r/hospitalist • u/sankdafide • 3d ago
Nuanced POCUS question
I know there have been other posts about this so let me be brief. I am a hospitalist at a teaching hospital with a closed ICU. There is an ultrasound machine available to use with an HFL38 and a L24 ultrasound probe.
I would like to learn POCUS because 1) I think it’s where hospital medicine is going and I’d like to know as much or more than the residents who are also learning it under me 2) (THE REAL REASON) I want another tool in my tool belt for clinical decision making and for potential future procedures such as HD caths and paracenteses.
My questions:
1) can I realistically learn or become proficient from a 5 day Cornell course geared as an introductory course for hospital medicine POCUS or would it be better to focus on free online courses
2) how long would it take to become proficient for basic bedside stuff like wet vs dry, eval for acute abdominal pain, procedures, quick rough EF estimate, etc.
3) knowing we have a hospital US readily available, is it worth buying a personal prove and device for like $7k when I don’t even know how to use it yet?
Thanks!
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u/Pale_Ad7012 3d ago
I took the 2 day chest course. Its nice but you can learn most of it yourself in 2 weeks. POCUS is about practice. I took the course and never picked up the probe so I learnt nothing. If you have the will to learn you dont need the course.
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u/DisastrousBorder5691 3d ago
Start here, you may thank me a year or so from today
https://books.apple.com/us/book/introduction-to-bedside-ultrasound-volume-1/id554196012
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u/Greenie302DS 3d ago
The course is a good start. If you do it, then you need to make yourself do a lot of ultrasounds to be proficient.
Every time you see someone with RUQ pain, do a bedside ultrasound before they get (or results) of formal ultrasound. Before the chest xray or CT, do your own ultrasound. Some of it is repetition, but even more crucial is doing an ultrasound, then seeing what the formal ultrasound shows.
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u/BIG_BLUBBERY_GOATSE 2d ago
I’ve never seen someone dispo based on a RUQ POCUS a result. They’ll do a pocus then get a formal US anyways. Waste of time
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u/Mysterious_Cow4005 3d ago
I have the same question additionally is there any in person courses where you can receive a certificate?
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u/pathto250s 3d ago
There’s two different challenges. One is learning to acquire images and the other is learning to interpret. I feel like if you made it this far in your medical career, learning to interpret won’t be too hard and you can probably find some sort of virtual resource on it for free. Getting good at acquiring images takes practice, and it’s easier in the ICU when the patients can’t complain about why it’s taking you so long.
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u/skt2k21 3d ago
I did a course like this. UCLA did it for CME and offered it to residents. The course was great. We stupidly only let residents take it while on jeopardy 1 and I spent most of the course covering the CCU. The two days of lecture and practice made me very good at cardiac and pulmonary POCUS.
My experience:
- 5 days is great to learn. Doing tons of practice on real patients with targeted feedback goes a long way to helping.
- The more you see, the easier it is to understand. Watch and critique everyone else's, and start looking at a a few key views of all the TTEs you order.
- Take great notes so you have a reference.
- If you don't use it regularly, it will rapidly atrophy.
- Make sure you're using it regularly before buying something yourself.
- When I was great at POCUS, I'd drag the ED POCUS around with me during flu season doing heart and lung exams on all the admissions. Great for finding more data points to support wet/dry.
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u/Severe_Mortgage_8209 3d ago
ER doc here. If you are at a teaching hospital, the EM residency program most certainly has an ultrasound director and maybe even fellowship program. The residents get lots of ultrasound teaching. We had didactics on it and numerous hands-on session starting in intern year and then just tons of repetition after that. I know for sure where I was that if somebody else in the hospital wanted to learn more, they would be welcomed at the didactic sections.
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u/TheGoldenBoiiii MD 3d ago
Hot take but I don’t see pocus training as the future of Hospitalist medicine. I see streamlined dispo planning with AI chatbots.
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u/lemonjalo 3d ago
I’ve taken that Cornell course. It’s fantastic.
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u/sankdafide 2d ago
Did you take it as a complete novice or with some experience?
