The evaluation of abdominal or pelvic pain and/or vaginal bleeding using pelvic ultrasound is a common practice of the emergency physician. In fact, the American College of Emergency Physicians (ACEP) in 2008 published guidelines listing evaluation of pregnancy as a core application and evaluation of the adnexa as a secondary application for emergency bedside pelvic ultrasound. In 2012 the Accreditation Council of Graduate Medical Education (ACGME) along with the American Board of Emergency Medicine (ABEM) introduced milestones into residency programs to provide a framework of cognitive and behavioral performance standards, including procedure-based skills. The milestones are the knowledge, skills, attitudes and other attributes for each of the ACGME competencies that monitor resident performance throughout the residency and range from less to more advanced levels. Goal-directed focused ultrasound is one of twenty-three specific milestones that will be measured during emergency medicine training. Discussion will focus on how to teach focused goaldirected pelvic ultrasound based on the five levels within this milestone.
Paul L Foster School of Medicine at Texas Tech University Health Sciences Center in El Paso offers the students a faculty (both clinician and basic scientists) guided clinical presentation based curriculum. Emergency physicians have been an integral part of this curriculum. Bedside transvaginal ultrasound has become an adjunct to the history and physical examination for the evaluation in a timely manner of acute pelvic and lower abdominal pain and vaginal bleeding in the female of reproductive years. Discussion of the approach to diagnosis is divided into two broad categories; evaluation when there's a positive pregnancy test (first trimester) and a negative pregnancy test. The discussion also illustrates how the emergency physician can, using ultrasound, introduce, integrate, and review, the pertinent basic sciences (anatomy, embryology, pathology, physiology, microbiology and biochemistry) with the medical student.
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