Credentialing

The first step in getting credentials for you at your hospital is assessing your current level of proficiency and experience with ultrasound.  Please fill out the ultrasound experience questionnaire so we can assess your needs and provide you with any extra education you may need to gain credentials at your hospital. Our goal is to follow ACEP credentialing guidelines (see summary below) and support you in your quest to meet those education recommendations.  If you've already met those recommendations, great! If not, we'll work with you to get you there ASAP. You can meet the requirements through our online education, outside courses, MEP courses, or with personalized training with our Ultrasound Director, Dr. Matt Dawson.

The following guidelines are pulled from the ACEP recommendations.
MESA's guidelines are developed from the following recommendations.

Core Emergency Ultrasound Training - Pathways for Completion

In 2008, there are two pathways for completion of training for basic competency. See Figure 2. The pathway for physicians in residency training in emergency ultrasound is to obtain basic competency during their 3 to 4-year ACGME-approved Emergency Medicine residency program. A practice-based pathway allows those emergency physicians not previously exposed to training in emergency ultrasound during residency to become proficient in utilizing this technology. Both of these training pathways require didactic lessons, hands-on skill sessions, and a quality assurance program set up to review examinations at least until the physician has the ability to integrate this skill safely into clinical practice. The core curriculum for emergency ultrasound for both pathways is listed in Appendix 2. Residency-based Pathway. The residency-based pathway for training and proficiency in emergency ultrasound is adopted from a document written in coordination with a consensus conference sponsored by residency leaders in EM with representation by ACEP. As EM physicians integrate ultrasound into patient care in the ED, these suggestions will adapt to the EM training environment. It should be noted that the intent of the guidelines is to provide minimum education standards for all EM residency programs for reference when establishing an emergency ultrasound training program. Emergency ultrasound skills are critical to the clinical development of an emergency physician and a minimum skill-set should be mandatory for all graduating EM residents.50,51 The ultrasound education provided to EM residents should be structured to allow residents to incorporate ultrasound into daily clinical practice.52 Image acquisition and interpretation are integral to the concept of emergency ultrasound but the ability to integrate findings into direct patient care in a busy clinical environment is the ultimate goal. Specific applications are listed previously in these guidelines. Specific guidelines for residency-based US education are listed in Appendix 3. Practice-based Pathway. A practice-based pathway for physicians who have completed their residency training without emergency ultrasound training should include initial training in a 16 to 24 hour introductory course (Appendix 4) covering the core applications with practical hands-on sessions. Shorter formatted (4-8 hour) CME courses covering single or a combination of applications may also be used to cover core and other emergency ultrasound applications. Some didactic training may take place by electronic means (slide, video, internet, online tutorials, CDs, DVDs, and others) but hands-on training must be incorporated for initial training of Core Emergency Ultrasound applications.50, 53,54 A wide variety of practical training models have been used in these courses eg, didactic image presentation, video review of genuine cases, multimedia simulation models, animal models, normal human models, cadaver models, peritoneal dialysis models and patients with clinical pathology (with their consent). The training process for emergency ultrasonography should then move beyond didactic and practical hands-on training to include experiential and competency components. The experiential component emphasizes and develops the psychomotor and cognitive components of emergency ultrasound. The skill of the practitioner improves significantly with repetition and there is overlap in the learning curves of the different primary applications when they are learned together. For example, competency in one abdominal application leads to better technique and interpretation when learning other applications. This period can be viewed as a training, proctoring, or provisional privileging period. Ultrasound examinations performed during this period should be reviewed for technique, speed of image acquisition, organ definition, and diagnostic accuracy.55 Methods of determining competency include traditional testing, testing using simulator models, videotape review, observation of bedside skills, over-reading of images by experienced sonologists (expert physicians who perform and interpret ultrasound examinations), and monitoring of error rates through a quality assurance process.  Performance improvement programs that monitor accuracy will help to ensure that quality ultrasound studies are being performed. If there is no US director or established US program, a cumulative log comparing training ultrasound examinations to other imaging tests, surgical findings, or patient outcome is a reasonable process to assess competency. At the end of this period of experiential training, we recommend that at least 25 documented and reviewed cases should have been obtained in each of the core applications with a range of 25 -50 cases. Some applications such as ultrasound for procedural access require fewer cases given the prior knowledge and clinical experience with the blind procedural technique. If a number of examinations for US guided procedure is required, we would recommend 10 US-guided procedures examinations or completion of a module on ultrasound guided procedures with simulation on a high quality ultrasound phantom. Learning curves in emergency ultrasound examinations have generally used an absolute number of examinations, but competency may have other equivalents than number of exams.56-60 Examples include training in the setting of significant supervised training, experience with similar applications (eg, near-field, torso, procedural ) or research with each application. For general emergency ultrasound competency, a minimum of 150 total emergency ultrasound examinations (with a range of 150 – 250 cases) is required, depending on the number of core applications being used. For example, a department using greater than seven core applications may require more than 150 examinations. For rare abnormalities, the recognition of abnormal pathology using other means of competency testing may be used if the trainee is exposed to limited numbers of abnormal findings. Finally, regarding non-core emergency ultrasound applications, a generally accepted number of 25-50 cases per application should follow didactic training, with variations (both smaller and greater in number) depending on the applications and technical aspects of the examination.