The Montefiore Einstein Department of Anesthesiology’s division of Graduate Medical Education (GME) is revamping its point-of-care ultrasound (POCUS) curriculum for residents, signifying an investment in training residents to utilize the latest innovative techniques to provide consistently safe and effective patient care. With support from GME leadership, Attending Anesthesiologist Dr. Sina Erfani is spearheading the initiative and organizing POCUS training for residents at all levels.

A POCUS exam allows the physician to take ultrasound images of a patient’s organs including the heart, stomach, and lungs. It is less invasive than the alternative technique – a transesophageal echocardiogram (TEE) exam – which requires the physician to place a probe down the esophagus, Dr. Erfani explained. A POCUS assessment can be conducted preoperatively, intraoperatively, and postoperatively for the anesthesiologist to have a clearer picture of the patient’s vitals.

“POCUS is a new frontier for anesthesia,” Dr. Erfani said. “It has tremendous diagnostic value because it provides insight into what is affecting the patient’s vitals. It allows you to understand why your patient’s blood pressure is low, for example. POCUS as a tool in the OR helps the patient, and it helps you as an anesthesiologist.”

One of the top priorities for Dr. Erfani, Residency Program Director Dr. Erik Romanelli, Vice Chair of Education Dr. Sujatha Ramachandran, and Critical Care Anesthesiology Division Director Dr. William Sauer is to ensure trainees are well-equipped to conduct POCUS assessments not only because they are an important tool for quality patient care, but also because they are a new addition to the American Board of Anesthesiology exams. According to Dr. Ramachandran, the ABA previously tested anesthesiologists’ knowledge of transthoracic echocardiograms as well as vascular and nerve ultrasound but have recently added lung ultrasound as well.

"Incorporating POCUS into our curriculum equips our residents with a valuable skillset that helps to enhance their clinical competence,” Dr. Romanelli said. “They gain proficiency in techniques like vascular access, regional anesthesia, and cardiac assessment, which are vital in anesthesia practice.”

Currently, a two-week rotation focused on POCUS is required for all CA3 residents. The rotating resident collaborates with faculty members who are POCUS certified, and they have the opportunity to utilize POCUS on a variety of patients undergoing a range of procedures and surgeries. CA3 Resident Dr. Max Gersh recently completed the POCUS rotation and said it allowed him to hone his skills using this essential tool and taught him how to use the four basic cardiac views to assess basic left-sided, right-sided, and valvular function.

“Being able to quickly do an ultrasound cardiac and lung assessment can add valuable information to a patient's preoperative assessment or help direct management during an acute event,” Dr. Gersh said. “All the knowledge in the world can't help if you aren't able to find and refine a view on a patient.”

Dr. Sauer teaches POCUS techniques at the American Society of Anesthesiologists (ASA) meetings and said he is working with the GME team to not only provide learning opportunities for department members but to also create a rotation for medical students in the Surgical Intensive Care Unit, where students can begin practicing this essential skill early in their training.

“I encourage everyone who wants to learn POCUS to be proactive and practice,” Dr. Sauer said. “I’ve been doing it since 2010, but I’m still learning. It’s a skill you’re always working to improve so you can apply what you see with the ultrasound to the patient in the moment.”