Resident Education in Ultrasound Using Simulation and Social Media AIUM14

There was a session at the American Institute of Ultrasound in Medicine 2014 Annual Meeting focusing on education in Point of Care Ultrasound.  There were several speakers and I was asked to speak on resident education, particularly to focus on simulation and social media and how it fits with EM Resident ultrasound education.  This is a fairly large and broad area to cover in 15 minutes or less.

I chose to focus on how to simulation and social media can assist in education and deliberate practice to get learners to an “expert performance” level.  The information may not be new to people who are familiar with simulation or social media. My goal was to show how these things can be helpful from a conceptual and design view for education.  Also to provide information that you can use if you have to justify to others why social media or simulation is important to your educational program and why it should be supported.

This is a recording of the presentation, sorry the audio is not as clear but did not have the external microphone for the recording.


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Twitter Feed from #ACEP13 Scientific Assembly

Another Emergency Medicine conference has come and gone.  Twitter was extremely active during the ACEP 2013 Scientific Assembly in Seattle.  There were meet ups organized all over the place, including the exhibitor floor booths.  I pulled the tweets with #ACEP13 and compiled them to the attached pdf document so you can search the tweets.  Be warned it is a large file 1,576 pages and 5 Mb.

A graph of twitter activity via Symplur’s healthcare hashtag project.  You can see the activity is during the conference but also the peaks are during the educational sessions.  This leads us to the thought that the tweets are about the sessions and conference more so then the social aspects of the gathering.  If you were following the hashtag you know this is true, at least in an unscientifically rigorous sampling anyway.

Some highlights include (estimates from aggregators and word counts not by hand):

  • In 12 pt font 1,576 pages
  • 10,842 tweets with the hashtag #ACEP13
  • 4,928 Original tweets (estimated)
  • 3,692 mentions
  • @srrezaie leading with 656 mentions followed by @gruntdoc with 523 mentions
  • @mastinmd (485 tweets), @kasiahamptonmd (454 tweets) and @gruntdoc (@444 tweets)

#ACEP13 Twitter Archive

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Clearing the SonoSite M-Turbo Memory

It is that time of year again with new residents and fellows for ultrasound programs.  Many Emergency Medicine programs are now using digital arching solutions for their ultrasound studies.  Also becoming popular are the use of middleware and/or PACS systems for quality assurance and education/feedback.

One problem that occurs if you are using a SonoSite system is that the studies are saved to the hard drive or internal memory before transmission to the middleware system, such as Q-Path.  Eventually the internal memory of the ultrasound unit will fill up.  When the memory is full the boot time can be longer and performance may suffer.  Most importantly you will NOT be able to save further studies to the hard drive in order to transmit to the arching solution you use.

Someone has to clear the memory periodically.  Unfortunately if you have several sites this could become a problem with schedules and new people in the program.  This short video is a walk through of how to clear the memory on the M-Turbo system from SonoSite, it also works for the Edge system.  Feel free to distribute the link to you people in your program or if you get that late night call asking how to clear the memory.

To make things easier to distribute you can also use this shortened link that will take you directly to the YouTube video: and is easier to remember.  Or you can use this QR Code:



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Ultrasound and the Emergency Medicine Milestones

If you are involved in Emergency Medicine education in the United States you have heard about the new evaluation process for residents known as the Milestones project. As a quick summary the ACGME and the RRC for EM has developed several key areas residents should be evaluated in during their residency education with milestones they should reach before graduation. Now there are discussions back and forth over the utility of the milestones, how they correlate or don’t correlate with competency, why these particular items and milestones were picked and many other topics. In the end the Milestones are here and being implemented.

One of the Milestones is PC-12 which involves Emergency Ultrasound. Not every residency program has a ultrasound fellowship trained faculty (not that every program needs one). So there was a lot of discussion on how to meet this milestone.  A joint taskforce was convened with the Academy of Emergency Ultrasound (AEUS), an Academy of the Society for Academic Emergency Medicine and the Council of Residency Directors in Emergency Medicine (CORD). There were also representatives from ACEP and EMRA.

In the July 2013 issue of Academic Emergency Medicine the consensus document was published to serve as a resource to programs. It is available at the journal website.

Lewis RE, Pearl M, Nomura JT, Baty G, Bengiamin R, Duprey K, Stone M, Theodoro D, Akhtar S, CORD-AEUS: Consensus Document for the Emergency Ultrasound Milestone Project. Acad Emerg Med:20;740-745.

The document discusses how the Milestone project relates to Emergency Ultrasound and brings some important topics and information. There are several data supplements that go along with the document which is what I wanted to mention and serve as resources.

One key area is the differentiation between what is basic and what is advanced emergency ultrasound applications. This list was developed through a modified Delphi method that also allowed input from educators and ultrasound practitioner from the involved groups (ACEP, SAEM, CORD). Now the differentiation was a consensus, so you may not agree with everything. The table of core vs advanced topics can be downloaded. Also to be clear this was to help define the educational base for an EM residency graduate; not to define Emergency Ultrasound as a whole.

The other supplement is the list of assessment methods and how they integrate in to the milestone. Programs currently have assessment  methods in place and there is no single way to meet each milestone or evaluate competency. This assessment table lists different methods, what they assess, limitations, and which milestones they can evaluate.

Residents will perform many ultrasounds during their residency, at least 150 per the milestones, and the assessment of progress through the milestones could be done differently. One method is to evaluate ultrasound performed by the resident individually for education, feedback, and performance improvement. This could be done using the CORD US-SDOT forms.

