Denver Health Intern Curriculum

This is an extremely self-driven educational experience. We know you are all strong adult learners, and we expect you to work hard to make the most of this rotation. In order to maximize your learning experience, we have provided online modules with rich multimedia that should appeal to learners of all types. It is imperative that you take responsibility for reviewing all recommended readings and online resources prior to meeting with us.

These educational modules are due by the end of week 1. You can find them by logging into dhha.butterflynetwork.com using your SSO login as instructed in orientation. At the top right of the screen, click “Education” > “Educational Content.” Click the Butterfly Academy link to start completing your assigned courses!

Fellows or faculty will meet with you (pre-arranged via email) and give a brief review of the ultrasound topic(s) for your week. They will also orient you to the machines and how to upload.

See instructions here for uploading scans if you start scanning before your first scheduled scanning shift. PLEASE READ BEFOREHAND.

You are expected to scan everyday of your rotation. At least 2 of these days will be supervised or on shift with one of our fellows or faculty and the rest should consist of independent scanning.

We expect you to record 200 scans during your two weeks of rotations.

The goal for each week is 100 scans. This means 100 “exam types” or organ systems which could be on far fewer patients than this.

See educational goals below for the focus of each of your 2 weeks.

Example strategy: FRAGLE each patient - (e)FAST, renal (same view but in two planes), aorta, gall bladder, lung (already done in the eFAST), echo (did subxyphoid as eFAST, just pursue other echo views). This is default 6 organ systems plus anything extra you may do… like the IVC. Each exam type tagged on butterfly will count as a point!

Every Thursday you will join us for conference with the fellows and tape review. This is mandatory and occurs on Thursdays at 12-5 pm (601 Broadway, room 404).

Expectations:

Come in person for video review (we’ll discuss your scans and other departmental QA).

Attend lecture and scan with ultrasound faculty after the lecture to solidify knowledge.

The first Friday of your first US week, we take you to the Denver Health Sim Lab to practice ultrasound guided procedures from 9a-12p!

Make sure to log any procedures in MyTipReport!

You will develop POCUS pearl about a topic you find interesting, or a great catch that is identified during image review. Your post will be featured on the Ultrasound Website. It should highlight interesting techniques, examples or tutorials about. Use relevant literature as you see fit!

Find a template for you pearl here

The intern with the highest total will win a prize at the residency award ceremony! Aim to hit each of the following scan types.

FAST/EFAST: 25

Lung: 25

Cardiac: 25

IVC: 10

Gyn/TAUS/TVUS/Pelvic: 20

Soft tissue/abscess: 10

Aorta: 10

Biliary: 10

Renal: 10

Bladder: 5

Ocular: 10

Nerve Blocks: 10

Vascular Access/Procedural Guidance: 10

Other: 20 (PTA, DVT, appy, SBO, anything not mentioned)

Master point-of-care ultrasound in the critically ill. Integrate echo, lungs, IVC and eFAST into the evaluation of the critically ill and dyspneic patient.

Become fluent in performing and interpreting the eFAST exam.

Understand the basics of echocardiography anatomy and physiology. Master the essential evidenced-based, clinical questions that we can answer instantly at the patient’s bedside. Integrate these concepts by understanding the cardiac physiology of the critically ill.

Rapidly and accurately narrow the differential in the acutely dyspneic patient. Integrate lung ultrasound with resuscitation strategies.

Understand how IVC may serve as a surrogate for preload in various shock states.

Understand the fundamentals of procedural guidance, especially for peripheral and central venous access.

Integrate diagnostic ultrasound into your workflow to change management and facilitate patient throughput.

Image acquisition and interpretation of can’t miss diagnoses of the aorta.

Diagnostic integration of the renal system utilizing ultrasound.

Master key image acquisition and interpretation in the evaluation of RUQ pain and the hepatobiliary system.

Confirmation of intrauterine pregnancies and the evaluation of unstable pregnant patients. Basic techniques of fetal dating.

Master shock states and key components of the RUSH exam. This will unite all of the specific goals of the rotation.