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EM Ultrasonography

Emergency Ultrasonography is well-integrated into the curriculum of the Emergency Medicine Residency at Maimonides. Residents spend 4 weeks in each of their first two years on an ultrasound rotation. During the rotation, residents participate in small group scan shifts with faculty members and fellows from the Emergency Ultrasound Division, as well as weekly ultrasound review/QA sessions. This combination allows the residents to become proficient in performing and interpreting a wide array of point-of-care ultrasounds.

In addition, mastering ultrasound-guided procedures such as nerve blocks and TEE is emphasized. Graduates of the program are expected to be proficient in using this important technology and adept in utilizing ultrasonography in managing critically ill patients.

Faculty

Currently, there are thirteen ultrasound fellowship trained faculty on staff in the Maimonides Emergency Department. The faculty members are recognized recipients of multiple grants, including NIH funding, have lectured regionally, nationally, and internationally, and have numerous peer-reviewed publications related to point-of-care sonography.

Technology

In our emergency department (ED) we use five Zonare and one Mindray TE7 machines. We utilize a streamlined wireless workflow that allows us to archive our images on Q-Path archival software and also on PACS. All of our adult attending emergency physicians are credentialed in each of the 12 ACEP core emergency ultrasound applications. We use cutting edge applications such as TEE (transesophageal echocardiogram) in our critical care patients to improve care and our diagnostic ability. Currently our faculty and residents are being trained to incorporate nerve blocks frequently into their practice. We are starting to use butterfly IQ technology to increase efficiency and “time to scan” in our busy ED.

Our pediatric emergency medicine attendings are additionally credentialed to perform studies for intussusception and appendicitis. Since all attendings are credentialed in point-of-care sonography, the residents receive ultrasound education from every attending in the ED, fellowship trained or not.

Training

There are approximately 10,000 ultrasounds performed in the Maimonides ED every year. It is by far the most common procedure performed in our ED. All ultrasounds performed in the department are recorded and reviewed, which allows residents to receive detailed feedback regarding their technique and interpretations. Residents receive both real time feedback during their scan shifts and also feedback on how to interpret the images during the image-review sessions.

All aspects of point-of-care sonography are covered during residency training, including advanced topics such as advanced echocardiography, musculoskeletal, ocular and procedural guidance. In addition to sonographic guidance of vascular access, paracentesis, thoracentesis, pericardiocentesis, arthrocentesis and lumbar puncture, our residents are taught how to perform ultrasound-guided regional analgesia including fascia iliaca compartment blocks, interscalene nerve block and various other peripheral nerve blocks.

Graduates of the Emergency Medicine residency program will be proficient in using this important technology and adept in utilizing ultrasonography when managing critically ill patients, as most will have performed at least 300 ultrasounds during their training. Some motivated residents have performed close to 1000 ultrasounds by graduation.We believe that point-of-care ultrasonography is life saving and makes us better doctors. Our residents benefit from this ethos.

Research

The ultrasound division has numerous ongoing research projects. Our residents and fellows participate in the different projects and have dedicated research support to start their own project. Many of our projects focus on teaching modules and incorporating ultrasound and simulation to improve procedural skills in our trainees. We also have projects in cutting edge applications such as TEE in cardiac arrest.

Fellowship goals

To become experts in general and advanced emergency ultrasound applications.

To hone their teaching skills and become seasoned educators in both clinical emergency medicine and emergency ultrasound.

To start their own research projects and participate in multiple ongoing research projects in the division. To participate and present their research in regional, national and international conferences.

To gain experience on how to run an ultrasound division and learn the administrative skills in order to become future leaders in point-of-care ultrasound.

EUFAC Accreditation

Our advanced emergency ultrasound fellowship was fully accredited by Emergency Ultrasound Fellowship Accreditation Council (EUFAC) for 3 years in April 2021. Our fellows will graduate eligible to take the Focused Practice Designation (FPD) exam offered by ABEM.