After a successful first iteration in 2018, we are pleased to announce the return of the Clinical Ultrasonography Elective in Clerkship.
This elective is open to 4th year students (2nd year of clerkship) and will run from Feb 4th – 17th, 2019.
Details to register can be found here: CUSEC Feb 4-17 2019
Check out the abstract below (presented at Medical Education Scholarship and Research Day)
The Clinical Ultrasonography Elective in Clerkship (CU/SEC): A Pilot for Senior Clerkship Students at the University of Saskatchewan
Zafrina Poonja, Ali Turnquist, Paul Olszynski
PURPOSE: The objective of the clinical ultrasonography elective was for senior clerkship students to acquire the skills and knowledge to safely integrate into patient care the following clinical ultrasound applications: pneumothorax, interstitial lung syndrome, pleural effusion/hemothorax, free fluid in the abdomen, pericardial effusion, abdominal aortic aneurysm, hydronephrosis, and bladder volume. The elective was deliberately designed to be relevant to a range of trainees including those pursuing residency training in internal medicine, general surgery, pediatrics, emergency medicine, neurology, family medicine and anesthesia.
METHODS: The trainees spent the first week of the elective scanning several standardized patients (12 hours in total) under the supervision of myself, another EM clinician, and a PGY4 EM resident who is completing a fellowship in POCUS. Each afternoon, the trainees participated in group discussion as well as lead a short presentation on the limits of POCUS in our core set of applications. The trainee’s skills and knowledge were evaluated at the end of the first week through a practical exam (scanning 4 patients across 3 scenarios) and MCQ exam. During the second week (clinical rotations in EM, IM, GSx and Neurology) trainees were evaluated by the clinical supervisors with in regards to clinical integration of POCUS into overall patient care. Programmatic evaluation was completed by all participants.
RESULTS: The trainee’s MCQ marks ranged from 80-95% (pass was set at 80%) and using an entrustment score on the practical exams, each was deemed “able to perform all of the scans with minimal or no prompting or supervision”. During the second week (a clinical rotation with the service of their choice/interest) the trainees were deemed to meet and/or exceed expectations as follows: 1) knowledge of the indications for clinical ultrasonography, 2) ability to reliably generate adequate images on a variety of patients, 3) demonstrate the ability to integrate clinical ultrasonography findings into the patients overall clinical assessment, 4) ability to describe the limitations of clinical ultrasound as well as impact on patient work up. The program was evaluated as very valuable with suggestions offered for improving the second (clinical) week of the elective.
As the role of clinical ultrasonography continues to grow throughout healthcare, the need for clear communication of bedside findings has never been greater. We know that communication plays a major role in high quality healthcare, and that miscommunication has been identified as a major contributor to medical error and patient complaints.
Last year at SASKSONO17 (Breaking the Sound Barrier), we discussed the need for clear communication amongst clinicians. Our panel of experts (Internist, Intensivist, Emergentologist and Hospitalist) offered great advice on how best to communicate clinical ultrasound (aka POCUS) findings with colleagues and consultants (you can check out the 8 minute video here: https://vimeo.com/215476593).
But clear communication with colleagues is only one piece of the puzzle. The other big piece is clear communication with the patient! And while this may seem self-evident, we suggest there’s more to it than simply applying basic clinician-patient communication skills. For example, I am sure you have heard a trainee or colleague say to their patient, after having completed a bedside scan, that everything looks OK. Seems harmless doesn’t it? But to the patient, there is now a very real potential for misinterpretation of both the purpose of the scan, and the findings! Here at Sasksonic we’ve heard it first hand. Patients have returned to their primary care providers with impressive stories of whole body scans where their liver, spleen and kidneys were evaluated by ultrasound and “Great news doc, everything was OK!”
By not clearly stating the indications for the scan, or not clearly explaining the findings, clinicians may give their patients the wrong impression that they have undergone a much more comprehensive evaluation than intended or necessary. This can lead to a lot of headache and frustration by downstream providers who now find themselves rummaging through the patient’s medical record looking for the “whole body scans” (assumed to be either consultative ultrasound or CT scans) when no such studies were performed. Furthermore, in the absence of a consultative report (or worse yet, no comments regarding to the point of care ultrasound in the visit note), it can also negatively impact the status of clinical ultrasonography in the eyes of our colleagues and patients. As an important and evidence-based part of the clinical assessment (now proposed to be the 5th pillar of the bedside assessment – inspection, palpation, percussion, auscultation and insonation), we need to ensure our colleagues and patients understand the role clinical ultrasonography plays in patient care.
