Emergency Ultrasound Section Newsletter - January 2014
State of the Section Special Edition
Year in Review: From the Immediate Past Chair - Emergency Ultrasound Section Newsletter, January 2014
Rajesh N. Geria, MD, FACEP
My tenure as section chair was filled with action, as there were many important advances on existing projects as well as some exciting new initiatives:
ACEP Resolution 33(13): Clinical Ultrasound is a Specific Imaging Modality
One of the biggest accomplishments of this year was the development of ACEP Resolution 33(13) that essentially defines clinical ultrasound as a diagnostic test and not an extension of the physical exam or stethoscope of the 21st century. The resolution was co-sponsored by NY and NC ACEP chapters, supported by the American Board of Emergency Medicine (ABEM) and passed on the council floor at ACEP13 in Seattle. I strongly believe this resolution will help eliminate “phantom scans” in the clinical setting, those that are not archived, documented or reported. In addition, it will create an accurate perception of what we do to other specialties and insurance companies. We are currently in the process of getting multi-specialty support for this resolution.
Response to “Updated” American Society of Echocardiography Commentary and FOCUS Policy
As most of you know, in 2010, ACEP and the American Society of Echocardiography (ASE) published a consensus statement on the value of focused cardiac ultrasound in the emergent setting. This year we were quite surprised when an editorial written in the Journal of the ASE questioned our training and ability to perform focused cardiac ultrasound. The author even suggested that the ASE should “help” our specialty in this regard. This was followed up by a revised expert statement from the ASE entitled “Focused Cardiac Ultrasound: Recommendations from the ASE.” This update essentially contradicted everything that was agreed upon in the original 2010 statement.
This new statement paint an entirely different picture of emergency physicians (EP) using small “inferior machines”, not having the skill to perform accurate apical four chamber views, and lacking the same practice expenses as echo labs. According to this article, EPs therefore should not be billing limited codes. Needless to say, we responded to both articles with a polite reminder that the AMA 1999 landmark resolution (CR 802) and current policy clearly states that ultrasound imaging is within the scope of appropriately trained physicians, regardless of specialty. Training and education standards are to be developed by each physician’s respective specialty society. We expressed concerned that this new ASE article is contrary to this AMA position, may possibly be construed as self-serving, and attempts to prevent well-qualified and trained physicians from providing and being reimbursed for this diagnostic modality. In addition we made it very clear that we are gravely concerned that this statement has the potential to negatively impact patient care going forward. I would like to specifically thank immediate past ACEP president Dr. Andrew Sama for his prompt attention and support in this matter.
ARDMS and Emergency Ultrasound
The American Registry for Diagnostic Medical Sonography (ARDMS) has expressed interest in creating an Emergency Medicine (EM) Ultrasound specific certification exam. A task force consisting of several section leaders was assembled and responded with concern that EM physicians would view the need to take another exam as needing a “merit badge” to practice clinical ultrasound. The Task Force EM physicians felt that it is important for the EM physician community to have ultrasound assessments within existing exams of known entities such as the ABEM and the American Board of Medical Specialties (ABMS).
The task force suggested that ARDMS should consider having discussions with ABEM to seek alliances or partnerships so ARDMS could offer its ultrasound assessment expertise within an existing, recognized EM assessment tool. We had a great break out session on this topic at the section meeting in Seattle and there will be many more such discussions within our section. As we move towards making clinical ultrasound training an official ACGME approved subspecialty we need to move away from obtaining RDMS certification, which is essentially an alternate pathway “merit badge.” I for one will not be renewing my RDMS this year.
Coming soon to your ED US Program: The Clinical Ultrasound Accreditation Program - Emergency Ultrasound Section Newsletter, January 2014
Michael Mallin, MD, FACEP
Vivek S. Tayal, MD, FACEP
ACEP13 was a big event for the Accreditation Subcommittee, also known as the Clinical Ultrasound Accreditation Program, or CUAP. The assembly marked the first broad introduction of CUAP to the ACEP Emergency Ultrasound Section and was met with excitement from members. As described at the section meeting and a town-hall style breakout session, CUAP is currently putting the finishing touches on our website and we are months away from accepting applications.
