Critical Care Ultrasound Fellowship

Oversight of didactic sessions

Didactic sessions will be integrated into the CCUS curriculum with scheduled sessions occurring during dedicated academic days. Broadly, these sessions will focus on ultrasound basics (controls, physics, probes and system care), cardiac assessment (basic and advanced), lung, vascular and abdominal ultrasound (eFAST) as well as the appropriate use of CCUS for clinical decision making. The operational characteristics of ultrasound findings for specific pathologies (i.e. sensitivity and specificity of lung sliding for pneumothorax) will also be included. Access to online resources including textbooks, screencasts and self-evaluation tools will be made available.

Advanced didactic sessions will include dedicated time for VTE, echocardiographic findings of cardiac tamponade, hemodynamic assessment, assessment of severe left sided valvular disease, left ventricular outflow tract obstruction and diastology.

Practical experience

Fellows will be the main point of contact for residents on clinical scanning rotations. This will provide hands-on learning experiences for educating in a fast-paced clinical environment where they will see a wide range of clinical pathology. With the CCUS rotation providing a concentrated learning experience, CCUS fellows will master advanced image acquisition techniques and interpretation. Given the variety of clinical cases, they will also integrate their findings into the patient’s clinical context and provide recommendations for management. CCUS fellows will have time to obtain scans for logging purposes in effort to obtain National Board of Echocardiography test-taker or diplomat status.

Academic activities

Fellows will be expected to complete a scholarly project in either research or medical education. This may include creation and dissemination of online learning material. Fellows will be asked to participate in Case Based Rounds and Acute Care POCUS Rounds. The opportunity to participate in CCM Journal Club may be available should a relevant POCUS publication be felt to require discussion amongst the section of Critical Care (no formal requirement).

The main objective of this program is to train physicians who manage critically ill patient populations in an advanced CCUS skillset to become a local educational leader and expert amongst their colleagues.

The Royal College of Physicians and Surgeons of Canada (RCPSC) has outlined expected POCUS competencies for multiple acute care specialties including Adult Critical Care. The proposed program aims to integrate the established competency guidelines (both international and domestic) with the hands-on experiences of clinicians with dedicated fellowship training in CCUS. 

The program is designed to provide experience in ultrasound education, research and administration in managing an ultrasound program. A program of this kind would provide the graduate with the expertise necessary to perform essential POCUS techniques in the critical care environment and the knowledge to teach the next generation of ultrasound users by providing hands-on education within the ICUs in addition to remote feedback through educational archiving systems. 

After completing this program, the individual will be able to use their advanced knowledge and skill to design, implement and maintain high quality curricula ensuring achievement of the increasingly high standards in the clinical use of goal-directed critical care ultrasound examinations.

The fellowship is one year in duration and will include the following:

• 8 Blocks Core Critical Care Ultrasound.
• 1 Block Transesophageal Echocardiography. TTE training will come from various opportunities in ICCS as well as through Cardiac Anesthesia where an educational opportunity exists for CCUS fellows to join for 5-10 clinical days and to do pre and post bypass TEE imaging on patients (Core resuscitative TEE views are only required).
• Must complete 12 blocks in total. Up to four can be POCUS related which include (but are not limited to) ED POCUS, Echocardiography, Cardiac Anesthesia.
• The rotations must add up to 12 in total but any completed blocks/rotations prior to fellowship can be given credit if deemed appropriate by the program director.