Types of Ultrasound Courses for UK Junior Doctors

There has never been a better time to go on an ultrasound training course. With the advent of handheld and bedside ultrasound, many think that the stethoscope may have competition for the space around our necks.

Ultrasound can be used in a number of different specialities across both primary and secondary care and is one of few skills in medicine which requires accreditation rather than a “see one, do one, teach one” approach.

So what types of ultrasound courses are available for doctors in the UK?

POCUS Courses for Junior Doctors

Point of Care Ultrasound (POCUS) scans focus on emergent care, being able to diagnose and treat medical emergencies with handheld and mobile ultrasound devices.

Generally practised in the ED, critical care, and acute medical wards, practitioners trained in POCUS focus on life-threatening acute issues. One common POCUS accreditation is FAMUS/FUSIC (Focused Acute Medicine Ultrasound / Focused Ultrasound in Intensive Care). Modules of the FUSIC course focus on different organ systems to rapidly rule in/out diagnoses:

Lung

• Pleural Effusion
• Pneumothorax
• Infection & Pneumonia

Heart

• Pericardial Effusion & Cardiac Tamponade
• Thoracic Aortic Dissection
• Myocardial Infarction
• Acute Heart Failure
• Massive PE

Abdomen

• Abdominal Aortic Dissection
• Bowel Perforation
• Urinary Retention & Obstructed Kidney
• Splenic Rupture
• Liver Abscess

Vascular

• Deep Vein Thrombosis
• Identify Peripheral Veins for PICC or Midline insertion
• Identify Internal Jugular and Femoral Vein for Central & Femoral Line Insertion
• Identify Radial, Brachial & Femoral Arteries for Arterial Line Insertion
• Ultrasound-Guided Cannulation

Following a POCUS course, accreditation can be gained from the parent organisation, such as the Intensive Care Society for FUSIC. You will generally be asked to find a mentor who can certify your competency in using ultrasound in practice. After that, you must record a number of observed & unobserved scans, before you receive accreditation.

For those who don’t work in acute medical care, there are more niche POCUS courses for specialities such as paediatrics and general practice.

Ultrasound-Guided Procedure Courses

Many procedures which previously relied on gusto and hands-on skill can now be performed with less risk under ultrasound guidance. For many in acute specialities, these procedures will be part of training and can be learned through practice on the wards.

However, if you want to get ahead of your peers and learn from experts, an ultrasound course will give you a more structured environment to hone these skills.

Ultrasound-guided procedures include:

• Abscess Incision and Drainage
• Arterial Access
• Central & Femoral Line Insertion
• Joint Aspiration & Injection
• Lumbar Puncture
• Nerve Blocks (such as fascia iliaca compartment block)
• Paracentesis (diagnosing/treating ascites)
• Pericardiocentesis (diagnosing/treating pericardial effusion)
• Peripheral Intravenous Access
• Regional Anaesthesia
• Suprapubic Bladder Aspiration
• Thoracocentesis (diagnosing/treating pleural effusion)

Core Emergency Medicine Ultrasound Courses

Those undertaking training in Emergency Medicine via the ACCS EM pathway are required to learn POCUS as part of the ACCS Curriculum. Previously, ACCS EM trainees were expected to pass “core emergency level 1 ultrasound” in order to pass their ARCP.

However, recently the RCEM curriculum has moved away from the “level 1-4” system, and instead has “entrustment scales”, meaning that most “Level 1 Ultrasound Courses” have now changed their name to “Core EM Ultrasound Courses”.

In order to pass ARCP in Emergency Medicine, you must show evidence of competency in:

• ACCS – Vascular access & fascia iliaca block.
• ST3-4 – ELS, AAA & eFAST / FAFF

This can be achieved on the ward, however, if are an ACCS EM trainee and would like to start adding indicative scan cases and reflections to your Kaizen ePortfolio, you should consider attending a Core Emergency Medicine Ultrasound Course.

Musculoskeletal Ultrasound Courses

Musculoskeletal ultrasound is useful to any junior doctor dealing with acute and chronic joint conditions, such as in GP, T&O, or Rheumatology.

Courses in MSK US include:

• Basic MSK Ultrasound – learn to use the ultrasound machine and introduction to ultrasound as a diagnostic tool.
• Advanced MSK US – improve your diagnostic skills so that you can identify complex muscle, nerve, and ligament conditions.
• Joint Injection – study joint anatomy and how to use an ultrasound probe to guide a needle into the correct space for therapeutic joint injections.

Learning this skill beyond a basic level is a “nice-to-have” addition to your portfolio, which might help you in your career if you wish to pursue a special interest in sports medicine or joint injection.

These skills can also make you a more appealing candidate if applying for a GP or Emergency Medicine job in a department which does not currently have an MSK Ultrasound accredited practitioner.

Echocardiography Courses

While POCUS often includes an assessment of heart function, Echo courses are aimed at junior doctors looking to use echocardiography as part of their regular practice.

Handheld ultrasound devices can provide a good picture of LV/RV function and rule in/out significant pathology, but a full departmental Echo will often be required to manage Cardiology patients in the community, on the ward, and in critical care.

Your speciality of choice and current grade will determine which course is appropriate for you, with advanced modalities being more appropriate for Cardiology trainees. Echocardiography courses include:

• Emergency courses such as FEEL and FUSIC Heart
• Foundation courses to allow you to start logging cases in pursuit of BSE Echo accreditation
• Transoesophageal echo (including fTOE for critical care practitioners)
• Advanced capabilities such as 4D and stress echo

Obstetric and Gynaecology Ultrasound Courses

If you’re having trouble accessing appropriate training on placement, a basic ultrasound course for obstetrics and gynaecology can provide O&G trainees with the fundamental skills to allow them to complete OSATS required for progression to ST4.

The Royal College of Obstetricians & Gynaecologists recommends taking a basic obstetrics & gynaecology course while in ST2 year, though those who attend one earlier may get more chances to practice their new skills while on rotation.

General practitioners may also wish to take an O&G US course if they provide antenatal care or perform obstetric ultrasound scans in primary care.

Ultrasound Accreditation

Accreditation for ultrasound depends on the speciality you are training in as a junior doctor.

For some specialities, such as GP, the only accredited courses available are substantive certifications carried out by academic institutes, whereby the course is accredited by the Consortium for Accreditation of Sonographic Education. These qualifications can be taken full or part-time, and often require months of training.

Specialities which make use of bedside ultrasound, such as acute medicine and anaesthesia, have the option of taking short POCUS courses, which are then accredited by societies following a certain number of supervised scans.

For those who are required to use ultrasound in their day-to-day job as standard – such as EM, O&G, and Radiology – ultrasound is taught as part of their core curriculum, and is therefore accredited by their training organisation.