Emergency Medicine Ultrasound Level 1: Resources

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Background

In 2010, College of Emergency Medicine’s Ultrasound Subcommittee (USSC) recognised that some Consultants and trainees in Emergency Medicine, particularly in London and the South East, were finding it difficult to find sufficient opportunities to carry out scans and log experience as part of their hands-on training towards Emergency Ultrasound Core (Level 1) competence, and that some others were finding it difficult to arrange formal assessment. Many Ultrasound trainers and trainees reported that they were finding it logistically challenging, resource intensive and time-consuming to arrange training opportunities and formal assessment.

With the above in mind, USSC agreed to work in collaboration with Infomed Research and Training in the design and implementation of the RCEM Emergency Ultrasound Core (Level 1) ‘Finishing School’ – two days of training and assessment. Since 2010, the Finishing School has been running three to six times each year.

In July 2017, RCEM’s Ultrasound Subcommittee was disbanded. Also, RCEM decided that it would no longer involve itself in the approval or accreditation of external educational or training activities. However, because of continued interest, Infomed has agreed to continue to run the School as previously, without changes, but as an Infomed event. Each School will continue to be directed by one or more Regional Leads.

Guidelines

Who is it for?

Day 1: The Finishing School Practice Sessions

The Practice Sessions are for the doctor seeking:

intensive supervised hands-on practice in each of the competence areas (FAST, AAA, Vascular Access and ECHO in Life Support) before being assessed on Day 2
opportunities to complete logged experience
opportunities to practice ultrasound (RCEM recommends that no more than 3 months should elapse without the trainee using her/his US scanning skills, otherwise the trainee must be re-assessed with a DOPS by a trainer.)

What you get?

Expert supervision from qualified Assessors: You will get scanning experience in an OSCE-style environment, based on clinical scenarios, as well as feedback in line with the expected competences.
Personalised feedback: You will receive immediate feedback on your performance – perfect preparation for doctors who have booked to be assessed on the following day.
Familiarity with the Assessment format: You will get familiar with the Assessment format.
Practice: The opportunity to perform AAA scans, FAST scans, ECHO scans and Vascular Access scans on models, patients (where available) and phantoms, which can serve as preparation for assessment or simply form part of you logged experience.

Day 2: The Finishing School Formal Assessment

For the doctor who needs and feels ready to be assessed formally in all four of the competence areas, with a view to final sign-off.

To secure a place, the candidate will need to demonstrate in advance that s/he has completed the “Theoretical and hands-on training” and “Logged experience” sections of the Triggered Assessment, that is:

Completed all six E-Learning modules and/or completed a approved Level 1 course
(e.g. Barts Health/Infomed EM US L1 course) or local modular training
Carried out scans [log book] – You must bring it with you
Produced follow-up notes and reflective writing on 10 case studies

What you get?

Assessment in all four areas of competence:

The candidate will be assessed in each of the four areas of competence, i.e. AAA, FAST, Vascular Access and ECHO in Life Support – as outlined in sections A, B, C and D of your Triggered Assessment

The Curriculum and Sections A, B, C and D of the Triggered Assessment

Each Assessment:

In each area of competence, you are asked to perform four scans, each based on a different clinical scenario. In each area of competence, you are assessed on the basis of all four scans performed. Note that as part of the assessment, you may be scanning on ‘normal’ live models, patients and/or phantoms/mannequins, and you will be asked to scan on a range of different ultrasound machines. Each area of competence is assessed in around 40 minutes. All four areas of competence are assessed in around 4 hours (including breaks, briefing and debriefing sessions).

The Assessment is strictly in line with criteria. Candidates should appreciate that the decision of the Assessors is final and independent of Infomed.

Assessors: The Assessors are experienced Faculty qualified to undertake Level 1 Assessment.

Final sign-off: By the end of the Assessment Session, successful candidates will get final sign-off, i.e. will be certified as competent in Level 1 (Core) Emergency Ultrasound.

Changes in RCEM guidelines on CPD and Emergency Ultrasound Core (Level 1) Training

[1] As you may already know, RCEM will no longer involve itself in the CPD approval or accreditation of external educational or training activities, or the award of CPD points or credits. It has agreed that “the focus of CPD should be on its quality and reflection of its impact on a doctor’s practice, rather than the amount of time spent on the activity and that the responsibility for identifying CPD requirements rests with the individual and should be based on their personal areas of practice and personal development plan agreed at their annual appraisal”. For further details, see RCEM’s CPD events page.

[2] In relation to RCEM EM US Core (Level 1) training, the requirement “to attend an RCEM-approved course covering basic theory” will now be “to attend a course covering basic theory” ;the Infomed Core (Level 1) Course remains eminently suitable under this revised criterion.

[3] In relation to the EM US Core (Level 1) Finishing School. The RCEM EM Ultrasound Core (Level 1) Finishing School was set up by RCEM Ultrasound Subcommittee (USSC) in collaboration with Infomed Research and Training, and has been running several times a year since 2011. RCEM Ultrasound Subcommittee is now been disbanded. However, the Finishing School will continue to run as previously, without changes, as an Infomed event, independent of RCEM. Each Finishing School will continue to be directed by one or more Ultrasound Regional Leads.

If you have any queries, feel to call us on 020 3236 0810.

Guidance on log book and logging scans

Your log book should:

include scans in all L1 competences (AAA and FAST and Echo for Life Support and Vascular Access), not just two or three competences only;
be produced over a reasonable period of time of sustained scanning (over three to six months), not just over a few short weeks;
include a reasonable number of scans (although the competency framework sets no minimum number of scans, most L1 trainers and assessors would suggest around 50 scans, half directly supervised;
RCEM L1 guidance used to specify – but no longer specifies- a minimum of 20 AAA, 20 FAST and 10 Vascular Access).

Each entry should:

log the scan fully (date and patient ID, indication for scan, scan findings, supervisor’s signature); and
describe the findings clearly and fully (i.e. three or fours words will just not do!).

Downloads:

Please download and print the following files and place them in a folder to keep a log of all of your Ultrasound scans in preparation for the Finishing School:

Scan Log – AAA

Scan Log – FAST

Scan Log – Vascular access

Scan Log – ECHO

Scan Log – Other scans

May not contribute to US Finishing School requirements

Guidance on case studies

Your case studies should:

include cases in all Core (Level 1) competences (AAA and FAST and Echo for Life Support and Vascular Access), not just two or three competences only; and
be produced over a reasonable period of time of sustained scanning practice (over three to six months), not just over a few short weeks.

Each case study should:

be fully documented (date of scan, patient initials, age, gender, location, emergency or elective, equipment, indication for scan, findings and outcome, reflection, images – see the template); — describe the findings and outcome fully;
demonstrate clearly that you have reflected on your scanning practice (for example, describing what you did well and what you didn’t do well, describing what you have learned, explaining how you will modify your practice, identifying areas for development, indicating how you intend to
improve further) (i.e. two or three quick lines will just not do!);
include images, either printed or on a USB stick or other device.

NB Faculty will expect images to be provided, and the reasons for failure to do so will be subject to faculty adjudication.

Case study form

Follow up notes and reflective writing

E-Learning

Please use the following link in order to register and access the the Ultrasound E-Learning modules:

http://www.rcemlearning.co.uk/curriculum/ultrasound/

Level 1 Ultrasound Presentations

Please use the following links to download and view presentations from the Level 1 Courses that have taken place recently.

Hands-on emergency ultrasound practice scanning stations