• The McMaster Acute Care POCUS AFC training program is a year-long experience designed to satisfy the Royal College of Physicians and Surgeons of Canada objectives and requirements to qualify trainees for the Acute Care POCUS Area of Focused Competency Diploma. The program is administrated within the structure of the Division of Emergency Medicine, Department of Medicine at McMaster University, and hosted within the Emergency Department at St. Joseph’s Healthcare Hamilton.

    Presently, up to two trainees can be accepted annually with the academic year beginning on July 1 and ending on June 31. Designed initially in 2010, the McMaster Acute Care POCUS curriculum is built upon a competency-based pedagogy with assistance from internationally recognized scholars in medical education. Educational experiences (both mandatory and elective) have been designed with associated learner assessments to allow trainees to achieve program objectives. The learner assessment structure is longitudinal and multimodal always anchored in the objectives of training, and as such, the intrinsic CanMEDS competencies. This framework is best appreciated in the curriculum plan layout of Appendix E: Objectives for the Educational Experiences companion document. 

    Practically speaking, the majority of a trainee’s time will be spent performing and interpreting POCUS examinations under direct supervision by a core faculty member at the core training site of the Emergency Department at St. Joseph’s Healthcare Hamilton. Given the self-scheduled nature of the training program, the day-to-day and month-to-month schedules are set at the discretion of the trainee within the framework of the curriculum plan.

  • Definition

    Acute Care Point-of-Care Ultrasonography is the area of enhanced competence within medicine concerned with the performance and interpretation of point-of-care ultrasonography examinations that are limited in scope, problem-oriented, and immediately integrated by the performing clinician into the management of the patient.

    Major Tasks of Acute Care POCUS

    The discipline of Acute Care POCUS includes responsibility for performance and interpretation of point-of-care ultrasonography for diagnosis and management in the acute care setting; application of POCUS to perform interventional procedures in the acute care setting; and management of an acute care POCUS service.

  • CORE TRAINING SITE

    St Joseph’s Healthcare Hamilton, Emergency Department

    Academic, tertiary care Emergency Department with ~65,000 patient visits per year. Regional referral centre for Nephrology, Obstetrics/Gynecology, Ophthalmology, Psychiatry and Thoracic Surgery. Closed 23-bed Level 3 ICU and associated Medical and Surgical Stepdown Level 2 ICUs. POCUS infrastructure includes QPath E archiving and remote access for real-time remote review, Zonare ZS3 (with transvaginal probe), Toshiba APLIO 300 (with transvaginal probe), Sonosite M-turbo (with transvaginal probe), Butterfly iQ, and GE Trophon high-level disinfection system. A dedicated POCUS office with storage, computer access and workspace is located within the Department. 

    DISTRIBUTED TRAINING SITES

    St Joseph’s Hospital, Intensive Care Unit

    Community, tertiary care high acuity ICU with access to Fellowship-trained POCUS preceptorship.

    Hamilton General Hospital, Emergency Department

    Academic, tertiary care Level I Trauma Centre and cardiac referral center with access to Fellowship-trained POCUS preceptorship.

    McMaster Children’s Hospital, Emergency Department

    Academic, tertiary care children’s Emergency Department with access to Fellowship-trained Pediatric POCUS and Pediatric Emergency Medicine preceptorship.

    St Joseph’s Healthcare Hamilton, Diagnostic Imaging

    Academic, tertiary care Radiology department with a high-volume comprehensive ultrasound program. Trainees are able to participate at the bedside with RDMS certified ultrasound technologists and have access to educational experiences with Radiologists with a focus on interpretation of ultrasound images. 

    St Joseph’s Healthcare Hamilton, Early Pregnancy Assessment Clinic/Obstetrical Imaging

    Academic, tertiary care regional referral center for the care of pregnant patients. Fellows have access to participate at the bedside in a department dedicated to obstetrical imaging, with the associated ultrasound technologists and interpreting Radiologists and Obstetrician/Gynecologists. Access to the Early Pregnancy Assessment Clinic for follow-up of pregnancies of uncertain location, uncertain radiologic viability, or pregnancy loss is also available.

