The Henry Ford Hospital Department of Emergency Medicine (HFH DEM) is a high acuity Level One Trauma Center located in Detroit Michigan, with an annual patient census of over 95,000. The department has a very active ultrasound program, and established the first Emergency Medicine Clinical Ultrasound Fellowship Program in the state of Michigan beginning in July of 2010. The 1-year fellowship program focuses on training prospective applicants to become experts and national leaders in Clinical Ultrasound in the areas of research, education, and administration.
Fellowship oversight is provided the Henry Ford Hospital Graduate Medical Education Committee (HFH GMEC), in accordance with the Accreditation Council for Graduate Medical Education (ACGME) institutional requirements. It also meets the American College of Emergency Physicians (ACEP) guidelines for ultrasound fellowship training. The department has a detailed fellowship curriculum document with specific goals and objectives focusing in all core areas of Clinical Ultrasound. Fellows are required to complete 1200 scans during the 1-year training period. Fellows have the unique opportunity of working closely with medical students at the Wayne State University School of Medicine (WSUSOM), where ultrasound education was first incorporated into the undergraduate curricula in 2006. The 4-year Longitudinal Undergraduate Ultrasound Curriculum developed at the medical school provides fellows with enormous opportunities to learn about curriculum design, course implementation, research and innovation in the exciting field of ultrasound in undergraduate medical education. Other unique aspects of the fellowship program include numerous research opportunities, a robust ultrasound QA program, and other educational opportunities in the ED and other departments in the hospital. A detailed description of the fellowship program can be found on the eusfellowships.com website.
Resident ultrasound education
Resident ultrasound training is based on the ACEP imaging compendium and recently published ultrasound milestones. A detailed ultrasound curriculum has also been written with specific goals and objectives for both categorical and combined EM/IM/Critical Care programs. Residents are required to archive 350 scans before graduation, using our wireless image archiving system (Q-path). Resident ultrasound training meets all the basic requirements as recommended by the Residency Review Committee (RRC), and the ACGME. By the completion of the program, residents will be able to integrate the latest Point of Care Ultrasound (POCUS) techniques into their daily practice. Outlined below is a brief description of the resident ultrasound program.
The emphasis during the first year is on building a strong foundation for residents to develop the necessary competencies in all aspects of POCUS. Residents are taught to become very familiar with the ultrasound user interface, demonstrate understanding of basic ultrasound physics, selection of the appropriate exam-type for any application, proper transducer handling and orientation, while adhering to the ALARA principle of diagnostic imaging. First-year residents participate in two separate ultrasound sessions during their orientation month in July. The first session is a 2-day POCUS course including didactics and hands-on practice sessions using live models and phantoms. The goal of the first session is to introduce residents to all aspects of POC ultrasound, and serves as a strong foundation for the development psychomotor skills, while emphasizing the cognitive and behavioral aspects of ultrasound education. Residents are introduced to Ultrasound-Guided Central Venous Access training with B-Line simulation testing to begin their credentialing process in this procedure. A detailed on-line course (Pokes & Prods) has to be completed by all learners with pre and post-tests prior to participating in the central line certification course. All courses are taught at the HFH Simulation Center, a $5M state of the art educational facility and the largest in South Eastern Michigan.
First-year residents also have specific ultrasound objectives developed for outside rotations including anesthesia, obstetrics, and trauma, providing them with unique ultrasound learning opportunities, web-based learning, literature review, and hands-on scanning opportunities. They also scan while rotating in the ED, and participate as teaching assistants during the numerous WSUSOM ultrasound training sessions.
The second year is dedicated to a systems based approach to ultrasound training. Residents participate in Ultrasound Simulation sessions scheduled during grand rounds throughout the year, focusing on musculoskeletal, echocardiography/hemodynamics, abdominal/trauma, procedural, and obstetrics. They also participate in ultrasound didactic lectures and literature review, presented by core faculty focusing on all aspects of POCUS. Residents also participate in small group sessions to further improve their ultrasound acquisition and interpretation skills. With the help of core faculty and ultrasound fellow(s), junior residents develop skills to integrate POCUS during patient evaluation in the ED, which allows them to compare their findings to comprehensive studies obtained by sonographers in the ED through the radiology department. Residents document their ultrasound studies using their unique Q-path IDs, and submit them for QA. The ultrasound director, core ultrasound faculty, and the ultrasound fellow are readily available to assist residents in the ED with scanning, and providing immediate feedback. The goal of the second year is to continue the process of archiving 350 scans before graduation. With the current emphasis on improving the quality of care provided to our patients, the use of ultrasound is also encouraged for procedural applications including, paracentesis, thoracentesis, central venous access (internal jugular vein), arthrocentesis, and nerve blocks. Residents are to demonstrate competencies in all core areas of POCUS, including obstetrics, cardiac, trauma, aorta, gallbladder, procedural, renal, deep venous thrombosis and musculoskeletal applications. The juniors also have the opportunity to participate during the WSUSOM training sessions, and serve as instructors to medical students during small group training sessions.
Third year residents are to complete the required # of 350 ultrasound scans for Level 1 credentialing, well exceeding the minimum requirements in the ACEP guidelines for resident training. Residents may also complete a 4-week ultrasound elective during their senior year which gives them an opportunity to participate in ongoing research projects, to complete the required number of scans, and to learn about advanced applications of ultrasound including echocardiography and hemodynamic assessment of critically ill patients. Senior residents also enhance their ultrasound skills by directly supervising medical students who are assigned to work with them during scheduled ED shifts, and also participate as instructors during the WSUSOM training sessions.
Medical student training
The Henry Ford Hospital has a unique affiliation with the WSUSOM to train medical students in the use of bedside ultrasound. This partnership was made possible through a $5M grant to the medical school in 2006 with the goal of incorporating ultrasound education into the medical school curriculum at the largest single campus medical school in the nation. A longitudinal curriculum has been developed for medical student training across all 4 years of their medical education. This has been a very successful program which has given senior staff physicians and residents excellent teaching opportunities.
Henry Ford Ultrasound University:
The HFH Ultrasound University was established in 2009, with the goal of promoting the widespread use of ultrasound by acute care practitioners in various clinical settings, and to serve as a resource of excellence in patient care and safety standards. A number formal ultrasound courses with CME credits are offered throughout the year, including special courses designed to train residents in specialties including Urology, General Surgery, Internal Medicine, and Critical Care departments. More information may be accessed via the website www.henryford.com/ultrasounduniversity/
EM residents and fellows have opportunities to participate in these courses as learners and instructors.
The DEM currently has eight ultrasound systems, including FOUR SonoSite Xporte systems, ONE GE Vivid Q, and three Sonosite SII systems. All systems are equipped with multiple transducers for all the various EM ultrasound applications. We also have multiple Butterfly IQ probes, which are available to fellow and residents. All of the systems have been set up for access to the worklist and wireless image archiving to Q-pathE; which allows for easy storage of images, provides statistical analysis, helps provide immediate feedback of active images off- site via e-mail, and helps facilitate our image process improvement sessions.
The EM ultrasound educational program at Henry Ford Hospital as described above has been carefully developed to fulfill all the requirements to graduate emergency medicine residents with the necessary skills and competencies to use ultrasound as a diagnostic tool in all the core areas of POCUS. The establishment of the ultrasound fellowship program has further strengthened the resident education program.