UNC has an active ultrasound program in the emergency departments at UNC, Wake Med and Hillsborough hospitals. This begins early in the residency with both a full-day ultrasound orientation course and a dedicated "ultrasound/procedures" month in the intern year.
The philosophy is that, by becoming comfortable with ultrasound early on, it will become an indispensable clinical tool throughout residency and beyond. There are dedicated ultrasound faculty who will provide bedside teaching as well as image review. There are comprehensive didactics and hands-on sessions throughout the year on basic ultrasound applications but also on secondary applications such as ophthalmic exams, DVT exams, and ultrasound-guided procedures.
The emergency medicine ultrasound director is Sarah Stahmer MD, who has been instrumental in developing EM US training and practice guidelines for nearly 20 years. She has recently assumed the directorship for US residency training and has expanded the role of US in clinical practice and the didactic program at UNC. Faculty at UNC and Wake Med routinely incorporate US into their clinical practice, nurses use US to guide IV access, and consulting services respect and ask for the ED US findings. Hillsborough hospital is a new UNC site that is 15 minutes from the main campus, and the US technicians have enthusiastically embraced the EM residents and supervise a wide range of US exams including first trimester pregnancy, ECHO and DVT.
The ultrasound program at UNC focuses on learning "real world skills" so that graduates of the residency program will utilize focused, bedside sonography to enhance the physical diagnosis and treatment for a wide array of ED presentations. Ultrasound is used to narrow the differential diagnosis of undifferentiated hypotension, dyspnea, and abdominal pain; risk stratify trauma victims; guide procedures; assess the patient with symptomatic first trimester pregnancy, joint pain and swelling, and visual loss.
During orientation there is a full day US orientation session that focuses on ensuring that incoming interns have the skills to assess patients with undifferentiated abdominal pain and hypotension.
Emergency Medicine interns have a month long rotation in US and anesthesia. During this month they schedule time in one of three sites where they can scan under close supervision of EM faculty, EM ultrasound chief residents and ultrasound technicians.
Ultrasound is routinely incorporated into the didactic program. Every month there is a lecture on US applications in the core topic area for that module. Interns on the US rotation present a clinical case with a brief evidence based discussion.
There is an US concentration for junior/senior residents that has defined roles and responsibilities for student/resident US education, supervised US scanning, monthly US journal watch presentations, and research initiatives. There are presently three US chief residents, who rotate responsibilities for education, research and clinical activities.