Emergency Ultrasound Section Forum
Backing UP Bedside Ultrasound Studies
I have a question regarding resident ultrasounds. Is your ultrasound division/residency requiring a follow up imaging study for resident ultrasounds when they are 1) working clinically and/or 2) on their ultrasound rotation scanning without an US trained attending?
Our program is having an old, but renewed discussion regarding the need for follow up imaging studies after a resident performed and interpreted study. We are looking to collect some information on how other institutions are dealing with this situation.
Any input you have would be great! Feel free to respond to the group or privately to my email address.
Cara Brown, MD RDMS
Division of Emergency Ultrasound
Staten Island University Hospital | Department of Emergency Medicine
You are presenting a time honored question. Several issues arise with "educational" studies that are not used for medical decision making. Our biggest concern with educational only studies was that some other provider might thing the patient had a formal study when the patient did not. For a long time, we encouraged residents to document in the chart that a preliminary bedside US was performed. If the attending did not have US privileges, a formal US was required to make any medical decisions. If the attending had US privileges, he/she could confirm the resident scan and document it.
More recently, we have gotten most of our attending physicians credentialed in US. It is now less if an issue as the attending can now confirm the resident study as needed. However, we had discouraged "educational only" ultrasound studies such as "Oh that patient has a known AAA, let me take a quick look at it while they are here for their ankle sprain."
Michael Baker, MD
One of the biggest concerns most facilities have is regarding credentialing. Most residents cannot be credentialed but attendings can.
This becomes a liability issue as well as a patient safety issue when residents scan without a qualified attending supervising. Many residents can correctly interpret images (better than some attendings!) but are technically still learning and not credentialed to do this.
If your malpractice carrier is agreeable to non-credentialed scanning for medical decision making, then it's probably ok to proceed. However, most malpractice carriers are not. This is why many programs have direct oversight or very close QA follow up on scans done by residents.
And I agree with Dr. Baker about education of the patient regarding the scans. Their interpretation of what is happening can be challenging sometimes, particularly if something important is missed.
Does this make sense?
Dawn M Prall, MD