Point of Care Ultrasound

[rev ronin]

Anyone messing around with POCUS besides me?  Is there interest in starting a discussion on this?  I don't think it fits well under any one topic, so I'm considering making a separate POCUS subforum under specialties.

[LT_Oneal_PAC]

I use POCUS a LOT. Would love to get a discussion going. It has so many topics I can never remember to list them all. 
 

bought my own Butterfly IQ. Disappointed in the cardiac views, but otherwise happy.

[UGoLong]

There is a lot of interest in teaching it in PA programs as well. Would like to hear more about what’s going on in practice and in programs.


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[karebear12892]

I second the idea of starting a subforum specifically for POCUS!

[LT_Oneal_PAC]

46 minutes ago, UGoLong said:

There is a lot of interest in teaching it in PA programs as well. Would like to hear more about what’s going on in practice and in programs.


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I taught a lab recently for graduating PA students at my alma mater. I asked for a week to teach around 80 students about POCUS for almost everything head to toe. I got a morning lab to teach E-FAST with 27 students an hour for 3 hours

[CookiePA]

I would really like to read what you all have to say about it. I am trying to get our program to teach new grad hires and students. I wonder if this will eventually become part of a physical exam in the near future “POCUS shows...”

 

[MediMike]

4 hours ago, LT_Oneal_PAC said:

I taught a lab recently for graduating PA students at my alma mater. I asked for a week to teach around 80 students about POCUS for almost everything head to toe. I got a morning lab to teach E-FAST with 27 students an hour for 3 hours

Right?!

It is incredibly difficult to squeeze in even required curriculum material given the time constraints.  I think when I go in to do an EM lecture on cardiac arrhythmias/arrest/resuscitation I get right around...3 hours.  At most.  6 hours to cover any basic arrhythmias/rhythm recognition/basic ECG.

It's hard man.  By the time you explain how the dang probe worked you were probably outta time.

Also, good to know about the Butterfly, was looking at buying one but my primary use is cardiac/thoracic imaging.

[UGoLong]

3 hours ago, MediMike said:

Right?!

It is incredibly difficult to squeeze in even required curriculum material given the time constraints.  I think when I go in to do an EM lecture on cardiac arrhythmias/arrest/resuscitation I get right around...3 hours.  At most.  6 hours to cover any basic arrhythmias/rhythm recognition/basic ECG.

It's hard man.  By the time you explain how the dang probe worked you were probably outta time.

Also, good to know about the Butterfly, was looking at buying one but my primary use is cardiac/thoracic imaging.

This is very true. There already is a lot of stuff to cover as it is in PA school. I've also heard that there are issues for PAs getting credentialed for ultrasound in practice settings but have not investigated at this point.

Some programs try to have a "ultrasound day" bringing in outside experts.

One program I know of has started ultrasound during anatomy, starts with lectures on the equipment, and then flips the classroom by having the students work through a checklist using each other as subjects. They repeat the checklist process about 6 months later.  This somewhat parallels what happens in physical diagnosis.

Rolling in abnormals is a challenge. We have a mannequin with RFID tags that a Sonosim system can detect and you can load in pathology. Haven't used it that way yet, but it's on my mind.

I'm interested in any ideas you may have (or have heard of).

[LT_Oneal_PAC]

4 hours ago, MediMike said:

Right?!

It is incredibly difficult to squeeze in even required curriculum material given the time constraints.  I think when I go in to do an EM lecture on cardiac arrhythmias/arrest/resuscitation I get right around...3 hours.  At most.  6 hours to cover any basic arrhythmias/rhythm recognition/basic ECG.

It's hard man.  By the time you explain how the dang probe worked you were probably outta time.

Also, good to know about the Butterfly, was looking at buying one but my primary use is cardiac/thoracic imaging.

 

1 hour ago, UGoLong said:

This is very true. There already is a lot of stuff to cover as it is in PA school. I've also heard that there are issues for PAs getting credentialed for ultrasound in practice settings but have not investigated at this point.

Some programs try to have a "ultrasound day" bringing in outside experts.

