VExUS/POCUS/Resus Mini-Fellowships

In the last couple of years VExUS has seemingly sparked a number of clinicians to focus on right-sided or venous congestion and its deleterious consequences. Many of us feel there is sufficient associative evidence and physiological basis to use VExUS to manage patients on a daily basis and do so routinely. Currently, several studies we know of (and probably many we don’t!) are on track to show that a VExUS-based approach is likely to be superior to a highly variable traditional approach. In teaching it at the bedside, however, we emphasize the fact that this tool should not be used in a brain-bypass, monosynaptic fashion – all elevated VExUS scores should NOT blindly be diuresed… These ways on how to integrate VExUS in clinical decision-making is what we will emphasize in this part of the Mini-Fellowship.

So due to demand, we have added this specific skill to our Mini-Fellowships which have been going strong for over a decade. The idea (just like in resuscitation!) is to tailor these days to what you need the most. Whether you want to focus on advanced POCUS, looking at coupling parameters and TDI or whether you want to learn to integrate these findings into a resuscitation approach, we will do our best to fill the gaps you may have.

We’ve been organizing mini-fellowships now for over a decade (obviously slowed by the whole pandemic business), because while learning the technical aspect of scanning is one thing, the translation into clinical application and decision-making is altogether another step that, for many, is achieved more readily by witnessing live clinical management.

This year, for the first time, we are adding a specific VExUS element. Participants will be able to pre-emptively watch the online VExUS Course, and then follow a senior instructor for 2-5 days of clinical practice (avg 4-6h/day) where they will be able to observe live scanning and management of real patients both in outpatient, inpatient, ED and ICU settings.

Tuition – Montreal Mini-Fellowships: 600$ CAN / 500$ USD per day for 1 physician, 400$ CAN / 350$ USD per person per day for additional days, and 400$ CAN / 350$ USD per person per day for a 2 to maximum 3 physician group. For physicians who are not from high income countries, do let us know, we will try to help get some industry sponsorship to make it possible.

CME : For Canadians, from the Royal College of Physicians standpoint, the Mini-Fellowships qualify for 25 Section 2 credits (regardless of the length) and 3 hours of Section 3 credits (per day of fellowship). For you Americans:

Through an agreement between the Royal College of Physicians and Surgeons of Canada and the American Medical Association, physicians may convert Royal College MOC credits to AMA PRA Category 1 Credits™. 

Please see the prior posts for participant feedback (https://thinkingcriticalcare.com/2018/05/09/ccus-institute-pocus-resuscitationist-mini-fellowship-evolution/), and if interested, please email hospresusconference@gmail.com and we will put you in touch with one of the senior instructors whose time matches your availability.

cheers!

The H&R Team

CCUS Institute POCUS & Resuscitationist Mini-Fellowship: 2022 Update!

So over the last couple of years, the POCUS Mini-Fellowships have been slowly but steadily morphing into POCUS-Resus training.  With POCUS essentially critical in all aspects in resus, including venous congestion assessment, ventilation, diagnostics, it is a natural extension to blend the exchange into many of the other tools that we use, including discussions around fluids choices, pressor choices, monitoring using NIRS tissue oximetry, ETCO2, and overall resuscitation strategies. Of course, we will also cover VExUS as it has become an important POCUS tool, not only for the resuscitationist gauging his fluid management, but also for any clinician dealing with patients with heart failure and renal failure.

Some structured workshops can include percutaneous pigtail insertion, vascular access phantom practice and both surgical and percutaneous surgical airway manikin practice, depending on participants’ choice.

We have recently expanded with the addition of Dr. Philippe St-Arnaud, ER and CC doc and EDE (Emergency Department Echography) Instructor extraordinaire, who will increase our availability – which had been fairly limited – apologies to those whom we could not accommodate due to scheduling reasons.

This is an excellent complement to an RLA (I’m part of that faculty) or ULA fellowship, to bring a real clinical experience into the mix.

Of course, if you are a canadian trainee/resident you can get a whole month of this for free by doing an ICU elective at Santa Cabrini Hospital (foreign trainees are also welcome but more hoops to jump thru!).

Tuition (Updated 2022)

Montreal Mini-Fellowships: 600$ CAN / 500$ USD per day for 1 physician, 400$ CAN / 350$ USD per person per day for additional days, and 400$ CAN / 350$ USD per person per day for a 2-3 physician group (maximum)

Toronto Mini-Fellowships: 800$ per half day (4h).

100% refundable until you start. Even if you don’t show up. Really. We’re not in it for the business. We get to go home earlier if you don’t come.

For more details and registration information see here.

And here is some of the most recent feedback from the fellows:

Anyway, I wanted to say thank you again. You have inspired our group to continue to move POCUS into our clinical practice; we have started a fluid management algorithm in our observation unit, and hoping that the soon-to-be-added ButterflyIQ to the unit will improve its utilization. Over the last few years, we have caught a few myocarditis cases and new CHF cases initially placed in observation as “influenza,” managed hundreds of CHF cases, and had a handful of +FAST exams in our ED that we were not quite expecting (in fact, having one that was just texted to me from a co-worker is what prompted this email!).   Our POCUS program is still in its infancy, but I think the horse is out of the barn at this point. On behalf of all of our patients that we will see, thank you.

Additionally, I have gone on to co-direct a sono-wars type event at our national physician assistant conference (AAPA), for PA students. At the inaugural event, we had free workshops and a competition that included 200 student learners, representing about 30% of PA programs from all over the country. We opened a huge door for PA programs to start implementing POCUS longitudinally within their curriculum. We received amazing feedback on the program, and are hoping to publish results soon (currently with journal editors)… 

I am excited to pay forward my debts to those that have helped me.  You not only helped me, but generations of PA’s for years to come. Thank you so much for your time and commitment to excellence. What you do matters; please keep running the mini-fellowship! Patrick Bafuma EM PA @EMinFocus, Hudson Valley, NY, USA. 2017.

        This review is for the CCUS Institute Bedside Ultrasound (US) Mini-Fellowship. I was fortunate to do the mini-fellowship after the Hospitalist & Resuscitationist conference, and I was able to put into practice various techniques that we learned. Dr. Rola was a pleasure to work with and was well-versed with the latest US and free online access meducation (FOAM). The atmosphere was conducive to learning, and we picked up an ultrasound almost immediately and used it extensively through each day. We used various US machines and were able to get a good feel for all of them. My US experience before the mini-fellowship had been a two-day introductory course with healthy medical students as volunteers. At the mini-fellowship, being able to learn on actual critically ill patients was illuminating and helped cement what I had learned. We also went over relatively new bedside techniques such as point-of-care trans-cranial doppler (TCD) and optic nerve US (ONSD). Overall, the experience was well worth the 2800 mile trip, and I would enthusiastically recommend it to anyone that is interested in learning practical applications of US. – Dr. Pranay Parikh, Los Angeles, USA. 2018.

Recently I went and studied with Philippe in Montreal. I was really impressed with how seamlessly ultrasound was used in the physical exam for each one of his patients without any loss in time and often a gain in clinical information that I doubt we would have had without the ultrasound. Philippe’s ability to teach was also amazing as we worked on some very interesting concepts like portal vein pulsatility, hepatic vein and renal doppler for fluid stop points. He definitely exemplified how facile one could become with ultrasound with dedicated practice. I very much enjoyed my time and believe I learned a lot that could be used immediately at the bedside. Thanks! Dr. Joe Quinn, EM/IM/CC, Vidant Medical Center, East Carolina University, 2018.

So join us for a few days of intense, real clinical learning.

cheers,

Philippe