Emergency Medicine Point of Care Ultrasound (POCUS) Curriculum
Emergency Medicine Ultrasound Training in Wessex @WessexEMUS
This document aims to describe the 2021 RCEM Curriculum with respect to POCUS including expectations of Wessex trainees at each stage of their progression through specialty training. The RCEM Ultrasound site can be accessed here: https://rcem.ac.uk/ultrasound/ , with links to both the curriculum and the Entrustment scale description document covering each POCUS modality.
RCEM Suggested milestones for POCUS progression:
This is put in to practice with the steps below:
Progression:
Core Training Principles of US Physics Principles of image interpretation Image acquisition and optimisation Begin clinical integration of images/findings 1. Complete Modular Online training. RCEM +/- Sonosim 2. Complete practical teaching session / course 3. Bedside POCUS learning 4. Commence a log-book (anonymised). Aim for >50% supervised (can be indirect/retrospective) 5. DOPS of central- and peripheral vascular Access and US-guided FIB
Intermediate Training Introduction of Diagnostic Modalities (including intro to Basic Echo/ELS) 1. Modular online training (related to image interpretation) 2. Practical teaching sessions 3. Bedside learning 4. Logbook Development 5. DOPs in ELS, AAA and eFAST ECHO Start early (during core or intermediate training) ELS. Obtain a view and ask: 1. Is the heart Contracting 2. Is there pericardial effusion (causing tamponade) or is there evidence of RV dilatation/strain (careful of clinical context)
Higher Training 1. Consolidate earlier skills 2. All other aspects of ECHO:(including Shock assessment/protocol) a. IVC Measurement b. Global contractility c. Assessment of fluid status 3. Maintain Logbook 4. Completion of remaining DOPS
Assessment
DOPs is the primary assessment tool (as per other practical skills/procedures within RCEM training). Other SLEs can be utilised to demonstrate competence (i.e within Mini-cex/ESLE etc)
DOPS are utilised to demonstrate: - Knowledge, skills and behaviours for appropriate image acquisition - Knowledge, skills and behaviours for image interpretation and pathology identification
Ultimate goal of training is the development of the ability to utilise POCUS (with appropriate indication) to acquire images and interpret them in the clinical context.
Entrustment scale to be used as with other competencies and SLOs – and these are assessed based on criteria within the categories of Knowledge, Skills and Behaviours. The college has released documents pertaining to the expected criteria for each of these categories at each entrustment level (link at the top of this page)
DOPs or supervised scanning to be completed locally, (by any Level 1/core US accredited person with ≥ 6/12 post level 1 accreditation experience). Multiple DOPs/SLEs should be undertaken over the course of your training to demonstrate progression.
It is encouraged among trainers, that a single DOPS, without logbook evidence/demonstration of experience/previous DOPS at an earlier stage, should not result in any higher Entrustment scale than 2b. – if you feel that your experience is greater than this, present your logbook to the assessor or to your local lead and a higher scale can be awarded.
Ultimate Level 1 competency sign off is no longer a formalised requirement by the college, but your local ED US lead, prior to ST6 ARCP can help you ensure you have demonstrated competency (and is effectively no more than a checklist of the competencies already gained i.e. Level 4 entrustment of each modality with a logbook of experience and evidence of reflection)
In HST, assessments can, and should also be carried out as part of the clinical management of a patient, i.e as part of a mini-CEX/CBD/ESLE where utility, interpretation and integration of the US findings can be observed/discussed.‘
Sign off’/achieving entrustment scale 4 is competency based, rather than by fixed numbers, however an Indicative number of scans is provided by RCEM as guidance of what is reasonably expected
There is a POCUS logbook on e-portfolio however other forms of logbook may also be used (i.e excel). Please ensure that these are anonymised
If indicative number is not met, supervisors can record on the Portfolio that they are aware of this, but it should not impede progression if appropriate entrustment level has been obtained
Imaging modality and RCEM recommended indicative numbers of cases
Current Wessex-wide opportunities for US experience:
Local leads (see below) in every trust
Abdominal Aorta Screening Clinics (Regional)
Clinical Educators with US experience in multiple trusts
Local Echocardiography Links for observation or echocardiography/supervised scans
SONOSIM laptop (for basic simulated experience) and many online modules·
4 Butterfly handheld US probes and a cloud storage subscription
Bodyworks/Heartworks Simulator access
ACCS and WREMTA sessions
Deanery funded Core US course and HST course annually
Regional Organisation
Wessex Deanery Ultrasound Lead - Joe Schrieber (joe.schrieber@porthosp.nhs.uk)
Local Trust ED Leads
Portsmouth - Joe Schrieber
Hampshire Hospitals Foundation Trust - Louisa Chan