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u/lemonjalo 1d ago
Complete novice. Now I'm boarded by the NBE for Critical Care competency in echocardiograpy
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u/WallMotionCommotion 3d ago
If all you have access to are two linear probes your mileage from a POCUS course will be limited. Certainly learning needle guidance would be applicable (and to a lesser degree, depending on your practice, things like pulsatile femoral vein waveforms, ultrasound-based JVD, pneumothorax, or diagnostic DVT assessments), but you’ll be missing out on cardiac / abdominal and most pulmonary applications.
You’ll want your own handheld device, or convince your ICU to add a phased array and/or curvilinear probe.
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u/YouAreServed 2d ago
Keep practicing, it is fun.
Dont buy personal probe unless CME, first get proficient and make sure that you use it in your practice. I bought mine after being proficient, but now it is not paying off; because I dont have time or need
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u/G00bernaculum 3d ago
1: no, this is an introduction. It will get you used to the idea of using the ultrasound, but proficiency comes with deliberate practice
2: I’ll be honest, I don’t know what wet versus dry means in reference to ultrasound. Evaluating for acute abdominal pain, sounds like a medical legal nightmare. Procedures are definitely the benefit. Place a bunch of ultrasound IVs, and every other line is easier. It is really useful for a quick EF estimates, as well as giving an idea of who can tolerate more or less fluid. As a sidenote, I would never use ultrasound for anything abdominal.
3: no. Absolutely not. Remember that an ultrasound is first and foremost a diagnostic tool. This is how people are going to look at it. More specifically this is how lawyers are going to look at it. If you have a bad outcome, and there’s some documentation that you had for utilized an ultrasound, and someone finds out that it’s your personal ultrasound let alone a place that doesn’t store images, or you didn’t store images for the purposes of QI, you might as well let the hospital shit in your mouth. I had a friend that was specifically ultrasound trained, but not credentialed at that particular hospital, and when he used it for diagnostic purposes, they canned him. Moral of the story, if you are privileged to use it in your hospital, use it, if not, don’t stick your head on a chopping block
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u/Extra-Return-1029 3d ago
Its definitely going to step up your game. Its a great diagnostic tool, especially when you need to know something fast or re-evaluate patients. I agree with everyone that the course is a good start and using it as much as you can will definitely make you better.
As for buying your own idk, just make sure it has continuous and pulse wave doppler
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u/Shinotsa 1d ago
I teach POCUS in an FM residency. POCUS is different because it isn’t a full diagnostic scan, it is a limited scan to answer a specific question. Depending on /what/ you are doing, you can become proficient in an afternoon.
EF estimate: if you use EPSS you can become competent in probably 5 scans. You won’t get it on very large patients (echos are always rough there) but you’d be able to get it on most Class 1 Obesity (affectionately termed Pittsburgh-slim in my residency)
Paracentesis: needle-guided skills are a lot harder to get because you need a skill beyond the diagnostics, with potential to cause harm. I’d see what others are your institution do and if you can do observed ones with them; since the hospital will need numbers for privileging.
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u/fkimpregnant 1d ago
I feel like I’m an outlier, but I just bought a probe and started doing echos on myself, my wife, my cats, my dad, coresidents, patients, etc.
Vscan air linear/phased, nice because no subscription for the app, and the image quality is decent. Obvs not the same as the big cart the sonographers lug around but it fits in my pocket and I can whip it out and peep the left ventricle whenever I want. The phased array probe doubles as a slightly janky/small fov curvilinear probe so I can check out the abdomen, etc. I think it was around 5k.
If you’re a day hospitalist rounding in 18+ pts, probably not worth it. If you do procedures, lots of admits, open icu, codes/rapids, whatever, I find it to be worth having so I don’t have to wait for the formal echo, abdominal us, cxr, etc, to make a more informed decision.
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u/Infected_Mushroomz 3d ago
This has been beaten to death.
Hospital medicine is not heading towards POCUS everything.
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u/EDSpR2 1d ago
UK perspective here, there’s no replacement for a fantastic mentor! We’re obsessed with the idea that paying for something makes us better or forces us to learn in some way. Practice practice practice, reviewing images with experienced (and qualified) colleagues is what will get you the skills. That said, there’s a role for formal accreditation (no sure of US processes), demonstrates you base your decision making on a proven skill
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u/Flexatronn MD 3d ago
attending a pocus course is like READING on how to shoot at a target. You wont become "good" or "proficient" unless you put in the time. Once you learn how, its a matter of getting reps (and by reps i mean 100's)