Emergency Ultrasound Fellowships Romolo Gaspari, MD, MSc, RDMS President, SAEM Emergency Ultrasound Interest Group Division

Director, Emergency Ultrasound Division University of Massachusetts, School of Medicine Overview o A comparison of fellowships o What do you learn during US fellowship? o Pros and cons of US fellowships o What do you do after the fellowship Why do a Fellowship? o Reasons that are commonly provided concerning why you should do a fellowship sometimes miss the mark. Common reasons are the following; o I want to work in academics. o I really like ________. o It will help my career. o Im not ready to be an attending yet. o I want to work at ______ and they need a _________. All of these reasons are minor reasons. The only reason to do a fellowship is because you like it. A quick comparison of fellowships

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A quick review of EMS fellowships o You are trained to go out and run a large city EMS system o The problem is there are not that many large city EMS systems and the jobs are taken. o Many graduates from EMS fellowships end up not using their training other then interacting with local EMS systems o Disaster medicine has been rolled into EMS and is being split out in many academic institutions. It is a natural fit with EMS but current focus means it may become its own fellowship. o Many business want consultants with disaster training. A quick review of Toxicology o You are trained to go out and work at a Toxicology center or see

toxicology patients o We all get toxicology training in residency but it is a large field and fellowship training helps. o You become a consultant, is that what you want. o You get to think a lot but common things are common. A quick review of pediatrics o You are trained to see pediatric patients o We all get pediatric training in residency o Do you need to be fellowship trained? Yes and no. It depends on the location, not on your training. Pediatric EDs primarily hire pediatric trained MDs. o You limit your job search to Urban hospitals, pediatric EDs. o Your salary suffers. A quick review of Disaster Fellowships o It all depends on the training you will receive. Will you learn enough to go out and be successful? It gets down to what do you want to do? o You can run the hospitals disaster planning. You can interface with businesses that want to structure their company in anticipation of a disaster. You can interface with government agencies. o You are going to do a lot of administrative work. o This field is evolving. A quick review of Research Fellowships o Most research fellowships in emergency medicine are shams. They provide cheap labor for the emergency department o If you want to do a research fellowship, do it with a person who is accomplished in research even if they are not in emergency medicine. o There are a lot of ways to get funding for a research fellowship if you plan ahead. Dont settle for the research fellowship where you are a resident! (unless you have accomplished funded researchers in your department) o Think about clinical and bench-top research. What do you want to do with your research career? Pros and Cons of Ultrasound? o Fellowship training does not isolate you from ED patients o Patients love it. o It is satisfying to interact with patients o You feel valuable to the department JOB SATISFACTION How to Apply for an Ultrasound Fellowship o No formal match o Apply separately to each program o Programs accept on a rolling admission o Each fellowship does things a little differently Website for Emergency Ultrasound fellowships o ACEP and SAEM websites

o www.eusfellowships.com o this is a new site but almost every program is participating o it is designed to compare programs - apples to apples Whats on the Emergency Ultrasound website o Information on fellowships Salary, hours, duties, equipment o Who runs the fellowship o Information on residencies!!! o You can find ultrasound rotations at other residencies What to look for in an Ultrasound Rotation o If you want to do an ultrasound fellowship Do an audition rotation Do it in an area of the country you want to be in Do it for a Letter of Recommendation o If you dont want to do an ultrasound fellowship What are your goals of the elective? Do you want to simply lean ultrasound? Basic ultrasound techniques? Advanced ultrasound techniques? Do you want to learn how to run an ultrasound program so that when you apply for a job you can use this skill to land the job you want? Are you simply looking for something different? o Do some research on the programs o Know what you are looking for and define your goals. Basic US fellowship stats o 1 year* (there are some 2 year research fellowships) o you will do 800-1000 ultrasounds during the year o you will most likely be required to do a research project, presentation or scholarly activity o Salary varies from $40,000-$100,000 year (take a look at the number of hours you need to work for the salary) o You will review ultrasounds by videotape or still image review. Videotape is much preferable. It is the most valuable time during the fellowship. Accreditation o There is no accrediting body for US fellowships o ACEP fellowship guidelines = Wide range of fellowships o Do your homework! Learn about the different programs and learn what questions to ask. o Look at who is going to teach you. You will be spending a lot of time with this person. Are they skilled? Have they been doing it for a long time? Are they fellowship trained? The Ultrasound Fellowship Landscape o 33 programs o Majority in Urban, Academic centers o Most on East Coast

o Beware of new programs IF director is not fellowship trained* What will you learn? o 32 different ultrasounds (+/- 30) o The basic ultrasounds - ACEP 6+1 o Cardiac, FAST, Gallbladder, Renal, Endovaginal Uterus, Aorta and LE Duplex o Advanced ultrasound protocols o Ultrasound guided procedures o Lumbar Puncture, Central lines, Fluid drainage (pericardial, thoracic, soft tissue), Nerve Blocks, Peripheral lines o Administration o How to structure a program, how to improve or adapt a program, how to interface with other administrative duties o Billing o Research What do you do when you graduate? o Fellowship Director o Ultrasound Division Director o Research Director o Ultrasound Education Director o Clinical Director - Administrator Administrative Duties for Ultrasound Director o Administrative - Personnel o Billing / Revenue Capture o Education o Research Ultrasound Education o Fellowship Education o Residency Education Emergency Medicine Residents Surgery, Anesthesia Residents o Attending Education (A BLACK HOLE) o Medical Student Education Rotations in ED Part of Curriculum Academic Advancement with ultrasound training o Progression from Assistant to Associate Professor o It gives you a niche to publish manuscripts o It give you a focus for grant funding o You will become a local recognized expert o CME talks, invited lectures What is Ultrasound Administration? o Image review/ Quality assurance video tape takes more time but it depends on how you structure your program. still images take less time but can introduce other problems.

o You will have to create Policies/ Procedures/ Paperwork o Program design/ maintenance takes a lot of forsight. How does a fellowship help me if I want to do Community Emergency Medicine? o Value for your skills get the job you want o You can earn more money o You can buy down your time or structure you time better. (less nights and weekends)