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Emergency Ultrasound

Ask the Expert: 2014: A Banner Year for Point-of-Care, Clinician-Performed Ultrasound (PoCUS)

Lawrence Melniker, MD, MS, FACEP and Robert Bramante, MD FACEP

I always enjoy the New Year and look forward to the year ahead. Rarely do I wonder: Can we do better next year than this one? - 2014 will be challenging to top from the standpoint of PoCUS.

Just a few things that made 2014 special:

Pediatrics: In 2014, we saw the start of a new organization, the P2 Group; P2 stands for Pediatric (EM) and PoCUS. In May, Jason Fischer at Toronto’s Sick Kids Hospital brought together many of the top pediatric sonologists in North America and beyond for the 1st P2 Conference. While many of our pediatric colleagues have trained many and completed fantastic scholarly activities, the advent of P2 is a watershed event that will herald a rapid expansion of the use of ultrasound in the care of children. In 2015, we will see the formal organization of P2 and the further expansion of PoCUS training in PEM programs, PICUs, and the general practice of pediatrics. If you think you have heard a lot about radiation mitigation (especially in kids) over the past few years…you ain’t heard nothin’ yet!

Cardiology: Back in the day, I went to medical school to become a cardiologist and, after seeing the light, became an emergency physician; and later added focused cardiac ultrasound (FoCUS) to my practice. Naively, I thought the cardiology world would be thrilled…I was wrong. 2014 marked the long-awaited rapprochement between cardiology and FoCUS practitioners. Starting with the landmark 2010 collaborative JASE publication by Arthur Labovitz, American Society of Echocardiography (ASE), and Vicki Noble, ACEP, et al. and concluding with the endorsement and publication of the WINFOCUS International Consensus Conference on Focused Cardiac Ultrasound, in July 2014, a new relationship begun. ACEP Immediate-Past President Andrew Sama was instrumental in bringing this about. Neil Weissman, current President of ASE, was speaker at the 10th World Congress on Ultrasound in Emergency & Critical Care Medicine in November. Collaborative education programs will be conducted by ASE and WINFOCUS globally in 2015.

Medical Education: The 3rd World Congress on Ultrasound in Medical Education (WCUME) was held in October. The 1st WCUME (2011) had 10-15 medical schools, the 2nd had about 75, and the 3rd had over 100. We end 2014 having reason to believe that by the end of the decade, most North American medical schools will have an ultrasound curriculum; but what will these curricula look like? Two independent multi-year processes beginning in 2015 will help us answer this question. An International Consensus Conference on Ultrasound in Medical Education (ICC-USME) will be convened by the Society for Ultrasound in Medical Education (SUSME) and WINFOCUS in March 2015; the first phase will address undergraduate medical education and later stages will take up curricula for residency programs and attending faculty in various specialties. Representatives from the American Medical Association (AMA), Association of American Medical Colleges, the Liaison Committee for Medical Education, and their European and Asian counterparts, will be invited to participate in the ICC-USME.

New AMA President and emergency physician, Steven Stack, spoke at ACEP14 (Scientific Assembly) and discussed the AMA’s establishment of a “Medical Education Reform Task Force” charged with a 5-year mission to generate a Flexner-like report for medical education in the 21st century, a once-in-multiple generations opportunity to impact healthcare globally. It is our great hope that the product of the undergraduate phase of the ICC-USME will be formally considered by this AMA task force and ultrasound training will become formally integrated into medical education.

So 2014 was a banner year for PoCUS, let’s do everything we can to make 2015 even better!

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