Letter to the editor: Acute Medicine Journal

2020 ◽  
Vol 19 (1) ◽  
pp. 56-56
Author(s):  
Adam Williamson ◽  
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Training Programme ◽  
Point Of Care Ultrasound ◽  
Internal Medicine Training ◽  
Acute Medicine ◽  
Front Door ◽  
Medicine Journal ◽  
Wide Range ◽  
Training Programmes

Editor- I note with interest that the Joint Royal College of Physicians Training Board curriculum for Acute Internal Medicine (AIM) has been reviewed and circulated for comment and consideration of implementation in August 2022. The proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It aims to produce a workforce that reflects the current trends of increasing patient attendances to bothprimary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with comorbidities and recognise when specialty input is require in a variety of settings, including ambulatory and critical care. The new curriculum moves away from each trainee being required to develop a specialist skill, such as medical education, echocardiography or endoscopy throughout their training1, to trainees acquiring competencies in a specialist theme for their final 24 to 30 months of their training programme after they have completed their Point of Care Ultrasound certification. The current curriculum allows trainees to have regular dedicated time to develop interests inside or outside acute medicine to supplement their professional experience and training. This often allows trainees time away from the ‘front door’, can be welcomed break from high intensity acute care and uniquely offers trainee physicians flexibility in their training programmes and curriculum requirements. This sets acute medicine training apart from other physician training programmes and can attract trainees to apply to the specialty. It also addresses Shape of Training recommendations, which suggest more flexibility and choice in career structure for postgraduate doctors.2 Point of Care Ultrasound will undoubtedly be a welcome addition to the curriculum and will benefit patients, trainees and front door services up and down the country.3 However, concerns regarding supervision and maintenance of competency exist.4 More importantly, time spent gaining competency in this before pursuing an interest in an additional area or procedure will offer trainees less time to attain accreditation in some of the existing specialist skills currently available. With ongoing concerns regarding recruitment and retention in Acute Internal Medicine5 we should be careful that we do not lose a unique selling point that acute internal medicine training offers.

Response to Letter to the editor: Acute Medicine Journal

2020 ◽  
Vol 19 (1) ◽  
pp. 57-57
Author(s):  
Ben Chadwick ◽  
◽  
Nick Murch ◽  
Anika Wijewardane ◽  
◽  
...  
Keyword(s):  
Internal Medicine ◽  
Acute Care ◽  
Working Group ◽  
Point Of Care ◽  
Early Years ◽  
Point Of Care Ultrasound ◽  
Acute Medicine ◽  
Front Door ◽  
Medicine Journal ◽  
Wide Range

Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care. Contrary to the situation described in the correspondence, the new curriculum does not move away from each trainee being required to develop a specialist skill, such as medical education, management, stroke medicine or focused echocardiography. Trainees will still need to acquire competency in a specialist skill for their final 36 months of their training programme, usually after they have completed their Point of Care Ultrasound (POCUS) certification. The thinking behind introducing mandatory POCUS in the curriculum is that: POCUS is in the proposed curricula for intensive care medicine, respiratory medicine and emergency medicine, therefore we feel that in order to recruit the best trainees it is imperative POCUS training is offered as standard As evidenced by the trainee surveys, they often do not get allocated time to develop their specialist skill, especially in the early years of Higher Specialty Training before they often have decided on a particular skill. The introduction of mandatory POCUS training should legtimise time off the ward to obtain this skill early in training. POCUS is becoming more and more standardised in 21st Century acute care alongside the reducing costs of Ultrasound probe e.g. Philips Lumify and Butterfly iQ which are compatible with smart phones POCUS has been heralded as the fifth pillar of examination (observation, palpation, percussion, auscultation, insonation)1 The proposed curriculum therefore facilitates trainees to have regular dedicated time to develop interests inside or outside acute medicine to supplement their professional experience and training. This will also enable trainees to have time away from the ‘front door’ high intensity acute care. Mandatory POCUS will continue to set AIM training apart from other physician training programmes and continue to attract high quality trainees to apply to the specialty. Formal feedback seen at the SAC meeting in October 2019 to the draft curriculum (personal correspondence from JRCPTB) showed a positive response from nine individuals, an ambivalent one from two people, and only two against the introduction of formal POCUS training in the curriculum. Point of Care Ultrasound will likely be a welcome addition to the curriculum and will benefit patients, trainees and front door services up and down the country. Concerns regarding supervision are being addressed by the POCUS working group, in anticipation of the lead in period of well over two years. It is anticipated that most trainees can achieve POCUS sign off (e.g. Focused Acute Medical Ultrasound) in 6 to 12 months (personal correspondence Nick Smallwood from POCUS working group). With ongoing concerns regarding recruitment and retention in Acute Internal Medicine we agree strongly that with POCUS inclusion, we have a further selling point for AIM training.

