During the early evolutionary years of emergency ultrasound, there was little distinction made between the processes needed to establish and build ultrasound programs in the community and academic environments. The two settings share some common challenges: obtaining acceptance of point-of-care ultrasound as a standard of care, training and credentialing physicians, assuring quality, and maintaining equipment. However, there are important differences in the two practice settings, their mission, and the scope of activities they pursue. Academic programs have a greater range of trainees each with their own needs, including medical students, residents, fellows, and faculty staff. Leaders of academic programs have an expanded and critical role in defining content and developing curriculums appropriate for different levels of training. They should also lead the way in developing effective methods of teaching, using newer innovative methods such as asynchronous methods and simulation. Ultimately, they bear the responsibility of setting standards for assessing competency of trainees with a rigor that has seen increasing scrutiny in all areas of medical education. Academic centers also need to establish priorities for research to justify expanded use for clinical applications, as well as assess the efficacy, cost effectiveness, and impact of point-of-care ultrasound on patient outcomes. Ultimately, academic centers need to train new leaders who can teach, write, and contribute to the future of the specialty.

This chapter will describe the qualities of an academic emergency ultrasound program, discuss how an academic ultrasound program can further a department’s academic mission, and detail the challenges facing an academic program.

The first curriculum for emergency ultrasound was published in 1994 (1). Since that time, there has been a rapid growth in use, number and variety of applications, and improvement in point-of-care equipment. In 2001, ultrasound training became a required component of ACGME accredited emergency medicine training (2).There has been consistent organizational support for the advancement of ultrasound training from professional societies, including the American College of Emergency Physicians (ACEP), the Society for Academic
Emergency Medicine (SAEM), and the American Board of Emergency Medicine (ABEM); these organizations provide valuable resources for training programs and professional development. In 2008, consensus recommendations from the Council of Residency Directors (CORD) were released in an effort to set minimum training guidelines for residency training (3). Current training programs have assorted training methods and guidelines. A 2010 survey of training programs in emergency medicine reported that 79% of programs had structured ultrasound curriculums; some programs rely on self-directed learning largely dependent upon resident interest and effort (4). However, in the same year, a survey found that most (98%) graduates of emergency medicine programs make use of ultrasound in their day-to-day clinical practice (5). As interest has grown, ultrasound fellowships have evolved out of the desire for advanced training and to meet the need for experts to lead academic departments. There are currently 84 ultrasound fellowships available in the United States. While there has been much growth and expansion in the use of ultrasound, there remains considerable variation between programs.

Historically, the individual with the role of Ultrasound Director may have been a faculty member who simply had an interest in ultrasound, but who ultimately may not have viewed the position as a potential area of academic focus or career development. As emergency ultrasound has grown, the potential for an academic career focused on ultrasound and the vision of academic centers have changed. Advanced and specialized training in point-of-care ultrasound is now widely available, including ultrasound fellowships; this training provides an opportunity to develop not only advanced, expanded sonography skills, but also skills in program administration, teaching, and research. The talent and skills required to fill the role of Ultrasound Director have become increasingly more defined and demanding.

Leaders of ultrasound programs should be recognized as expert emergency sonographers. Their ultrasound expertise should be more advanced than a graduate from an emergency medicine residency program. Furthermore, their knowledge of advanced applications should be the basis for leading the department to implement new and cutting edge applications for bedside ultrasound.

Ultrasound faculty should also be renowned for their educational skill set, since it requires special talent to convey technology that includes motion, while at the same time doing it in such diverse settings as large and small groups, simulation centers, and at the bedside. Besides, ultrasound educators must be able to teach the skills to perform an exam, make diagnostic decisions, and guide procedures using ultrasound. As a result, the tool kit of ultrasound education involves much more than the ability to give a lecture.

The ultrasound leader needs to possess skill and proficiency in scholarly activities and research. The expertise of a superior Ultrasound Director can advance the research agenda that drives the search for new applications, approaches, or utilization of bedside ultrasound. When successful, an academic ultrasound leader places his/her department at the forefront of advances in ultrasound. Second, he/she contributes to the academic mission of the department and, when completed, serves to advance faculty toward academic promotion. Lastly, he/she mentors residents in scholarly activity early in their career.

Finally, ultrasound faculty need to be able administrators to organize and maintain ongoing image review, quality assurance, competency assessment, and machine maintenance for both faculty and residents, sometimes practicing at multiple sites.

Academic departments who lead the way in ultrasound teaching and research may find that the job of Ultrasound Director is bigger than any one individual. Large programs with diverse programmatic, administrative, and teaching needs or major ultrasound research efforts may require the resources of several faculty. Consequently, it may be advisable to combine the faculty’s talents in a Section or Division of Emergency Ultrasound. Specific guidelines for developing a Section or Division within an academic department are typically defined by rules within the School of Medicine and will vary from institution to institution.

A number of factors unique to an academic setting will drive the scope of clinical practice and the most relevant ultrasound applications. Most notably, educational needs of trainees should govern applications incorporated into clinical practice. Priority should be given to applications utilized during the resident’s clinical rotations, those they will be tested on for specialty certification, and skills they will need to enter the work force and stay up to date with current and future practice standards.

This approach to developing a scope of practice incorporates current recommendations, while also maintaining a vision for applications that will shape clinical practice after residents have completed their training. For example, current ACEP ultrasound guidelines should be considered the foundation for developing a scope of practice (6) (Table 1.1). True to the explorative nature of an academic setting, the ACEPdefined applications should not be considered exhaustive, but instead a starting point for defining clinical practice. Certain centers will have specific research, procedural, and population needs that will further define the scope of clinical practice.

Once the scope of clinical practice has been defined, attention can be directed toward the department’s educational needs. In an academic ultrasound program, training can involve widely different audiences, educational backgrounds, preferred methods of delivery, and learning objectives. Not uncommonly, education is needed for faculty, residents, ultrasound fellows, medical students, and in some cases, physicians from other academic specialties or other medical providers. Each group merits special mention since they are varied in their educational challenges and needs.