-       Performance and real-time interpretation of clinically indicated POCUS examinations in acute care environments is the cornerstone of the McMaster Acute Care POCUS AFC training program. 

-       The vast majority of this training will take place at the core training site of St. Joseph’s Healthcare Hamilton Emergency Department with real-time preceptorship from core faculty members either in person or via remote review utilizing the QPath E archiving system. Distributed training sites as well as faculty are also acceptable for these experiences. 

-       Each examination will be archived and reported with anonymized details collected in the trainee’s logbook.

-       Minimum recommended scan performance numbers are as follows:

o   Abdominal/General: 800

o   Cardiac: 300

o   Pelvic: 200 (including 50 transvaginal)

Format: POCUS image acquisition/interpretation with real-time image review

Duration: Longitudinal self-schedule

Location: St. Joseph’s Healthcare Hamilton Emergency Department and Distributed Training Sites

-       Performance of clinically indicated POCUS guided procedures in acute care environments supervised by POCUS Faculty occurs coincidentally with the provision/interpretation of acute care POCUS examinations as outlined above.

-       Simulation utilizing anatomic models and ultrasound phantoms is possible for vascular abscess, collection drainage, as well as pericardiocentesis.

-       Each examination will be archived and reported with anonymized details collected in the trainee’s logbook

-       Minimum recommended procedure performance numbers are as follows:

o   Procedural Guidance: 50

Format: POCUS procedural guidance with real-time image review, simulation

Duration: Longitudinal self-schedule

Location: St. Joseph’s Healthcare Hamilton Emergency Department and Distributed Training Sites

-       Trainees are responsible for completing the quality assurance and peer review (QA/PR) of studies archived to the core training sites QPath E POCUS database for the duration of their experience. 

-       The goal of QA/PR is twofold. First, the trainee is exposed to images generated and interpreted by both expert and non-expert peers. This increases their exposure to POCUS images many-fold beyond what they acquire themselves and forces them to interpret images of varying quality in a delayed fashion. Secondly, trainees are able to benefit from and contribute to the continual practice improvement inherent to a formalized QA/PR program.

Format: Delayed comparison of reported POCUS results versus gold-standard with faculty preceptorship

Duration: Longitudinal self-schedule

Location: St. Joseph’s Healthcare Hamilton Emergency Department

Lecture series and forum for trainee presentations by virtual gathering biweekly. Major Topic and Hotseat Rounds are delivered by faculty. Case Presentation, Evidence Snapshot, and Comprehensive Cases are delivered by trainees. The didactic curriculum is an accredited educational session by the Royal College of Physicians and Surgeons of Canada, as well as Sonography Canada.

Major Topic

-       Comprehensive interactive presentations delivered by core and adjunctive faculty addressing the theory and practice of acute care POCUS examinations. 

-       Major topics include Biliary, DVT/Vascular, Early Pregnancy/Gynecology I/II/III, Echocardiography I/II/III, Head/Neck, Lung, Musculoskeletal, Occular, Pediatrics I/II, Procedural/Regional Anesthesia, Program Administration, Renal, Reporting/Communication, Shock, Skin/Soft Tissue, Testicular, and Ultrasound Physics.

Case Presentations

-       Brief presentation of case(s) of interest by trainee, including comprehensive imaging and clinical course follow-up.  May include some supporting literature.

Evidence Snapshot

-       Presentation of article(s) by trainee, including a brief critical appraisal and implications for current/future practice.

Hotseat Rounds

-       Challenge cases presented by POCUS faculty with a goal of solidifying and probing trainee fund of knowledge.

Comprehensive Case

-       Trainee presentation of a case with an associated question answered by the supporting literature.

-       Follow-up cases/questions for the trainee are presented by faculty with a goal of probing the trainees knowledge-base surrounding the topic presented.

Format: Web-based interactive live faculty didactic lectures and trainee presentations 

Duration: Longitudinal bi-monthly Wednesday evenings

Location: video conference

-       Trainee presentation to St. Joseph’s Healthcare Hamilton Emergency Department Rounds

-       Topic related to continual professional development of POCUS skills, or morbidity/mortality when able.

Format: Trainee presentation

Duration: 1-2 occurrences per year

Location: in-person/video conference

-       Graduated responsibility for bedside instruction at the discretion of the Program Director/Faculty.

-       Supervision (with faculty oversight) of Junior Emergency Medicine Residents on POCUS rotations, including bedside teaching and delayed image review.

-       Bedside instruction of senior resident POCUS Hemodynamic Assessment elective rotators at the bedside.

-       Bedside/classroom instruction of St. Joseph’s Healthcare Hamilton Emergency Physicians within the POCUS continual professional development framework, including a Faculty Teaching Project as a component of the Educational Portfolio.

-       Instruction at annual FRCPC-EM/CCFP-EM POCUS scanning weekend

-       Emergency Department resource for bedside teaching of off-service Residents and Staff requiring ad hoc assistance

Format: In-person bedside teaching by trainee, precepted by faculty

Duration: Longitudinal self-schedule, beginning in Block 3

Location: St. Joseph’s Healthcare Hamilton Emergency Department

-       Responsible for weekly checks of Emergency Department POCUS physical environment, equipment, and supplies

-       Liaising with vendor support staff to coordinate upgrades/repairs of POCUS equipment, physical plant and IT infrastructure

-       Participation in Acute Care POCUS-related committee over the course of training.

Format: Trainee performed checklist; contact with vendors as needed; quarterly committee meetings

Duration: Longitudinal self-schedule

Location: St. Joseph’s Healthcare Hamilton Emergency Department

-       Trainee representative to Acute Care POCUS AFC Committee

-       Responsible for contribution to long- and short-range planning cycles of training program.

-       Fostering of training environment that supports colleagues in need and provides an environment amenable to continuous practice improvement.

Format: Quarterly committee meetings

Duration: Longitudinal 4 meetings per year

Location: Video conference

-       Trainees must begin a scholarly product in the course of their AFC training. The focus of this work may be research, however other examples include quality, or educational scholarship.

-       Approximately one day per week should be dedicated to work on the scholarly product.

-       It is expected that the trainee should either present their research plan in forum outside of the AFC program (i.e., Departmental rounds), have an abstract accepted to a research conference, or have completed a publication to have satisfactorily completed this objective.

Format: Trainee conceived and executed scholarly product

Duration: Longitudinal self-schedule

Location: St. Joseph’s Healthcare Hamilton Emergency Department

-       Performance of POCUS in the acute care environment involves the examination and treatment of undifferentiated patients. Interaction with consulting services is routine. Trainees are expected to communicate urgent/emergent results as well as unexpected findings with consultants either in person or by telephone. This interaction serves to provide a more robust context for the significance of the sonographic findings, thus contributing to the trainee knowledge base and expertise.

-       Collaboration with learners/trainees/mentors outside of the Emergency Department and acute care POCUS community is also strongly encouraged. This may take the form of bedside teaching, didactic teaching with and invited rounds presentation, or collaboration on an area of scholarly interest.

Format: varied

Duration: Longitudinal self-schedule

Location: St. Joseph’s Healthcare Hamilton Emergency Department and Distributed Training Sites

-       Participation in experiences at distributed training sites is strongly encouraged.

-       See Training Sites: Distributed Training Sites above for further details.

-       Review of echocardiography case archive is strongly encouraged.

-       Review of QPath E teaching case archive is strongly encouraged

-       Participation in regional POCUS rounds (e.g., SonoToronto), or university/hospital based interdisciplinary rounds is strongly encouraged.

-       Attendance/participation in local/national/international POCUS conferences is strongly encouraged.