Section Editor: Robert M. Bramante, MD, FACEP
Interview with Michael Felicetta, DO
Clinical Ultrasound Program Director, Good Samaritan Hospital Medical Center, Progressive Emergency Physicians
What are the challenges you face as a new ultrasound fellowship director?
When starting an emergency ultrasound division, there are many factors to consider and hurdles to overcome. These considerations may vary widely among different institutions, depending on the available resources, the culture of the institution, and practice setting. As a relatively new ultrasound fellowship director at an academic emergency department, I would like to share my experiences with this task.
The first order of business in starting a program is determining the department’s goals for the ultrasound division, as well as assessing the ultrasound resources already present and political issues at play in the institution. Depending on the systems in place prior to starting, there may already be machines with workflow solutions and QA/credentialing policies in place, although more likely, that will not be the case. There are many resources available on the ACEP Ultrasound Section website that are extremely helpful when starting a program from the ground-up, which is something I found extremely useful. I am lucky enough to be at an institution where my chair and administrators are even more experienced in emergency ultrasound than I am; however, most will not be so lucky and may have a difficult time navigating political/cultural issues at their institution while the program is in its infancy.
Then comes the training of faculty and residents. In the absence of a structured ultrasound division, you can expect a significant variation in ultrasound proficiency among providers. Some will be enthusiastic and embrace bedside ultrasound, while others may not. Taking time out to teach during clinical shifts goes a long way in both educating faculty and demonstrating the positive impact bedside ultrasound can have on patient care, safety, and satisfaction. For me, it was when I first saw my ultrasound director diagnose a type A dissection on bedside ultrasound 10 minutes after patient arrival that I was officially sold on its utility (shout out to Jerry Chiricolo). Coming in for “scan days” and educating faculty at the bedside can also go a long way in improving their skills and spiking their interest in ultrasound. At my institution, I have found that most faculty (and all residents) respond very well to this and are eager to learn when the occasion presents itself. When performing QA, providing constructive feedback (and giving props when due) is also important for educational purposes, but also comes with its own challenges. At first, there will be some staff who may have a false heightened perspective of their ultrasound proficiency, and it may take tact to educate them further without them becoming offended.
When you contemplate starting an emergency ultrasound fellowship, it brings even more considerations into play. At this time, you have to think about fellow education and try to get adequate faculty-protected time to ensure hands-on time with fellows on the scanning shifts (at least in the beginning of their fellowship). The extent to which this is needed is obviously dependent on the number of fellows you have and the number of credentialed ultrasound faculty members in your division. If you are successful in recruiting an adequate amount of trained faculty, this (as well as the remainder of the duties of the ultrasound division) can be accomplished relatively simply. However, if you are alone or short-handed, that will not be the case, and you may encounter some difficulties with time management.
Though not all-inclusive, these are the majority of challenges/considerations I have encountered as a new fellowship director. While mildly anxiety provoking, it’s important to consider that “Rome wasn’t built in a day.” Neither, for that reason, are ultrasound divisions. While it may be challenging, if you use the resources at your disposal and look to colleagues for advice, it can be very rewarding and help improve patient care in your community.
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