Featuring Dr. Charles Murchison (UCSD), Dr. Alan Chiem (UCLA), & Dr. Michael Schick (UC Davis)
Interviewers: Oliver Marigold (UCSD), Kenneth Kim (UCLA), & Meg Maeda (UC Davis)
Accessible Text Version
1. What is Emergency Ultrasound?
Dr. Chiem: In 2020, we use ultrasound to guide resuscitation in our sickest patients, to perform regional anesthesia in patients in which procedural sedation is impractical or would incur greater risk, and to help us to dramatically tailor our work-ups so as to avoid many other laboratory and imaging studies. In a time when burnout is prevalent, with the lack of patient interaction cited as one factor, ultrasound also brings us back to the bedside, where we possess the power to show our patients their internal organs and physiology. This awe is shared by both patient and doctor, reminding us why we chose medicine in the first place.
2. What was your path to Emergency Ultrasound? Are there other typical paths to your subspecialty?
Dr. Schick: I became interested in emergency ultrasound during my second emergency sub I when I witnessed its use for the first time at Highland Hospital. I completed an elective in ultrasound during my fourth year of medical school and it has been an important part of my practice ever since. My scholarly work during residency focused on POCUS, where I created a medical school curriculum and traveled to Tanzania to teach nurse midwives basic POCUS. I went on to complete fellowship training at UC Davis where I now co-run the medical school ultrasound curriculum and serve as the director of international ultrasound within my department.
3. How is working in the field different from what you imagined as a medical student or resident?
Dr. Chiem: I was one of the residents in my program that loved to use the ultrasound machine. However, I found that many other specialties did not recognize our findings. When I was applying for fellowship, I did not see the benefit of teaching medical students such an advanced skillset. However, my fellowship director, Dr. Chris Fox at UC Irvine really opened my eyes to the advantages of teaching all physicians POCUS, starting on Day 1 at medical school. I still remember going to the first-year medical student orientation at UC Irvine and doing a POCUS demo with him back in 2011. Now, as a fellowship director myself and having been involved with the development of ultrasound education at the UCLA David Geffen School of Medicine, I can clearly see the multi-specialty vision of POCUS.
4. Why should or shouldn’t a resident pursue fellowship training in your field?
Dr. Murchison: I don't see a lot of downsides to fellowship training, unless you are certain you don't want to do academics and/or you hate ultrasound. Some will say the money aspect, but one more year of earning a lower salary did not feel like an unreasonable commitment to me, even with loans. I tried to think about my ten-year plan, as opposed to my one-year plan, and fellowship made sense. The upside of fellowship: you don't close any doors (if you do community and want to come back into academics at some point you have your fellowship), you learn an practical clinical skill, and the fellowship year itself is a pretty nice year post-residency
5. What has your fellowship training allowed you to do or learn that you might not have had the chance to do otherwise?
Dr. Schick: I am involved with a number of dynamic programs and projects around the world that I would not have been able to do otherwise. I serve as the Director of Ultrasound for Global Emergency Care and travel every year to Uganda. I am working on research projects in Vietnam and Laos. I have run training programs in Uruguay, Nepal, The Gambia and Belize. Locally, fellowship training has allowed me to teach a number of conferences, expand ultrasound exposure and training within the school of medicine, and mentor a number of students, residents, fellows and faculty.
6. Are there specific practice environments or jobs that open up with a fellowship in your subspecialty?
Dr. Murchison: In academics, a fellowship will help you get on track a little quicker and give you a niche. In the community, a fellowship will set you up to be an Ultrasound Director, which is the doctor in charge of all ultrasound activity in the Emergency Department (buying machines, credentialing other providers, teaching, billing, etc). Internationally, ultrasound is an incredibly useful technology for resource-poor settings so there is always a need for ultrasound-trained physicians to do ultrasound teaching abroad.
Dr. Chiem: It has allowed me to establish a network of like-minded thinkers and POCUS practitioners through the country and the world. Fellowship training also gave me a solid foundation in the POCUS literature, which has given me a deeper appreciation of pioneers not just from EM, but from other specialties like radiology and cardiology. It has also allowed me to further develop my interests in other areas, such as in curricular design, clinical research, and simulation.
7. What advice do you have for aspiring Emergency Ultrasound doctors?
Dr. Chiem: Continue to challenge yourself on every shift by practicing POCUS. Learn to take a stab at interpretation and take each accurate call as a pat in the back. Take each misstep as an opportunity to grow in your training. Any expert will tell you that it takes a lifetime of practice, of challenges, success, and mistakes, to truly become an expert. Not just in POCUS but in any field.
Dr. Schick: Follow your passions and scan as much as you can! Get involved in education, organizations and committees early.
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[Included in our Q4 newsletter. Editor: Tiffany Fan]
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