scholarly journals The balancing act: the variation among deaneries across Great Britain regarding provision of focus on diabetes and endocrinology training

2018 ◽  
Vol 18 (1) ◽  
pp. 22-24
Author(s):  
Adnan Agha ◽  
Baldev Singh ◽  
Wasim Hanif
Keyword(s):  
Internal Medicine ◽  
Great Britain ◽  
General Internal Medicine ◽  
Medical Specialty ◽  
Training Programme ◽  
Internal Medicine Training ◽  
Accreditation Training Programme ◽  
General Internal ◽  
Accreditation Programme ◽  
Training Programmes

Diabetes and endocrinology is a medical specialty, and a five-year dual accreditation training programme in diabetes and endocrinology and general internal medicine is offered, with active participation in medical on-call rota. Some deaneries offer some respite from the ever-increasing general medical workload by offering a few months of training focusing only on specialty work in diabetes and endocrinology. The authors wanted to see if this experience is available uniformly to all the trainees in diabetes and endocrinology/ general internal medicine across Great Britain. To assess this, a survey of specialist training registrars on a dual accreditation programme for diabetes and general internal medicine from all deaneries in England, Scotland and Wales was performed by directly interviewing and asking them about any relaxation in either their on-call or ward commitments to focus on diabetes and endocrine specialty during their five years of training. The results showed that the acute take/general medical commitment-free training periodfocusing only on diabetes and endocrinology ranges from zero in some deaneries to nearly three years in others. This simple survey highlights the extent of variability that exists in dual diabetes/endocrinology and general internal medicine training programmes across deaneries in England, Scotland and Wales, which may increase further once the training programme is reduced to four years after new changes from Shape of Training.

scholarly journals Focused Acute Medicine Ultrasound (FAMUS)

2018 ◽  
Vol 17 (3) ◽  
pp. 164-167
Author(s):  
Karim Fouad Alber ◽  
◽  
Martin Dachsel ◽  
Alastair Gilmore ◽  
Philip Lawrenson ◽  
...  
Keyword(s):  
Focused Ultrasound ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Curriculum Mapping ◽  
Acute Medicine ◽  
Good Medical Practice ◽  
Steady Growth ◽  
Core Skill ◽  
Training Programmes ◽  
Mapping Exercise

Point of care ultrasound (POCUS) has seen steady growth in its use and applications in aiding clinicians in the management of acutely unwell patients. Focused Acute Medicine Ultrasound (FAMUS) is the standard created specifically for Acute Medicine physicians and is endorsed by the Society for Acute Medicine and recognised by the Acute Internal Medicine (AIM) training committee as a specialist skill. In this document we present a curriculum mapping exercise which utilises a ‘knowledge, skills and behaviours’ framework and incorporates the GMC’s ‘Good Medical Practice’ (GMP) domains. We believe this will provide a standard for consideration of integrating focused ultrasound in AIM training programmes, with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.

scholarly journals The balancing act: the variation among deaneries across Great Britain regarding provision of focus on diabetes and endocrinology training

2018 ◽  
Author(s):  
Adnan Agha ◽  
Baldev Singh ◽  
Wasim Hanif
Keyword(s):  
Internal Medicine ◽  
Great Britain ◽  
General Internal Medicine ◽  
Medical Specialty ◽  
Training Programme ◽  
Internal Medicine Training ◽  
Accreditation Training Programme ◽  
General Internal ◽  
Accreditation Programme ◽  
Training Programmes

