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Emergency Ultrasound

Ask the Expert: Why Should Emergency Physicians Train Physician Assistants in Ultrasound During Emergency Medicine PA Fellowships?

Robert M. Bramante, MD, FACEP 

Moises Moreno, DO
Director of Residency Ultrasound Education
Assistant Professor, NY Institute of Technology
Good Samaritan Hospital Medical Center
Progressive Emergency Physicians, PLLC

Point of care ultrasound (POCUS) is widely used in emergency departments (ED) throughout the nation to provide rapid and critical information at the bedside. Mounting research continues to demonstrate that POCUS benefits ED patients. Emergency medicine physicians have become increasingly competent in POCUS, largely due to the education received during residency.

Physician assistants (PAs) play a vital role in providing emergency care in the United States. In many facilities, PAs are expected to see patients independently and expedite care through the ED with minimal guidance by an ED physician. Many PAs choose to obtain further training through emergency medicine fellowships, which provide the opportunity to specialize in the nuances of emergency medicine, including procedures pertinent to the ED. These fellowship programs have grown rapidly in the last few decades. However, just as for an emergency medicine physician, the emergency PA should receive training in POCUS in order to improve patient safety and quality care in the ED. The lack of formal ultrasound training represents a major barrier to the incorporation to POCUS in clinical practice.

Within emergency medicine residency training programs, POCUS education is standardized, and residents are required to show mastery of specific imaging protocols, as well as log a specific number of scans prior to graduation. These requirements are prescribed through the ACEP Ultrasound Guidelines and the ACGME. Because of this, all residents completing an EM residency program are expected to demonstrate proficiency in POCUS. The goal is that this training will allow young physicians to employ the use of POCUS to improve quality of care.

While emergency medicine residencies now incorporate POCUS into their training curriculum, training for emergency PA fellows is far more varied, with many receiving little to no official training in POCUS. With the success of structured resident POCUS training, a paralleled approach should be taken to PA education. Similar to other procedural skills, learning to perform POCUS in the ED requires hands-on experience. Ultrasound is an operator-dependent skill and becoming proficient necessitates formal training under the guidance of physicians trained specifically in POCUS. Further, those trained in POCUS and who incorporate it into their practice often become advocates of its use in the ED and share their knowledge with others. Similarly, after acquiring POCUS training, PAs will be able to utilize POCUS skills and show that the implementation of such skills into training is not only valuable, but also directly improves care. The training of EM PAs in POCUS should be mandated and structured with the hopes that, in the future, it will have guidelines similar to residency training programs.

Despite the fact that POCUS is a clinical adjunct that has become so prevalent in the ED, it continues to remain underutilized by the ED PA community. POCUS education should be integrated into the curriculum for EM PA fellowships. As part of the EM community, ED physicians have a responsibility to train PA fellows in POCUS as a way of improving patient care and ED throughput. Creating a structured curriculum to be taught during emergency PA fellowship will contribute significantly to the incorporation of POCUS into the practice of the PA community.

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