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1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD, FAAFP Lacy Smith, MD, FAAFP Daniel J. Hurst, PhD Brittany Shanks Cahaba Family Medicine Residency (Centreville, AL) POCUS Point-of-care Ultrasound 2

Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

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Page 1: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

1

Primary Care Ultrasound: Lessons

Learned in 10 Years of Ultrasound

Training in a Rural Residency

John B. Waits, MD, FAAFP

Lacy Smith, MD, FAAFP

Daniel J. Hurst, PhD

Brittany Shanks

Cahaba Family Medicine Residency (Centreville, AL)

POCUS

Point-of-care Ultrasound

2

Page 2: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

2

Outline

1. Personal journey with POCUS

2. Rotation journey with POCUS

3. Implementation

4. Curricular development

5. Lessons learned

3

Poll Question #1

Do you currently use POCUS in your

practice?

A.Yes

B.No

4

Page 3: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

3

Poll Question #2

Do you currently use POCUS in your

practice for more than OB?

A.Yes

B.No

5

Background

2014 Council of Academic Family Medicine Educational

Research Alliance (CERA) survey:

• Only 2.2% of FMR reported an established US curriculum

• However, 29% reported having started one in the last year

• 11.2% reported being in the process of starting curriculum

• 40% reported no plans of establishing US training

Hall JW, Holman H, Bornemann P, Barreto T, Henderson D, Bennett K, Chamberlain J, Maurer DM. Point of Care Ultrasound in Family

Medicine Residency Programs: A CERA Study. Fam Med 2015; 47(9): 706-711. http://www.stfm.org/FamilyMedicine/Vol47Issue9/Hall706

6

http://www.stfm.org/FamilyMedicine/Vol47Issue9/Hall706
Page 4: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

4

Personal Ultrasound

Experience

… the narrative backdrop of the

lessons learned…

Personal Ultrasound Journey

• Residency (my own)

• First years of practice

• Program Director role(s)

8

Page 5: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

5

Private Practice Implementation

• ROI on the machine

• CME - didactic and hands-on

• Implementation– scanning

– documentation

– over-reads

– hiring a technician

9

Residency Implementation

• Hospital setting

• University setting

• RTT / Rural Health Clinic setting

• THC / FQHC setting

10

Page 6: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

6

One major “take-away”

(foreshadowing)

… you need a faculty ultrasound champion

11

Curriculum Development

Page 7: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

7

Curriculum Development

• Shadowing

• Scanning

• What to read?

• What to work on first?

• Mentoring

• Evaluation

13

Our Curriculum

• (see handout)

• ever-evolving

• flexible and individualized

14

Page 8: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

8

Workshops

• orientation

• academic afternoons (early)

• hands-on workshops (later in year)

• OSCEs

15

SonoSim

Curriculum

16

Page 9: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

9

Recommended Books

Point of Care Ultrasound by Soni, Arntfield, and

Kory. (1st edition, 2014; Kindle or Inkling

version)

Introduction to Bedside Ultrasound by Matthew

Dawson and Mike Mallin (iBooks or Inkling

only)

17

Field

Notes

18

Page 10: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

10

Our OSCE

• (see handout)

• essential to evaluate

19

Sonosim Dashboard

20

Page 11: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

11

Our Data

• Alumni using ultrasound

• PGY-3s

• PGY-2s

• PGY-1s

21

Lessons Learned

Page 12: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

12

Ultrasound Legal Issues

• Ultrasound privileging

• POCUS vs. Departmental Ultrasound

– .... or is ultrasound more like an MRI or more like a stethoscope?

• Credentialing issues

– National society guidance and turf-wars

– clinic

– hospital

• Malpractice issues

• Reimbursement issues

23

Facilitated Discussion

Page 13: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

13

Who is stuck?

… and Why?

• Ideas from the group

25

Who has had success?

… and How?

• Questions from the group

26

Page 14: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

14

27

Poll Question:

Enter your email address to be included in any follow-up communication from the presenter(s).

28

Page 15: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

15

Please…

Complete the

session evaluation.

Thank you.

29

John B. Waits, MD, FAAFP, Program Director and CEO

[email protected]

Lacy Smith, MD, FAAFP, Associate PD and COO/CMO

[email protected]

Daniel J. Hurst, PhD, Curriculum and Research Coordinator

[email protected]

Brittany Shanks, Program Coordinator

[email protected]

Cahaba Family Medicine Residency (Centreville, AL)

Page 16: Primary Care Ultrasound: Lessons Learned in 10 Years of ......1 Primary Care Ultrasound: Lessons Learned in 10 Years of Ultrasound Training in a Rural Residency John B. Waits, MD,

16


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