Since presenting at the ACEP Board of Directors in 2008 with the objective to develop an accreditation organization, we have been hard at work in the background developing a system that can review and accredit point-of-care ultrasound programs for meeting a minimum standard of excellence within our subspecialty. Our goals have been to promote quality, patient safety, communication, responsibility, and clarity in regards to the use of clinical ultrasound. Most importantly, however, we have developed this program as a means of assistance in the design and creation of new clinical ultrasound programs by both academic and community emergency departments. We have thus created sample documents that can be used by growing programs to help understand the standards that the 2008 ACEP ultrasound guidelines set forth, and more importantly, allows them to ask for administrative support to meet those standards.
CUAP was priced to be significantly cheaper than other accrediting programs and not designed to make a profit. New applications will cost $1500 dollars and accreditation will last for 3 years. Renewal will cost only $750. Additional departments will cost $500 for the initial application and $250 for the renewal fee.
Sometime in 2014, look for our website to go live through the ACEP domain. If you’re interested in preparing your shop for CUAP accreditation and want to get a head start, or if you just need help starting your program, the sample documents we have created are available now on the Ultrasound Section Microsite under “Running a Program”. Check them out.
Fellowship Development: Progress Toward Subspecialty Accreditation - Emergency Ultrasound Section Newsletter, January 2014
Resa E. Lewiss, MD, FACEP, Chair-elect
Committee for Subspecialty Development
The ACEP Ultrasound Section Committee for Subspecialty Development was initially formed in 2007 with the following aims: To endorse a certification or board examination process for the subspecialty. To standardize fellowship training for sub-specialists in emergency ultrasound.
In 2011, ACEP published the information paper on Emergency Ultrasound Fellowship Guidelines. That same year, the emergency ultrasound community voted to pursue Accreditation Council for Graduate Medical Education (ACGME) model for subspecialty development. The current ACGME approved subspecialties for Emergency Medicine are EMS, Toxicology, Pediatrics, Sports medicine and Undersea and Hyperbaric medicine.
Updates from 2012-2013:
This past year, a discussion ensued regarding a name for the subspecialty. As point-of-care ultrasound is not solely an Emergency Medicine competency, a more inclusive and comprehensive term was chosen: Clinical Ultrasonography.
The core content of fellowship training in Clinical Ultrasonography is a separate and unique body of knowledge not obtained during an emergency medicine residency. A reference table distinguishing resident from fellowship level applications was published the article CORD-AEUS: Consensus Document for the Emergency Ultrasound Milestone Project. A core content model for Clinical Ultrasonography Fellowship training curriculum was also drafted and submitted for publication.
Ongoing relationships were further developed in order to begin collaborating on the process of writing the ABMS and ACGME applications. The ABEM board of directors organized a group to be more responsive to the needs of the committee and to shepherd the process. They formed the ABEM Clinical Ultrasonography Task Force in December 2012.
As all 24 existing ABMS member boards must endorse the ABMS application, task force members have begun the process of contacting ABMS specialty member organizations. ABMS application was drafted. Lastly, ABMS Committee on Certification itemized responses for the ACGME was drafted.
Fellowship Development: EUSFellowships.com Updates - Emergency Ultrasound Section Newsletter, January 2014
Romolo Gaspari, MD, MS, FACEP
The number of Emergency Ultrasound Fellowships continues to grow. As of October 2013 there were 94 fellowships listed on EUSFellowships.com. For this current interview season there were 71 applicants. As an independent organization, EUSFellowships.com coordinates the fellowship application process and increases transparency for applicants by disseminating information on all emergency ultrasound fellowships.
