The Family Medicine Clerkship Ultrasound requirements aim to provide clinically relevant
education on how to use point-of-care ultrasound (POCUS) during your Family Medicine
clerkship. The ultrasound requirements are designed to give you a deeper understanding
of some of the concepts taught during the clerkship through the experience of ultrasound.
Ultrasound at the bedside to screen the aorta for abdominal aortic aneurysms and to
scan the IVC for fluid status are ultrasound exams that are used often in the office
and hospital settings for Family Medicine patients . Since these ultrasound imaging
views are so frequently performed, we want our medical students to be proficient at
this exam as they move through this clerkship.
Complete the following quizzes (includes patient consent attestation, image upload,
and mock case scenario questions) prior to the end of your Family Medicine clerkship
rotation by submitting 3 separate quizzes in this D2L course by the noted due dates.
You will receive feedback on your images by email after they are graded. Quizzes must
be completed by due dates.
WHAT DOES THE FAMILY MEDICINE CLERKSHIP ULTRASOUND IMAGE REQUIREMENT INCLUDE?
The Family Medicine Clerkship Ultrasound requirement consists of acquiring aorta and
IVC images as follows:
The aorta should be imaged at the proximal, mid, and distal segments and the anterior
to posterior diameter measured.
The IVC image includes a longitudinal view of the IVC, liver, hepatic vein, and right
atrium.
WHAT SHOULD THE IMAGES FOR THE FAMILY MEDICINE CLERKSHIP ULTRASOUND REQUIREMENT LOOK
LIKE?
Proximal Aorta
Mid Aorta
Distal Aorta
IVC
WHY AND HOW DO I COLLECT THE IMAGES FOR THE ABDOMINAL AORTIC ANEURSYM SCREENING EXAM?
Why do we do screening exams? Many pathologic conditions are easier to treat when found early in the course of the
disease. Arterial vascular diseases, particularly Abdominal Aortic Aneurysms (AAA),
are one such disease. In fact, ruptured AAA is the 13th most common cause of death
in the US.
Why do we screen for AAA? Many factors but predominately atherosclerotic disease can cause the wall of the
aorta to weaken and bulge (aneurysm). The risk of rupture increases exponentially
with increasing diameter, making it important to find these aneurysms early in the
course so that they can be safely repaired. However, many people do not get screened
even though there are very clear screening guidelines (USPSTF Aortic Aneurysm Screening Guidelines). Some studies have documented the screening rate as low as 36% of those needing
a screening ultrasound exam versus patients that actually obtain one.
How do we screen for AAA? Screening for AAA involves using ultrasound to measure the aorta diameter. This is
easily done at the bedside using a portable ultrasound system. The Family Medicine
clerkship assignment is designed so you can have hands-on practice performing a non-invasive
screening exam.
Who do we screen? It is important to perform the screening exam on those patients at risk for AAA.
The USPSTF recommends 1 time screening for AAA in men aged 65-75 years who have ever
smoked. A secondary recommendation is that men 65-75 years who have never smoked be
selectively offered screening. This recommendation should be based on the individual
using their medical and family history and other risk factors and personal values.
It is unclear if women aged 65-75 years who have smoked should be screened for AAA,
but during the clerkship these are appropriate patients to screen.
Why do I also need to obtain a video / image of the IVC? The IVC is often confused with the aorta on ultrasound imaging. Evaluation of the
IVC is included in the Family Medicine Clerkship to help you understand the anatomical
differences in the IVC and aorta and to assure you do not mistake the IVC for the
aorta during your AAA screening exam.
DO I NEED TO DOCUMENT INFORMED CONSENT FOR THE PATIENT BEFORE I BEGIN THE EDUCATIONAL
ULTRASOUND?
Yes, you will need to ask your preceptor and the patient if you can perform an educational
ultrasound for your FM Clerkship Ultrasound requirement. Once the patient has agreed
to be scanned, you will need to explain the procedure to them and include the following
aspects:
Ultrasound has no known adverse side effects and it uses sound waves to visualize
structures
The patient will not be charged for the educational ultrasound (They may have an additional
ultrasound for clinical reasons for which they will be charged)
The student will touch their abdominal wall and pelvis with the transducer on their
body with possibly cold gel and cool, gloved hands to obtain the images
The lights in the room may be dimmed for better visualization of the images
Results from the educational ultrasound will not be included in their chart or patient
care decisions
If any type of problem is detected, the student will inform their preceptor and the
preceptor will direct the next steps
After reviewing this information with the patient, the student will ask the patient
to type their name and sign the Educational Ultrasound Informed Patient Consent. Images will NOT be accepted for the requirement if the patient does not complete
this consent.
WHAT DOES THE FM CLERKSHIP ULTRASOUND REQUIREMENT QUIZ INCLUDE?
The FM Clerkship Ultrasound Requirement Quiz includes:
Attestation question that you and your patient completed an "Educational Ultrasound
Informed Patient Consent" prior to scanning your patient
Attestation question that you have submitted your images and case information through
the provided link
Acquiring three sets of images for submission on three different patients
FM ultrasound content and case questions
WHAT IF I HAVE TROUBLE OBTAINING PATIENTS FOR IMAGING, IDENTIFYING EQUIPMENT TO USE,
OR HAVE TROUBLE UPLOADING IMAGES?