Despite a general consensus that ultrasound is an important skill to teach in medical school, the integration of ultrasound education in U.S. schools is highly variable. This study indicates a need for national standards to guide the integration of ultrasound education into U.S. medical school curricula.

A structured curriculum that includes abundant opportunities for fellows to practice and receive feedback using a behavioral checklist during their ICU rotations helps to develop physicians with advanced communication skills.

The VSP enables students to practice their history-taking skills before encounters with standardized or actual patients. Future developments will focus on creating an assessment module that will automatically analyze VSP sessions and provide immediate student feedback.

Quantifying Quality in Ultrasound Imagingltrasound has been proven in multiple studies to improve physician clinical performance through a wide range of potential applications, including diagnostic and procedural applications. 1 With the approval of American Medical Association policy H-230.960 in 1999, the scope of practice for physicians performing ultrasound examinations increased dramatically beyond traditional indications. 2 Individual specialties have since been responsible for determining the ultrasound scope of practice within their individual field. For example, the American College of EmerDavid P. Bahner, MD, RDMS, Eric J. Adkins, MD, MSc, Rollin Nagel, PhD, David Way, MEd, Howard A. Werman, MD, Nelson A. Royall, MD Received April 14, 2011, ORIGINAL RESEARCHObjectives-Ultrasound image interpretation and education relies on obtaining a highquality ultrasound image; however, no literature exists to date attempting to define a high-quality ultrasound image. The purpose of this study was to design and perform a pilot reliability study of the Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET) method for ultrasound quality image assessment.Methods-A single sonologist performed a Trinity hypotensive ultrasound protocol on 3 participants of varying body types. Each participant's ultrasound examination was repeated in 4 locations; static clinic location, mobile ambulance, airplane, and helicopter. Images were reviewed by a sonographer, radiologist, and emergency medicine physician using the B-QUIET method and underwent statistical analysis using generalizability theory for reliability of the assessments using the tool.Results-The B-QUIET method showed high reliability of most subscale items. Approximately two-thirds of the reviewed images had complete inter-rater reliability on 90% of the items. There was relatively low inter-rater reliability for the Identification/ Orientation subscale items. The inter-rater reliability κ value was calculated as 0.676 overall for the method.Conclusions-The need for a standardized method to evaluate the quality of an ultrasound image is well documented. The B-QUIET method represents the first attempt to quantify the sonographer component of ultrasound images. Further reliability and validation studies of this method will be needed; however, it represents a tool for standardized ultrasound interpretation, ultrasound training, and institutional quality assessment.

IntroductionIntravascular volume status is an important clinical consideration in the management of the critically ill. Point-of-care ultrasonography (POCUS) has gained popularity as a non-invasive means of intravascular volume assessment via examination of the inferior vena cava (IVC). However, there are limited data comparing different acquisition techniques for IVC measurement by POCUS. The goal of this evaluation was to determine the reliability of three IVC acquisition techniques for volume assessment: sub-xiphoid transabdominal long axis (LA), transabdominal short axis (SA), and right lateral transabdominal coronal long axis (CLA) (aka “rescue view”).MethodsVolunteers were evaluated by three experienced emergency physician sonographers (EP). Gray scale (B-mode) and motion-mode (M-mode) diameters were measured and IVC collapsibility index (IVCCI) calculated for three anatomic views (LA, SA, CLA). For each IVC measurement, we calculated descriptive statistics, intra-class correlation coefficients (ICC), and two-way univariate analyses of variance.ResultsEPs evaluated 39 volunteers, yielding 351 total US measurements. Measurements of the three views had similar means (LA 1.9 ± 0.4cm; SA 1.9 ± 0.4cm; CLA 2.0 ± 0.5cm). For B-Mode, LA had the highest ICC (0.86, 95% CI [0.76–0.92]) while CLA had the poorest ICC (0.74, 95% CI [0.56–0.85]). ICCs for all M-mode IVCCI were low. Significant interaction effects between anatomical view and EP were observed for B-mode and M-mode measurements. Post-hoc analyses revealed difficulty in consistent view acquisition between EPs.ConclusionInter-rater reliability of the IVC by EPs was highest for B-mode LA and poorest for all M-Mode IVC collapsibility indices (IVCCI). These results suggest that B-mode LA holds the most promise to deliver reliable measures of IVC diameter. Future studies may focus on validation in a clinical setting as well as comparison to a reference standard.

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AHC elephants are prevalent and detrimental to learning, organizational decision making, and morale, yet the academic medicine community, particularly its leadership, insufficiently confronts them.

Objectives: Emergency medicine (EM) trainees are expected to learn to provide acute care for patients of all ages. The American Council for Graduate Medical Education provides some guidance on topics related to caring for pediatric patients; however, education about pediatric topics varies across residency programs. The goal of this project was to develop a consensus curriculum for teaching pediatric emergency care.Methods: We recruited 13 physicians from six academic health centers to participate in a three-round electronic modified Delphi project. Participants were selected on the basis of expertise with both EM resident education and pediatric emergency care. The first modified Delphi survey asked participants to generate the core knowledge, skills, and experiences needed to prepare EM residents to effectively treat children in an acute care setting. The qualitative data from the first round was reformulated into a second-round questionnaire. During the second round, participants used rating scales to prioritize the curriculum content proposed during the first round. In round 3, participants were asked to make a determination about each curriculum topic using a three-point scale labeled required, optional, or not needed. Results:The first modified Delphi round yielded 400 knowledge topics, 206 clinical skills, and 44 specific types of experience residents need to prepare for acute pediatric patient care. These were narrowed to 153 topics, 84 skills, and 28 experiences through elimination of redundancy and two rounds of prioritization. The final lists contain topics classified by highly recommended, partially recommended, and not recommended. The partially recommended category is intended to help programs tailor their curriculum to the unique needs of their learners as well as account for variability between 3-and 4-year programs and the amount of time programs allocate to pediatric education. Conclusion:The modified Delphi process yielded the broad outline of a consensus core pediatric emergency care curriculum.E mergency medicine (EM) physicians acquire proficiency in the emergent management of all patients including pediatric patients during their training. Despite the growth of pediatric EM as a subspecialty, pediatric EM (PEM) subspecialists only care for 10% to 20% of the pediatric patients in the emergency setting across the United States.1 The remaining 80% to 90% of pediatric emergency care patients are cared for by EM physicians and/or general practice pediatricians.2-5 The Accreditation Council for Graduate Medical Education (ACGME) requires EM residents to have approximately 20% of their patient encounters with patients less than 18 years of age, including the critical care of infants and children.6 While time dedicated to pediatrics has increased in recent years, 7 concerns remain as to whether this allows sufficient experience to develop the mastery level competency for the EM physician to effectively care for children. 4,7 Although the type of clinical experiences available is beyond the...