Diabetes and endocrinology is a medical specialty, and a five-year dual accreditation training programme in diabetes and endocrinology and general internal medicine is offered, with active participation in medical on-call rota. Some deaneries offer some respite from the ever-increasing general medical workload by offering a few months of training focusing only on specialty work in diabetes and endocrinology. The authors wanted to see if this experience is available uniformly to all the trainees in diabetes and endocrinology/ general internal medicine across Great Britain. To assess this, a survey of specialist training registrars on a dual accreditation programme for diabetes and general internal medicine from all deaneries in England, Scotland and Wales was performed by directly interviewing and asking them about any relaxation in either their on-call or ward commitments to focus on diabetes and endocrine specialty during their five years of training. The results showed that the acute take/general medical commitment-free training periodfocusing only on diabetes and endocrinology ranges from zero in some deaneries to nearly three years in others. This simple survey highlights the extent of variability that exists in dual diabetes/endocrinology and general internal medicine training programmes across deaneries in England, Scotland and Wales, which may increase further once the training programme is reduced to four years after new changes from Shape of Training.

scholarly journals The Use of Lung Ultrasound in Acute Medicine

2019 ◽  
Vol 18 (4) ◽  
pp. 239-246
Author(s):  
Prashant Parulekar ◽  
◽  
Tim Harris ◽  
Robert Jarman ◽  
◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Point Of Care ◽  
Good Evidence ◽  
Point Of Care Ultrasound ◽  
Acute Medicine ◽  
Wide Range ◽  
Recent Addition ◽  
Pleural Catheter ◽  
The Uk

POCUS (Point of Care Ultrasound) refers to ultrasound performed by clinicians as part of their initial patient evaluation, often with the aim of answering a specific question as opposed to being a comprehensive assessment. Such ultrasound is noninvasive, involves no radiation and can be rapidly performed at the bedside. It is also widely practiced in emergency and intensive care medicine leading to earlier and more accurate diagnoses for a wide range of presentations such as shock, renal failure and dyspnoea. POCUS has evolved from cardiological or radiological studies, reduced in complexity and scoped for clinician use. Lung ultrasound (LUS) has been largely developed by acute care clinicians and is a more recent addition to POCUS. Procedural LUS is widely recommended to improve the safety profile of pleural catheter placement (referring to BTS guidelines) but in the UK diagnostic LUS is not widely practiced despite good evidence and guideline support for its use. In this article we briefly review and describe the role of diagnostic LUS as applied to acute medicine. Potential advantages of LUS include a decreased time to diagnosis, improved diagnostic accuracy, a reduction in radiation exposure and unnecessary expensive tests. Studies have shown that at least one diagnosis was missed in around a fifth of patients with acute respiratory symptoms, resulting in increased length of stay and mortality in a third of patients.

scholarly journals Point-of-care ultrasound as a competency for general internists: a survey of internal medicine training programs in Canada

2016 ◽  
Vol 7 (2) ◽  
pp. e51-69 ◽  
Author(s):  
Jonathan Ailon ◽  
Maral Nadjafi ◽  
Ophyr Mourad ◽  
Rodrigo Cavalcanti
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Clinical Use ◽  
Internal Medicine Training ◽  
Program Leaders ◽  
University Of Toronto ◽  
General Internal ◽  
General Internists ◽  
The University

Background: Point-of-care ultrasound (POCUS) is increasingly used on General Internal Medicine (GIM) inpatient services, creating a need for defined competencies and formalized training. We evaluated the extent of training in POCUS and the clinical use of POCUS among Canadian GIM residency programs.Method: Internal Medicine trainees and GIM Faculty at the University of Toronto were surveyed on their clinical use of POCUS and the extent of their training. We separately surveyed Canadian IM Program Directors and Division Directors on the extent of POCUS training in their programs, barriers in the implementation of POCUS curricula, and recommendations for POCUS competencies in IM.Results:  A majority of IM trainees (90/118, 76%) and GIM Faculty (15/29, 52%) used POCUS clinically. However, the vast majority of resident (111/117, 95%) and GIM Faculty (18/28, 64%) had received limited training. Of the Program Leaders surveyed, half (9/17, 53%) reported POCUS clinical use by their trainees; however only one quarter (4/16, 25%) reported offering formal curricula. Most respondents agreed that POCUS training should be incorporated into IM residency curricula, specifically for procedural guidance.Conclusions: A considerable discrepancy exists between the clinical use of POCUS and the extent of formal training among Canadian IM residents and GIM Faculty. We propose that formalized POCUS training should be incorporated into IM residency programs, GIM fellowships, and Faculty development sessions, and identify POCUS skills that could be incorporated into future IM curricula.

