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Ultrasound

Mayo Clinic physician performing an emergency ultrasound

Emergency point-of-care ultrasound 

The training in emergency point-of-care ultrasound (POCUS) involves a variety of training experiences that work synergistically to provide residency graduates with the skills needed to effectively and efficiently use POCUS to improve the quality and safety of the care they provide for patients. The training begins in the first year of the residency and extends throughout the training program. Highlights of the Emergency Ultrasound training at Mayo Clinic are advanced ultrasound applications such as transesophageal echo (TEE) during cardiac arrest, contrast-enhanced ultrasound, and ultrasound for procedural guidance, especially musculoskeletal procedures and regional anesthesia.

First year of residency

Incoming first year residents will attend a full-day Ultrasound Bootcamp to be introduced to the breadth of emergency POCUS. All of the first year residents have their schedules reserved and join our internationally recognized emergency ultrasound faculty in the Mayo Clinic Simulation Center – they have very brief didactic training followed by hands-on guidance and practice of each of the core POCUS studies expected of emergency physicians.

There are two distinct weeks in the PGY-1 year that are reserved for the trainee to focus on focused assessment with sonography in trauma (FAST), cardiac POCUS, abdominal aortic POCUS, and basic procedural POCUS. The PGY-1 trainee also will be completing asynchronous online POCUS learning modules and be performing POCUS for their patients during their clinical shifts and receiving feedback on their scanning performance via QPath™, the emergency department-specific PACS system.

Second year of residency

Building off the foundation of emergency POCUS created by the first year of residency, the PGY-2 trainee will continue with online modules throughout their rotations. These are paired with specific rotations such as Orthopedics to augment their rotational experience and their POCUS ability. Throughout the second-year trainee clinical shifts there will be more opportunities for emergency POCUS performance (with feedback on scan performance through QPath™) as well as teaching and supporting first year residents and medical students with their ultrasound journey.

Furthermore, there are two consecutive weeks dedicated to learning emergency POCUS. The focus of this rotation is to reinforce abilities with the FAST, cardiac, and abdominal aortic POCUS and build on the procedural POCUS experience from the first year – also to supplement with biliary POCUS, and lower limb venous POCUS to look for deep vein thrombosis.

Third year of residency

The final year of training is about making the application of emergency POCUS more seamless into clinical practice. Trainees are working to become more efficient with setup, performing, and follow through of emergency POCUS while on their clinical shifts as well as incorporate teaching and support for junior trainees in their clinical pods. There is continued scan performance review and feedback for these trainees.

For final year residents who wish to take an elective in POCUS, there is an effort made to create a custom experience tailored to the needs of the trainee. This may involve more advanced ultrasound experience such as in contrast-enhancement, or more subspecialty procedural experience. There is more discussion of advanced cardiac ultrasound, transesophageal echocardiography, etc.

Additional features of emergency POCUS training

Throughout residency there is a spaced didactic presentation schedule so that ultrasound remains top of mind throughout the length of residency. There is a Mayo Clinic specific web-application that covers numerous emergency POCUS topics, and a Google Classroom™ dedicated to the Mayo Clinic Ultrasound Division operations and education. The POCUS faculty are exploring alternative ways to teach and support the resident physicians  such as immersive video/virtual reality, etc.

Residents practicing an ultrasound on an arm

Emergency ultrasound faculty

Throughout Mayo Clinic Emergency Medicine Enterprise practice, we have nine emergency ultrasound faculty members. In Rochester specifically, there are three primary faculty members involved in the training of the resident physicians (Tobias Kummer, M.D.; Venkatesh Bellamkonda, M.D.; Robert Hyde, M.D.). Each of them has been or is currently serving as directors of large emergency POCUS programs, serving on national committees related to POCUS topics, and recognized educators for their work. Two have been recognized as Mayo Clinic Residents and Fellows Association as Teacher of the Year for Emergency Medicine.

Venkatesh Bellamkonda, M.D.

Venkatesh Bellamkonda, M.D.

Assistant Professor, Emergency Medicine
Chair of Education
Wellness Officer
Ultrasound Faculty
Healthcare Quality Faculty

Medical School: Northeastern Ohio Universities College of Medicine
Residency: Mayo Clinic School of Graduate Medical Education
Fellowship: George Washington University School of Medicine, Emergency Ultrasound
InterestsI have a passion for improving the system of accessing and delivering care including optimizing experience, outcomes, and minimizing costs of all kinds. I am particularly interested in (1) healthcare quality, (2) POCUS, (3) wellbeing, and (4) all aspects of education.

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Tobias Kummer, M.D.

Tobias Kummer, M.D.

Assistant Professor, Emergency Medicine
Medical Director, Emergency Ultrasound

Medical School: University of Hamburg Undergraduate/Medical School Program
Residency: The Warren Alpert Medical School of Brown University
Fellowship: The Warren Alpert Medical School of Brown University, Emergency Ultrasound
Interests: Point of care ultrasound, advanced ultrasound in trauma and acute surgical care, ultrasound-guided MSK procedures and regional anesthesia

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Robert Hyde, M.D., M.A.

Robert Hyde, M.D., M.A.

Assistant Professor, Emergency Medicine
Director of Undergraduate Medical Education

Medical School: University of Massachusetts Medical School
Residency: Mayo Clinic School of Graduate Medical Education
Fellowship: Christiana Care Health System, Emergency Ultrasound
Interests: Point of care ultrasound, medical education, EMS

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SonoGames competition

Mayo Clinic Emergency Medicine Residency has supported resident participation in the Society of Academic Emergency Medicine SonoGames competition and is proud that our residents were the third ranked team (out of 37 national residency teams) in the ultrasound knowledge assessment round of 2021 competition. They were also the winners of the Best Costume/Zoom Background competition in 2021.

Residents compete in the annual SonoGames competition

Ultrasound equipmentResidents practice ultrasound

We believe that training with numerous different machines and companies is important to being able to flex into a variety of clinical practice environments. For this reason, we have trainees exposed to equipment of varying ability including limited handheld models, through feature-laden advanced devices as well as the spectrum in between. In total we have 11 machines owned by the department as a whole and numerous handheld devices owned by individual attending physicians.

To assist in training, we have numerous vascular access simulators, a transesophageal echocardiography simulator, and an endovaginal ultrasound simulator for residents to learn with.

List of Mayo Clinic Emergency Medicine graduates who completed an Ultrasound Fellowship

NameYear
Reinier Van Tonder, M.D. Class of 2009
Robert Hyde, M.D. Class of 2009
Venkatesh Bellamkonda, M.D.  Class of 2010
Zachary Soucy, D.O. Class of 2011
Jeffrey Wiswell, M.D. Class of 2013
Jeffrey Shih, M.D. Class of 2014
William Smoot, M.D. Class of 2019
Lacey Shiue, M.D. Class of 2021