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IDEA Series: Implementing an Integrative Longitudinal Online Ultrasound Curriculum

2018-06-06T09:33:25+00:00

The Problem

Idea Series LogoEmergency ultrasound (EUS) has quickly become a fundamental aspect of emergency medicine (EM) residency training. While still relatively novel to the field, there has been a significant focus on curriculum development in accordance with the core ultrasound application guidelines set forth by the American College of Emergency Physicians (ACEP).1 Currently, there is no consensus on the optimal approach to EUS education that will provide learners with true clinical competence post-matriculation. Furthermore, a recent survey demonstrated that there is conflict between what ACEP guidelines consider to be competence in EUS and resident opinion on the matter.2 One potential identified issue with our current model is the focus on early ultrasound learning in junior EM residents with a lack of ongoing EUS education in senior years.

The Innovation

Development of a comprehensive ultrasound website, built to encourage ongoing asynchronous learning throughout EM residency training, focused on 3 core principles of EUS:

  • Foundations: Core EUS application fundamentals
  • Clinical Application: Unique EUS cases to bridge the gap between core knowledge and clinical utility
  • Evidence Based Medicine: Analysis of novel and landmark EUS literature
UCSD EM Ultrasound website curriculum

The EM Ultrasound website provides a longitudinal, integrative curriculum covering the core applications of EUS.

Target Learners

EM residents

Materials Needed

  • Web-hosting service that does not require significant HTML/programming experience (i.e WordPress, Squarespace)
  • An ultrasound fellowship (or very eager residents)

Description of the Innovation

The website, UCSD EM Ultrasound, serves as a home base for residents to learn EUS throughout their entire residency experience.

The EM Ultrasound website covers each core EUS application with respect to 3 different domains: Foundations, Clinical Applications, and Evidence-Based Medicine.

Foundations

This component intends to teach EM residents the knowledge required to understand core EUS applications and is easily assigned to interns as required material.

  • As demonstrated in the figure below, each core application includes a range of subsections. The 2016 ACEP EUS guidelines were utilized as a reference to fill in a majority of these subsections.
  • Video lectures were recorded for each core EUS application. We also scoured the world wide web to provide additional learning resources on each application for the most eager of learners. In order to generate this content, all ultrasound faculty were asked to convert their formal didactic lectures to recorded video.
  • Lastly, a curated collection of articles regarding each application was put together using the Read by QxMD app to facilitate a deeper dive into the literature for curious residents. Our entire collection of EUS literature collection can be also be accessed.

Example of the content covered in the “Foundations” component of the website with regard to basic echocardiography.

We created a blog-style format for both the Clinical Application and Evidence Based Medicine components of the website in order to promote continued use of the website to read about clinical cases and EUS literature by senior residents. The blog format provides residents with new content in an ongoing manner to keep them engaged.

Clinical Application

This component emphasizes clinical cases in which ultrasound proved useful for diagnosis (similar to the #US4TW series).

  • A clinical case is provided to the learner with an associated ultrasound clip. The learner can then reflect on the differential diagnosis and further work-up prior to clicking the drop down button to reveal the answer and learning point.

Example of the “Clinical Application” Component of the EM Ultrasound website.

  • In order to generate this educational content, all junior residents rotating through their ultrasound elective are required to complete a clinical case blog post. The blog post is then peer-reviewed by an ultrasound trained EM attending or fellow. The EUS fellow is responsible for formatting and uploading to the website.

Evidence Based Medicine

This component is based upon critical analyses of novel or landmark EUS literature.

  • A standardized template (figure below) is utilized to analyze each article and put it in perspective regarding its potential for practice change.
  • As novel literature is released, the learner’s understanding of EUS can evolve simultaneously.
  • In order to generate this content, all medical students rotating through their ultrasound elective are required to complete a journal club blog post. The blog post is then peer-reviewed by an ultrasound trained EM attending or fellow. The EUS fellow is responsible for formatting and uploading to the website.

Example of content that a resident might review as part of the “Evidence-Based Medicine” component of the EM Ultrasound website.

Lessons Learned

  • The website has been a work in progress this year, and we are in the process of obtaining tangible written feedback. Verbal feedback thus far has been positive among residents and faculty, who have noted an increase in their knowledge base of more nuanced EUS topics.
  • In order to achieve sustainability for this continuous content generation project, we enlisted our EUS fellows to champion the project. All learners that rotate through their ultrasound elective (both residents and medical students) are required to participate in content development by creating their own original blog post.
  • Our main area of interest and plans for future research centers on how this project will contribute to ongoing EUS education throughout residency training and whether or not it will also promote competency post-graduation.

Conclusion

Many EM residencies struggle with maintaining enthusiasm for ongoing EUS education during the final years of residency following the initial aggressive focus on EUS training during the early phases of training. Our EUS website encourages ongoing learning and reinforcement of foundation EUS knowledge via periodic release of EUS content that can appeal to learners of various levels. It can also serve as a tool for learners to use on-shift for reinforcement of knowledge and skills gained from a clinical experience.

Read more about the IDEA Series.

1.
Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2017;69(5):e27-e54. [PubMed]
2.
Stolz L, Stolz U, Fields J, et al. Emergency Medicine Resident Assessment of the Emergency Ultrasound Milestones and Current Training Recommendations. Acad Emerg Med. 2017;24(3):353-361. [PubMed]
Michael Macias, MD

Michael Macias, MD

Emergency Ultrasound Fellow
Department of Emergency Medicine
University of California, San Diego
San Diego, CA