scholarly journals 145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

2020 ◽  
Vol 37 (12) ◽  
pp. 839.1-839
Author(s):  
Dominic Craver ◽  
Aminah Ahmad ◽  
Anna Colclough
Keyword(s):  
Point Of Care ◽  
District General Hospital ◽  
Training Programme ◽  
Service Evaluation ◽  
University Hospital ◽  
Junior Doctors ◽  
Point Of Care Ultrasound ◽  
Face To Face ◽  
Point Of Care Diagnostics ◽  
Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

Innovation Through Collaboration: Creation of a Combined Emergency and Internal Medicine Point‐of‐Care Ultrasound Fellowship

2018 ◽  
Vol 38 (8) ◽  
pp. 2209-2215 ◽  
Author(s):  
Cameron M. Baston ◽  
Paul Wallace ◽  
Wilma Chan ◽  
Anthony J. Dean ◽  
Nova Panebianco
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound

scholarly journals Curriculum mapping for Focused Acute Medicine Ultrasound (FAMUS)

2018 ◽  
Vol 17 (3) ◽  
pp. 168-168
Author(s):  
Karim Fouad Alber ◽  
◽  
Martin Dachsel ◽  
Alastair Gilmore ◽  
Philip Lawrenson ◽  
...  
Keyword(s):  
Focused Ultrasound ◽  
Point Of Care ◽  
Evidence Base ◽  
Response To Treatment ◽  
Point Of Care Ultrasound ◽  
Curriculum Mapping ◽  
Acute Medicine ◽  
Portable Ultrasound ◽  
Sonographic Assessment ◽  
Radiology Training

Dear sir/madam, Point of care ultrasound (POCUS) in the hands of the non-radiologist has seen a steady growth in popularity amongst emergency, intensive care and acute medical physicians. Increased accessibility to portable, purpose-built ultrasound machines has meant that clinicians often have access to a safe and non-invasive tool to enhance their management of the unwell. Focused Acute Medicine Ultrasound (FAMUS) is the point of care ultrasound curriculum created to aid the management of the acutely unwell adult patient. Following a survey of trainees and consultants, it was apparent that there was a strong desire for Acute Medics to be able to use point of care ultrasound to aid their clinical diagnostic skills. The FAMUS committee was set up to develop competencies using the evidence base available. FAMUS stands in contrast to traditional radiology training modules, which focus on carrying out comprehensive assessments of anatomy and pathology. Instead, FAMUS delivers a syndrome-based sonographic assessment with the aim of ruling out gross pathology and interrogating underlying physiology. It serves as a useful adjunct to history and clinical examination by way of providing key information quickly and non-invasively. Furthermore, it provides a feasible way to monitor response to treatment or progression of disease and thereby providing useful dynamic information quickly and safely. The accreditation in FAMUS involves the sonographic assessment of three systems: lung, abdomen and the deep veins of the lower-limb. Accrediting in each one involves theoretical learning, a formal course attendance and achieving a set number of supervised and mentored scans. As well as technical skills, the candidate must demonstrate competence in recognising key pathology and drawing appropriate conclusions about each scan, including when to refer for departmental imaging. FAMUS was met with enthusiasm by trainees and consultants in acute medicine, and its popularity rises as more courses are becoming available for accreditation paired with increasing access to portable ultrasound units. It is envisioned that this will continue to grow and formal ‘train the trainer’ courses have been held in order to increase the pool of available supervisors. Currently, FAMUS is endorsed by the Society for Acute Medicine and recognised by the AIM training committee as a specialist skill that can be undertaken during specialist training. It has been proposed that FAMUS should be considered for integration into the acute internal medicine (AIM) curriculum, which will be re-written for 2022 in line with the GMC’s revised standards for curriculum and assessment. Thus we present in this letter, a curriculum mapping exercise that utilises a ‘knowledge, skills, behaviours’ framework in order to be considered for the AIM curriculum rewrite. We believe this will provide a standard and framework to integrate focused ultrasound in AIM training programmes with the aim of ultimately incorporating FAMUS as a core skill for all AIM trainees.

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