The Internal Medicine Clerkship Ultrasound requirements aim to provide clinically
relevant education on how to use point-of-care ultrasound (POCUS) during your Internal
Medicine clerkship. The ultrasound requirements are designed to give you a deeper
understanding of some of the concepts taught during the clerkship through the experience
of ultrasound.
Ultrasound provides an excellent way for you to understand the heart function and
pathophysiology. Many of the patients you will encounter on your Internal Medicine
clerkship will have pathology such as hypertension or coronary artery disease which
will affect the heart. By imaging the heart, you can correlate the ultrasound findings
with that of the EKG and physical exam.
QUICK LINKS:
HOW TO DOWNLOAD IMAGES FROM MACHINES OTHER THAN LUMIFY
LEARNING OBJECTIVES
At the end of this module, you will be able to:
Acquire cardiac images (Subcostal 4-Chamber, PSLA, and Apical 4-Chamber) of the heart
and a lung image of the lung sliding sign with limited assistance.
Interpret the findings of heart and lung ultrasound images on actual patients and
mock case scenarios.
Integrate the findings of heart and lung ultrasound images in the care plan of actual
patients and mock case scenarios.
TO DO
Complete the following quizzes (includes patient consent attestation, image upload,
and mock case scenario questions) prior to the end of your IM clerkship rotation by
submitting 3 separate quizzes in this D2L course by the noted due dates.
You will receive feedback on your images by email after they are graded. Quizzes must
be completed by due dates.
WHAT DOES THE INTERNAL MEDICINE CLERKSHIP ULTRASOUND IMAGE REQUIREMENT INCLUDE?
The Internal Medicine Clerkship Ultrasound requirement consists of acquiring cardiac
and lung images as follows:
There are 3 traditional windows (views) of the heart: the subcostal, parasternal and
apical windows. The key point for you is that while each of these windows are important
for you to be familiar with, it is more important for you to be able to identify the
structures of the heart and assess how they correlate to the EKG and physical exam
findings. The key structures to identify are the left ventricle, interventricular
septum, and the mitral valve. As you become comfortable assessing these structures,
evaluating the relative size of the chambers and the flow across the valves using
color Doppler will help you achieve a more advanced understanding of the heart.
The Subcostal 4-Chamber (Subxyphoid) heart image includes the left lobe of the liver,
all 4 chambers of the heart, and visualization of the pericardium.
The Parasternal Long Axis (PSLA) heart view includes the left ventricle, left atrium,
mitral valve, aortic valve, ascending aorta, and the right ventricle.
The Apical 4-Chamber heart view is taken from the apex of the heart and includes all
4 chambers of the heart.
The Lung view to assess for pneumothorax is acquired in the longitudinal plane on
the anterior chest on either side of the sternum.
WHAT SHOULD THE IMAGES FOR THE INTERNAL MEDICINE CLERKSHIP ULTRASOUND REQUIREMENT
LOOK LIKE?
Subcostal 4-Chamber Heart
Parasternal Long Axis Heart
Apical 4-Chamber Heart
Lung for Pneumothorax
DO I NEED TO DOCUMENT INFORMED CONSENT FOR THE PATIENT BEFORE I BEGIN THE EDUCATIONAL
ULTRASOUND?
Yes, you will need to ask your preceptor and the patient if you can perform an educational
ultrasound for your IM Clerkship Ultrasound requirement. Once the patient has agreed
to be scanned, you will need to explain the procedure to them and include the following
aspects:
Ultrasound has no known adverse side effects and it uses sound waves to visualize
structures
The patient will not be charged for the educational ultrasound (They may have an additional
ultrasound for clinical reasons for which they will be charged)
The student will touch their chest wall and abdomen with the transducer on their body
with possibly cold gel and cool, gloved hands to obtain the images
The lights in the room may be dimmed for better visualization of the images
Results from the educational ultrasound will not be included in their chart or patient
care decisions
If any type of problem is detected, the student will inform their preceptor and the
preceptor will direct the next steps
After reviewing this information with the patient, the student will ask the patient
to type their name and sign the . Images will NOT be accepted for the requirement if the patient does not complete
this consent.
WHAT DOES THE IM CLERKSHIP ULTRASOUND REQUIREMENT QUIZ INCLUDE?
The IM Clerkship Ultrasound Requirement Quiz includes:
Attestation question that you and your patient completed an "Educational Ultrasound
Informed Patient Consent" prior to scanning your patient
Attestation question that you have submitted your images and case information through
the provided link
Acquiring three sets of images for submission on three different patients
IM ultrasound content and case questions
WHAT IF I HAVE TROUBLE OBTAINING PATIENTS FOR IMAGING, IDENTIFYING EQUIPMENT TO USE,
OR HAVE TROUBLE UPLOADING IMAGES?