Then the resident’s progress in the US milestone could be evaluated over time by examining their ultrasound performance in aggregate. This was the approach for the evaluation document by the Joint Milestone Task Force (they have a wiki) from CORD.  The form that was created is available on the wiki and I have adapted it as a New Innovations questionnaire or evaluation form.  The JMTF form allows you to add ultrasound studies to evaluate in addition to the FAST exam, in the example these are multi-view echo and abdominal aorta, but you can customize this to fit your program.


  1. Core vs Advanced Emergency Ultrasound for Residents
  2. Assessment methods with skills tested, limitations, and associated milestones
  3. CORD US-SDOT Forms
  4. New Innovations version of the JMTF US milestone evaluation form

As a disclaimer I was an author on the consensus document and served on the CORD-AEUS Task Force and the CORD JMTF.

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Central Line Kit Walk Through and Line Placement

This video is a walk through of placing an ultrasound guided internal jugular central line in  a sterile fashion.  The technique and individual steps will depend on the brand of kit and how it has been customized for your institution.

This video was originally created as a review for the residents at my institution.  It focuses on the process of placing the line and less so on the ultrasound guidance.

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#SAEM2013 on Twitter

The Society for Academic Emergency Medicine just held it’s 2013 Annual Meeting during mid May.  Before the conference the hashtag #SAEM13 was advertised online by SAEM and in distribution materials.

Here is a collection of some of the Symplur graphical interpretations of the hashtag usage at the conference.  All of the tweets that were pulled by a #SAEM13 search during the conference are listed, the last pull being on May 18th, after the conference was finished.

It was a great conference that provided opportunities for some meet ups in real life with various tweeples in EM.  It also got some new people engaged onto Twitter.

There are 1.767 tweets in the list (including retweets).  Enjoy the pearls chosen by our colleagues for sharing via twitter.

#SAEM13 Twitter Feed

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AIUM 2013 Annual Meeting on Twitter

The American Institute of Ultrasound in Medicine had their 2013 Annual Meeting in New York.  Several sessions were live tweeted by myself and others.  It was an interesting meeting for several reasons.  I was able to sit in on the Bioeffects committee meeting and participate in several interesting discussions.

A pre-convention session on education in ultrasound during medical schools was created and used to discuss the topic, @SonoMedEd.  This was coordinated in part by @EDUltrasound. Also during the meeting I had the chance to meet @MarcoAlvarez in real life.

There was a hands on workshop on Ultrasound Guided Vascular Access co-sponsored by the Emergency Medicine-Critical Care and Interventional Radiology Communities of Practice (AIUM’s version of interest groups/sections).  The short voiced over lecture will be voiced over and posted later.

Here is a transcript of the Twitter feed for #AIUM13 with some informational graphics from Symplur.



Here is a transcript of the

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Practical Tips on Emergent Transcutaneous and Transvenous Pacing

Was one of the faculty for a simulation day with some lecture stations.  The station I had was a short lecture on the setting up of emergent transcutaneous and transvenous pacing followed by some hands on.  Figured I would record the lecture and post it up for whoever was interested.  I did have to put in some echo guided pacemaker insertion clips since I was giving the presentation.

A side note some of the discussion points may not be applicable depending on what kind of equipment your facility regularly stocks.


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Ultrasound First

I recently had the chance to attend the American Institute of Ultrasound in Medicine’s Ultrasound First Forum.  This was held on November 12, 2012 in New York.  In full disclosure I did attend as a representative of the AIUM as an invitee.

Members from different societies and groups attended this forum to discuss medical ultrasound and how it can be promoted as a first line diagnostic therapy when appropriate. The thought of ultrasound first is to use a dynamic imaging modality that has no ionizing radiation and can provide the diagnostic information in many cases.

The discussion focuses on using ultrasound rather CT scans or MRI in cases where appropriate.  Examples were given of female pelvis pain where ultrasound was more diagnostically appropriate and informative then CT scanning.  Musculoskeletal complaints that could be evaluated dynamically, more thoroughly, and with better resolution with ultrasound compared to the static MRI were also given.  These discussions all had merits and we heard from medical organizations, patient advocacy groups, and practitioners about why ultrasound should be considered before some other imaging modalities.

I agree that we should consider ultrasound before other imaging modalities such as CT and MRI when appropriate and available.  That is the key point that has to be kept in mind.  When ultrasound is an appropriate test it should be considered first.  It does not mean it always has to be the first test, but considered and if appropriate be the first test.

It also depends if you have the equipment and personnel to perform and interpret ultrasound in some of these situations.  We are leaders in our areas of medical expertise; but there is a variability in ability and resources across the country and the world.  Not every hospital in every corner of the world can provide ultrasound in all its myriad forms and applications.  In some areas ultrasound may not be the best first choice due to limitations in equipment, skill, personnel or other factors.

While I am an ultrasound evangelist and firmly believe in the technology and its role in patient care I also do recognize that there can be limitations in making ultrasound first even when appropriate, at least for today.

Here are links to the Ultrasound First site with the Sound Judgement series from JUM and AIUM.

Here is the collection of the tweets using the #US1st hashtag during the forum.

PS: As a side note ultrasound guidance for vascular access was also discussed at the forum. The AIUM Practice Guideline on US guidance for vascular access is forthcoming, I was able to see a draft at the forum.  If you have ultrasound and are performing an non-crash IJ there is no reason to not use ultrasound.

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Ultrasound Article Review Nov 2012

A recent article was published in the Journal of Ultrasound in Medicine regarding non-pathologic abdominal free fluid in males.  If you read only the abstract and don’t delve into the study the wrong conclusions can be drawn.

Short video reviewing the key points of the article and some example images to highlight key points.

Trying a little something different with the video posted on YouTube to see if this makes it easier for people to view the videos.  Let me know what you think in the comments.

The article is online at the Journal of Ultrasound in Medicine at

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