanning sessions. We also offer help and mentorship with ongoing SUIS, student ultrasound interest sections to continue the learning. "No time in the curriculum" -The medical school model of ultrasound integration isn't just about learning the applications. It's also enhancing the learning that is going on in other classes. For example, part of the physical diagnosis time learning the heart and the cardiac cycle are spent on the ultrasound machine seeing where the valves are closing, what is causing what sound, where the blood is flowing, how that fits on the EKG, and how this affects and creates murmurs, hypertrophy, and cardiomyopathies. It's learning the same material but with another tool. Use that tactile fremitus, pectoriloquy, egophany much? yeah, me either... how about you taking the hour you took to learn Anatomy is portioned off so not all the time is spent in the cadaver lab, but some in "live and clinical anatomy" using ultrasound. Same material is covered, grades have improved
  14. I was hoping students or faculty could provide me with an idea of what items are typically required to start PA school, and if the PA school makes suggestions as to which to purchase. For example otoscope, ophthalmoscope, stethoscope, scrubs, jacket, computer lap top ect. As a follow up question, if you were a student starting school today and had the option of a $400 "buy in" for each student to have a shared ultrasound machine and the teaching to learn 12 applications while still in school, would you do it?
  15. Very well said Serenity, you are 100% correct. 25+ scans will not make you an expert, but it will give you enough experience to incorporate POCUS into your practice and answer very specific binary questions. The new ACEP guidelines are just waiting for the signature from the ACEP board. They are even more lenient in the initial training requirements and ACEP acknowledges some indications may take even less. I would argue that with just a few soft tissue scans most PAs can improve their practice and outcomes to differentiate abscess vs. cellulitis vs. necrotizing fasciitis. Peripheral IV placement only takes 10 proctored exams. The new scanners are basically the ultrasound probe which is leased- academic pricing put it at about $125/month per probe. The screen is a hand held tablet which can be purchased at any electronic store. If your practice requires you to put a needle into a particular place in a patient, or differentiate PNA vs. CHF vs. COPD vs. PE in a dysgenic patient, or wonder if your patient is dehydrated, or work through a pts abdominal pain or leg pain then I would urge anyone who isn't using POCUS to reach out to SPACUS to obtain some resources. They will be provided for free. If there is any faculty interested in learning the modules, please reach out to SPACUS. I will second Serenity's comment on certification. I am personally eligible for certification but will not pursue this pathway. I don't discourage anyone from pursuing their happiness, but certification is not required for POCUS. They are two different pathways.
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