One program I know of has started ultrasound during anatomy, starts with lectures on the equipment, and then flips the classroom by having the students work through a checklist using each other as subjects. They repeat the checklist process about 6 months later.  This somewhat parallels what happens in physical diagnosis.

Rolling in abnormals is a challenge. We have a mannequin with RFID tags that a Sonosim system can detect and you can load in pathology. Haven't used it that way yet, but it's on my mind.

I'm interested in any ideas you may have (or have heard of).

it is very hard for them to squeeze anything in. I utilized the flip classroom model and sent them a PDF and video on basic knobology, that only a handful reviewed.

I think anatomy integration is good, but I think students would get the most out of it integrated into physical exam.

if I had a magic wand that suddenly made me a PD, I would try to make a deal with Buttefly or Lumify for a group discount, probably butterfly with a group account for easier image review, and make it a mandatory purchase included in tuition. Talk with Sonosite, which I know has a GME rate, for one of their models. Hire a part time or another faculty appointed to US director for teaching US lectures and image review. Integrate US onto existing physical exam and pathology lectures. Integrate into clinical medicine to help understand when to use, the sensitivity and specificity, when to also get a formal or second radiologic test to confirm findings. All applicable procedures now taught with US. Teach how to write Interpretation notes for billing. Legal lectures presenting the evidence no one has ever been sued for using POCUS. OSCEs would have an US component. Shoot for 300 scans in clinical with 10-25 minimums in each category. Give a certificate to help them with credentialing. I would advertise the push for US I’m the program to applicants and think it would attract quite a few.

just my dream

[rev ronin]

9 minutes ago, LT_Oneal_PAC said:

bought my own Butterfly IQ. Disappointed in the cardiac views, but otherwise happy.

Me too, but in Primary Care/Walk-in, I do a LOT more soft tissue and abd/pelvis/retroperitoneal.  Seems to work fine for AAA screenings, too. I am very careful to discuss and document the discussion of a negative predictive value of POCUS, but hey, if I can't see anything on abd px besides a ton of bowel gas and the exam is nonspecific, I've likely saved that patient a trip to the ER.  Doing a 12 week transabdominal OB U/S and finding an 8 week size with no cardiac activity sucks, though.

[greenmood]

I use it a lot as a hospitalist and I'm currently working towards my certification from SHM. For me, it's been most helpful for a quick glance at the IVC and lungs when I'm on the fence about additional diuresis. I've also saved patients a trip down to radiology for cellulitis to rule out abscess. I'm pretty careful in my documentation to never pin my medical decision making solely on POCUS. I'll probably be less anxious about that once I have the certification so that I can have something to say about my credentials if I'm ever pressed.

[kang1208]

https://www.pocus.org/for-physician-assistants/

What are your thoughts on getting clinical certification from POCUS academy? Any PAs who've done this? Seems like they do offer it to PAs but I have not heard anyone who has done it.  

[SEMPA]

If anyone is interested, SEMPA is offering an emergency ultrasound course Jan 27-28, 2020 in Jacksonville, Florida. There are only a couple spots left so sign up now!

https://www.sempa.org/education/ultrasound-jacksonville/

[rev ronin]

I did the three-day course from Practical Pocus, which is a PA-run business: https://www.practicalpocus.com/

I liked it, but I really didn't have anything else to compare it with.  My biggest challenge is that I only get to do 1-2 scans per week in my current work setting.

[lemurcatta]

Student perspective- my program did some POCUS teaching in first year (mostly e-fast) over several weeks with repeat sessions and verification of competency. But I think it should be integrated throughout the year with physical diagnosis/patient assessment class. There is a lot of enthusiasm for it among students and we want to learn. 

[dphy83]

Integrating it into the PA curriculum sounds interesting. Honestly, I wish we had dedicated radiological anatomy in PA school where you learn anatomy as traditionally taught, but then you also learn it by various radiological techniques (eg. XR, CT, US, MRI, etc) simultaneously in the classroom. Similarly, learning pathology in this manner would help. But PA school is already so condensed I imagine this would be difficult. Plus, POCUS really hasn't come into the mainstream until the last several years, so finding faculty might be hard short of finding some bored radiologist to teach the stuff. I just dont think it is something that could realistically become standardized across all 200 or so PA programs.