    St Joseph’s Healthcare Hamilton, IV Team

    Bedside observational experience with inpatient IV team with a goal of improving POCUS guided peripheral IV access skills.

    Afiya Spine and Pain Institute

    Introduction to US-guided interventional pain procedures.

  • Orientation

    Comprehensive program orientation occurs coincident with the beginning of the AFC training experience. All program requirements are addressed. A practical in-department orientation is provided to the physical plant and equipment at the Core training site.

    Clinical

    Trainees receive close mentorship by faculty with POCUS expertise, either in-person or with real-time remote review when performing and interpreting POCUS examinations in the clinical environment. When being precepted by remote review, a daily faculty call schedule provides coverage from 0800h to 0000h with extension of hours available by request. At the end of each day, a focused daily evaluation is performed.

    Scheduled Comprehensive Reviews

    Monthly, trainees review the details of their In-Training Evaluation Reports. At the end of months three, six, nine and twelve a structured meeting addressing the trainee’s progress on program requirements takes place. This review includes but is not limited to the trainee’s progression through the program objectives, and discussion of the trainee’s progress on the competency portfolio.

  • Evidence-based Practice

    Educational objectives within the McMaster Acute Care POCUS training program are approached with a focus on practice based in contemporary evidence. This is goal is supported in the following ways:

    -       Staff roster of POCUS expert faculty who have received training in an evidence-based fellowship level training program. 

    -       Daily real-time supervision by POCUS faculty for all scans performed by Trainees, allowing the possibility for each patient encounter to be anchoring in contemporary evidence.

    -       Twice-monthly presentations by Trainees at McMaster Acute Care POCUS didactic curriculum of either a clinical case with associated evidence, or a critical appraisal of POCUS literature.

    -       Trainee presentation of three “Comprehensive Case” presentations at McMaster Acute Care POCUS didactic curriculum of a clinical case with associated evidence. These presentations are meant to include a “deep dive” into the literature surrounding at topic relevant to POCUS practice.

    -       Summative written examination at the conclusion of the training experience with some questions specifically designed to probe the trainees understanding of the evidence base for POCUS practice.

    Scholarship

    MAC POCUS trainees are expected to begin a scholarly project in their training. Within the MAC POCUS Faculty group a wide range of interests and experience with respect to scholarly activity serves to support trainees in their AFC requirements. The focus of this work may be research, however other examples include quality, or educational scholarship. It is recognized that the completion of such a project may not be possible in one year depending on the scope of the project, however, at the least the trainee is expected to have a project design, and methods completed with a plan in place for data acquisition/implementation. 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. 

  • Upon completion of training, a number of avenues for certification are presented to qualified trainees.

    McMaster University Post-Graduate Medical Education

    A certificate of completion indicating the dates of training in the Acute Care Point-of-Care Ultrasound post-graduate program will be provided.

    Royal College of Physicians and Surgeons of Canada – Acute Care POCUS Area of Focused Competency

    Upon successful completion of program requirements, trainees will have achieved the necessary competencies and produced the required portfolio document for submission to and assessment by the RCPSC.  If satisfactory, an Area of Focused Competency Diploma will be awarded.

    American Registry of Diagnostic Medical Sonographers – Registered Diagnostic Medical Sonographer

    Upon successful completion of program requirements, trainees will have the qualifications necessary to pursue the RDMS certification.

    Alliance for Physician Certification and Advancement – POCUS Badges

    Upon successful completion of program requirements, trainees will have the knowledge and experience necessary to pursue the APCA-POCUS designations.

  • Item description Learning objectives, educational experiences and evaluation rubric are reviewed by the McMaster Acute Care POCUS AFC Committee annually.

    Trainee evaluation of the overall MAC POCUS AFC Program occurs annually, at the end of the academic year.

     Faculty evaluation by trainees occurs on an semiannual basis.