This interview season had a few changes compared to the previous year. These changes were enacted following consultation with prior applicants and current fellowship directors. Emergency ultrasound fellowship programs agreed to wait until 11am (EST) on November 14th to offer applicants a spot for 2014-15. Applicants were then given 2 hours to consider the offer (if needed) before the fellowship program would contact other applicants. This system hopefully gave the applicants sufficient time to interview at multiple programs, while helping to prevent situations where programs placed undue pressure on the applicant to immediately accept a position after the interview.
EUSFellowships.com is changing its name! As the group has continued to evolve and grow, we are changing our structure and name to better reflect our current mission. Over the next few months EUSFellowships.com will become ASCUF, American Society of Clinical Ultrasound Fellowships. As we expand our activities, you will hear about exciting new developments related to ultrasound fellowships.
Each year the board of directors changes slightly as members who have served step down and others are appointed from ACEP and SAEM or are voted in by fellowship directors. Thank you to Drs. Mike Stone, Anthony Weekes and James Moak for their service to the board and congratulations to Drs. Andrew Liteplo and Srikar Adhikari for being newly elected to the board of directors.
Collaboration and Communication: Contributing to the Section and Finding Key Information - Emergency Ultrasound Section Newsletter, January 2014
Rajesh N. Geria, MD, FACEP
Subcommittees and New Special Interest Discussion Groups
We continue to try and encourage discussion of all ultrasound related topics and develop subcommittees so that all section members can get involved. Upon reviewing all the existing subcommittees it became clear that only a handful actually had regular agenda items and conference calls, while other subcommittees were more for specific interests.
This led to the subdivision of these groups into subcommittees and Special Interest Discussion Groups (SDG’s). For example, accreditation is a subcommittee while pediatrics is a SDG. A full listing of these can be found on the ACEP US section website. Check out all the Subcommittees and Discussion Groups at https://www.acep.org/_Ultrasound-Section-Microsite/Sub-Committees/
Clearing the List Serve Inbox Clutter while Organizing SGD Content…Work in Progress
We are currently working to create dedicated subcommittee and SDG landing sites in the forums. Then give each chair access to post topics and send links out on the list serve. Interested section members can then click those links on our section’s website at https://www.acep.org/ultrasound/. Members will then be directed into the forum discussion without congesting the list serve. This is a work in progress and requires heavy IT support from ACEP but I believe it could go a long way to juice up the forums and get more members involved and informed on areas they are interested in.
Year Ahead: From the Current Chair - Emergency Ultrasound Section Newsletter, January 2014
Christopher C. Raio, MD, FACEP
I want to first thank everyone for the support in allowing me to represent this dynamic, energetic, productive section. I am looking forward to a lot of hard work and progress in the upcoming year. It was evident in a packed house in Seattle that our section has the talent and enthusiasm to accomplish great things moving forward.
There are major challenges ahead of us. The issues of certification and accreditation are apparent. Clinical Ultrasound Accreditation Program will provide a valuable resource to Emergency Physicians, and we are excited for a successful launch as it nears beta testing. The subspecialty development team is also hard at work with our ABEM colleagues to pursue the ACGME model for subspecialty development. And finally the ARDMS has stated its desire to pursue an Emergency physician pathway to RDMS certification. The section expressed a strong desire to develop a formal written stance in response to this project, and this process is underway.
Please check out our award winning website a https://www.acep.org/ultrasound/ that now includes our forums and subcommittees. The section email listserve will continue to assist in keeping our membership updated. But the sometimes heated discussions will be moved to the forums section at https://www.acep.org/forum.aspx?param=218483. These discussions will also be cataloged to serve as a resource in the future. There are a host of other important projects actively engaging our section membership - please get involved!
Interested in Contributing? - Emergency Ultrasound Section Newsletter, January 2014
If you have a great case, an article review, commentary, tech update, or other ideas to contribute to the next newsletter, then just email John Bailitz, MD, FACEP.