Nitin Arora 75x75

 Dr Nitin Arora (@aroradrn), Consultant Intensivist at Heart of England NHS Trust, discusses his journey in attempting to complete #fiftyscansinfifty days and offers advice to those undertaking the FICE accreditation.

Over the last few years, FICE has become the de-facto standard bedside focused echo accreditation for UK intensive care. Having tried and failed to complete my FEEL logbook as a registrar in 2012, I decided I’d try again as a consultant. After 2 years, a business case and having trialled various machines, our 2 new machines finally arrived in April 2017, and I immediately set about finding a FICE course.

Day 1 (FICE Course)

The course was fantastic! I came back with great enthusiasm and set myself a target of doing fifty scans in fifty days. I knew this would not be easy, but I was determined to try. In addition, I decided to only log patients in whom I had 3 good echo views (rather than the minimum 2 views).

To fit scans into a life with a family and a dual-speciality 11 PA job-plan was always going to be a challenge. Over the next 2 months I was scheduled for only 10 days on intensive care, which would not be enough. So I decided to go to the unit whenever there was a break in my anaesthetic list or at the end of the day.

quote2

The course was fantastic! I came back with great enthusiasm and set myself a target of doing fifty scans in fifty days.

In the first few weeks, I spent 6 sessions in the echo department to ‘get my eye in’ and learn valuable skills, like probe placement/handling and image optimisation. It helped that I already did a fair amount of ultrasound-guided nerve blocks and was used to ultrasound knobology and pattern recognition.

Day 14 (17 scans)

In my first 2 weeks, I picked up 1 pericardial effusion, 1 peripartum cardiomyopathy, 1 very narrow aortic valve, and 2 severely impaired left ventricles. This helped to keep my enthusiasm, and I got 17 good scans signed off in 2 weeks. I tweeted about my progress regularly, and received plenty of positive feedback and advice from the online ICM community, which spurred me on.

I tried integrating echo into the ward round to discover that this slowed us down considerably, and the rest of the team had to wait for me while I found a good ‘window’. I then started doing an ‘echo’ round after the ward round. I initially scanning ventilated patients, but found obtaining views in this group challenging in the early stages.

Day 18 (20 scans)

I approached a patient on NIV and was surprised when, on explaining that this was a training scan, he happily agreed to be scanned and even tried his best to get into the optimal position for the scan. Emboldened , I then started approaching other patients and found that not one refused my request to scan them for my benefit.

Day 24 (25 scans)

After the halfway point was reached, I slowed down a little. It was summer holiday season and between myself, my Mentor & Supervisor, we had 4 weeks of leave.

quote2Emboldened , I then started approaching other patients and found that not one refused my request to scan them for my benefit.

Day 60 (40 scans)

Getting from 30 to 40 scans took 28 days, and I was worried that I’d lost momentum. A friend suggested that I should set a date, and I duly arranged my final assessment 12 days time.

Day 64 (50 scans)

The last 10 scans were dispatched in one day. I came in on a day off and went to both hospitals in my trust, scanning all the ICU patients. I found myself looking at the anaesthetic rota and then visiting my Mentor on her lists so she could look at my FICE images.  I felt relieved that I’d done it, but also a bit disappointed at not having got #FiftyScansInFiftyDays

Day 73

The final assessment, which I had been dreading, was actually very pleasant, and I managed to get 5 good views and some positive findings. I sent the Summary of Training Record to FICE and received my certificate of FICE accreditation in less than 24 hours.

The whole process took 73 days (64 days to complete my 50 scan logbook).

What would I recommend to people looking to train in FICE?

  1. You can do it! Just break it down into chunks of (say) 10 scans each; set a goal of 5 scans a week, and you’re good to go!
  2. Make sure you scan some patients in the first couple of weeks following your FICE course (that’s when your enthusiasm will be at its highest)
  3. Find a Mentor and Supervisor before your course
  4. Don’t use your training scans to change clinical management unless they’ve been reviewed by someone more experienced at echo.

quote2You can do it! Just break it down into chunks of (say) 10 scans each; set a goal of 5 scans a week, and you’re good to go!

 

What’s next?

Currently our department has one FICE Mentor. I plan to teach on a FICE course and apply to become a mentor. Starting shortly are 2 new, FICE-accredited consultant colleagues, both interested in Mentoring, which will mean that a department with 16 consultants will soon have 4 FICE Mentors.

We are planning to have 2 of our 9 ACCPs FICE-accredited in the first half of 2018. Our aim would then be to have all the ACCPs, and at least half of the consultants, FICE-accredited by end 2019. If successful, our department will be ready for the coming age of intensive care ultrasound!

Acknowledgements:

My Colleagues: Anna Dennis, Sultan Ramzan, Olusegun Olusanya

Most importantly: my wife Ira

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Are you a clincian who has achieved their FICE Accreditation?  You may be interested in Extended – Fice on 03/12/17. This course to aims to increase understanding of the capabilities and limitations of FICE.

You can find out more and register here.

You can download a flyer here.

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