Denver Health Intern Curriculum

This is an extremely self-driven educational experience. We know you are all strong adult learners, and we expect you to work hard to make the most of this rotation. In order to maximize your learning experience, we have provided online modules with rich multimedia that should appeal to learners of all types. It is imperative that you take responsibility for reviewing all recommended readings and online resources prior to meeting with us.

Access your online modules at dhha.butterflynetwork.com Under the Education tab, then “Butterfly Academy”. These are due by the end of week 1.

Fellows or faculty will meet with you (pre-arranged via email) and give a brief review (< 10 min) of the ultrasound topic(s) for your week. They will also orient you to the machines and how to upload.

You are expected to scan everyday of your rotation. At least 2 of these days will be supervised or on shift with one of our fellows or faculty.

In accordance with CORD and ACEP guidelines, we expect you to record 150 scans during your two weeks of rotations and 200 by the end of your intern year. These must be backed up on saved on the cloud. Instructions/how to upload to the cloud are found here.

Any US guided procedures or simulation should also be logged in MyTipReport. The goal for each week is 75-100 scans. This means 100 “exam types” or organ systems which could be on far fewer patients than this.

Example strategy: FRAGLE each patient - (e)FAST, renal (same view but in two planes), aorta, gall bladder, lung (already done in the eFAST), echo (did subxiphoid as eFAST, just pursue other echo views). This is default 6 organ systems plus anything extra you may do… like the IVC. Each exam type tagged on butterfly will count as a point!

Every Thursday you will join us for didactics with the fellows and tape review. This is mandatory and typically occurs on Thursdays at 12:00 in 601 Broadway on the 6th floor, room 671.

Expectations:

Come in person for video review.

Bring a point-of-care ultrasound based paper to critically appraise and discuss.

Attend lecture and scan with ultrasound faculty after the lecture to solidify knowledge.

The first Friday of your first US week, we take you to the Denver Health Sim Lab to practice ultrasound guided procedures from 9a-12p!

Make sure to log these in MyTipReport!

200 for intern year, 150 for intern 2 weeks all/any organs. If you capture 200 exam types and the following specific types of studies, you are eligible to win a prize at residency award ceremony.

Specific goals:

FAST/EFAST: 25

Lung: 25

Cardiac: 20

IVC: 10

Gyn/TAUS/TVUS/Pelvic: 20

Soft tissue/abscess: 10

Aorta: 10

Biliary: 10

Renal: 10

Bladder: 5

Ocular: 10

Nerve Blocks: 10

Vascular Access/Procedural Guidance: 10

Other: 20 (PTA, DVT, appy, SBO, anything not mentioned)

Master point-of-care ultrasound in the critically ill. Integrate echo, lungs, IVC and eFAST into the evaluation of the critically ill and dyspneic patient.

Become fluent in performing and interpreting the eFAST exam.

Understand the basics of echocardiography anatomy and physiology. Master the essential evidenced-based, clinical questions that we can answer instantly at the patient’s bedside. Integrate these concepts by understanding the cardiac physiology of the critically ill.

Rapidly and accurately narrow the differential in the acutely dyspneic patient. Integrate lung ultrasound with resuscitation strategies.

Understand how IVC may serve as a surrogate for preload in various shock states.

Understand the fundamentals of procedural guidance, especially for peripheral and central venous access.

Integrate diagnostic ultrasound into your workflow to change management and facilitate patient throughput.

Image acquisition and interpretation of can’t miss diagnoses of the aorta.

Diagnostic integration of the renal system utilizing ultrasound.

Master key image acquisition and interpretation in the evaluation of RUQ pain and the hepatobiliary system.

Confirmation of intrauterine pregnancies and the evaluation of unstable pregnant patients. Basic techniques of fetal dating.

Master shock states and key components of the RUSH exam. This will unite all of the specific goals of the rotation.