Whenever possible, clearly communicate with patients about the indications, findings and limitations of the clinical ultrasound scan in question. When performing a FAST scan this means letting the patient know you are looking for free fluid in the abdomen or chest, which if seen, would suggest internal bleeding. If no free fluid is seen, instead of saying “everything looks OK” we suggest you say “I don’t see any free fluid on my scan, but this clinical application of ultrasound has limitations and sometimes we miss injuries. Keeping the clinical picture in mind, I think we should proceed with…”
And there’s more! Whenever possible, be sure to give the patient a clear understanding of what the scan will include including where the transducer will be placed. Be sure to warn them about the room temperature gel that often feels ice cold. Then, while scanning, try to talk them through the findings as much as possible (this gets easier as your image generation skills improve). For example, when scanning the gallbladder for suspected cholelithiasis, take time to show them their gallbladder, what the wall looks like and whether there are any stones. Remember, one of the advantages of clinical ultrasonography is that you are learning about your patient’s (patho)physiology in real time at their bedside. So let the patient know what’s going on in the moment, tell them in a way they will understand, and quell their curiosity while also empowering them!
For an example of good communication with a patient (and other aspects of ultrasound etiquette) , check out this short clip we’ve prepared at Sasksonic for our trainees.
Paul Olszynski and Qasim Hussain
Peer Review: Drs. Kish Lyster and Irene Ma
Congrats to “No Pain, No Gain”, our first place team at this year’s SASKSONO conference! Big thanks to all of our participants and to the crowd for cheering the teams on as they battled it out. Also big thanks to Dr. Quinten Paterson (PGY2 EM) and Ms. Alixe Dick (MS2 USASK) for their hard work in preparing the games this year and Drs. Kawchuk and Jelic for their sound judgment!
All in all, a very successful SASKSONO18 – We hope to see you next year at SASKSONO19!
Great news! We’re hosting an IP Core SKanapalouza for Rural and Regional Clinicians on March 10th!
This ultrasound scanning day is to facilitate clinicians seeking to obtain their Canadian Point of Care Ultrasound Society (CPoCUS) CORE Independent Practitioner certification. The intent is to provide clinicians working in rural areas an opportunity to obtain scans towards their certification that are otherwise difficult to achieve in such locations. There will be an opportunity to obtain up to 28 scans towards your certification. All standardized patients will be female to allow for maximum scanning applications. There will be a high instructor to participant ratio to ensuring a quality scanning opportunity.
For more details and to register, click on this link
The Sasksonic Team
Continue reading the full article here
Our annual conference is coming together and we’re now accepting abstracts for our lightning oral abstract presentations. Each abstract submitted will be reviewed and scored by our team of reviewers. The top 5 abstracts will be awarded 8 minutes for presentation just prior to the SONOGAMES. Submission deadline is Feb 5th – details below!
As we wrap up another great year at Sasksonic, we are thrilled to learn that one of our own recently took home POCUS-Toronto’s “Case of the Year” award!
USask EM’s Dr. Puneet Kapur (PGY5 EM, @Kapurp) was recognized for his stellar case submission involving identification and test performance of several transthoracic echo findings as they relate to identifying acute pulmonary embolism. Many of you have heard of the value of each of the following findings as they relate to distinguishing acute from chronic RV strain:
Here are clips from the actual case that show RV dilation in the PSL and McConell’s sign in the A4C. Despite these – it may remain challenging to reliably determine acute vs chronic strain (see details in the cited article below).
Well, don’t give up hope – introducing RVOT systolic excursion! This measurement is obtained using the parasternal short axis view at the level of the aortic valve.
It appears that measuring RVOT systolic excursion (as a percentage of end-diastolic RVOT diameter minus end-systolic RVOT diameter divided by end-diastolic RVOT diameter) is both specific and highly sensitive for acute PE. Analysis of right ventricular outflow tract systolic excursion showed that a value <24.3% can be found in acute pulmonary embolism patients with 100% sensitivity and 95.56% specificity (AUC = 0.987, P < 0.0001).
Sounds promising – looking forward to hearing and learning more about this.
We’re proud of Puneet! And while we’re at it – big thanks to the team at POCUS-Toronto for giving trainees like Dr. Kapur an opportunity to learn and excel in emergency POCUS.
Want to learn more about RVOT systolic excursion and acute RV strain? Check out the article below:
- Lõpez-Candales A, Edelman K. Right ventricular outflow tract systolic excursion: A distinguishing echocardiographic finding in acute pulmonary embolism. Echocardiography. 2013;30(6):649-657. doi:10.1111/echo.12120.