On a different note, has anyone attended the Castlefest conference? I'm considering it but am interested in feedback from those who have attended.

[PACali]

Great resource on POCUS 

Short 5 mins videos http://5minsono.com/

 

 

[Jackofallmasterofnone]

Another great resource: http://www.thepocusatlas.com/

[Aware]

23 hours ago, lemurcatta said:

Student perspective- my program did some POCUS teaching in first year (mostly e-fast) over several weeks with repeat sessions and verification of competency. But I think it should be integrated throughout the year with physical diagnosis/patient assessment class. There is a lot of enthusiasm for it among students and we want to learn. 

Start your own POCUS club/interest group if there is interest. All you really need is someone to teach and US machines. Both shouldn't be hard to obtain if your program is attached to a med school or major hospital network.

[bike mike]

One good resource:

Spocus.org

I was one of three PAs that were credentialed for POCUS at my last job. Officially I was allowed to perform US looking at gross LV function, gross RV function, and  evaluate for pericardial effusion. In reality the physicians asked us to assess for everything from evidence of TAVR thrombosis to evidence of an LV free wall rupture in the setting of a code. It's definitely a great skill set to have. 

 

[dfw6er]

On 12/26/2019 at 11:34 PM, SEMPA said:

If anyone is interested, SEMPA is offering an emergency ultrasound course Jan 27-28, 2020 in Jacksonville, Florida. There are only a couple spots left so sign up now!

https://www.sempa.org/education/ultrasound-jacksonville/

I can't recommend SEMPA's EM US course enough.  I took it a few years back then followed up with POCUS courses taught by the ER group I worked for (participants were >90% physicians)......the SEMPA course was vastly superior.  I submitted the training I'd performed to medical staff at my hospital and was then credentialed to perform and bill for my POCUS studies.  It made me a better provider and, IMHO, made PAs look like we belonged in the main ED and not just fast track.  POCUS also helped boost my billing numbers.....which always looks good.  

 

[rev ronin]

8 minutes ago, dfw6er said:

POCUS also helped boost my billing numbers.....which always looks good. 

After four months of use, I'm on track to recoup the cost, both hardware and CME, based on actual reimbursement, in under a year. Of course, as a part-time 1099, the probe and CME cost come off of my net profit, so there's some tax advantages there, but then revenue sharing for procedures is not direct either...

[dfw6er]

POCUS is sexy.  It's high tech.  It's something a lot of old school ER docs aren't comfortable with.  It's something most NPs I've run into don't know how to do.  The more PAs can adopt POCUS and become adept at it, the more it makes the PA profession stand out as skilled providers.  

I don't mean to derail this thread.....but PAs need to do everything they can to shine as providers as the NPs are backed by a very powerful nursing lobby that easily outspends the PA lobby.  POCUS is a great tool to show physicians and administrators alike that the PA profession is very well trained and competent and should never be considered inferior to NPs.

[Kaepora]

On 12/29/2019 at 12:47 PM, dfw6er said:

POCUS is sexy.  It's high tech.  It's something a lot of old school ER docs aren't comfortable with.  It's something most NPs I've run into don't know how to do.  The more PAs can adopt POCUS and become adept at it, the more it makes the PA profession stand out as skilled providers.  

I don't mean to derail this thread.....but PAs need to do everything they can to shine as providers as the NPs are backed by a very powerful nursing lobby that easily outspends the PA lobby.  POCUS is a great tool to show physicians and administrators alike that the PA profession is very well trained and competent and should never be considered inferior to NPs.

My acute care NP program included many hours covering POCUS, with didactic and hands on content with hired "models" to let us practice.  FAST scan, abdominal, lung / thorax, vascular access, the 4 main cardiac views, etc.  Definitely an exception, not the rule, but certainly not the only NP program doing this.  

[jsw59058]

Anyone take emergency ultrasound class from 3rd Rock. Very interested in POCUS but I missed Sempa's course this year. Didn't want to wait until this winter.