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Here's part 1 of our first Spotlight on Specialist Skills. FAMUS stands for Focused Acute Medicine UltraSound; it is the point of care ultrasound standard specifically for physicians in AIM.
Nick Smallwood ( @NHSmallwood) is an AIM consultant and co-TPD for AIM in HEKSS. He was heavily involved in setting up FAMUS and uses point of care ultrasound in his daily practice.
Nick first became interested in point of care ultrasound after seeing bedside echo used as an FY2.
Nick was offered a job as an ultrasound fellow during his specialty training. As he trained, it became clear the advantages he would gain in being able to do this for future patients.
Nick estimates that around 25% of patients he sees on the ward round will need a scan – “I can just do that at the bedside – more often than not it changes my decision making at the time instead of waiting for a departmental scan”
“Supervisors remain our biggest challenge across the whole of the UK. Hopefully as it gets more embedded this will become less of a problem. As it becomes more embedded it will become the standard of care and will be available to all trainees”
There are 3 main types of scanning within FAMUS - chest, abdominal and vascular
“In older people that can be a difficult nut to crack because they’ve often got COPD and a bit of heart failure. On the take that’s probably the most common thing.”
Scanning patients with AKI and ruling out obstruction is not something Nick does all the time, but it can quickly change the trajectory for patients when obstruction is identified.
“Ultrasound guided vascular access is becoming an increasingly core skill.” Nick also does DVT scans in ambulatory care, which is particularly useful out of hours when access to departmental scans is limited.
“One or 2 conversations with a radiologist or sonographer where you make it clear you are committed to it and want to learn is usually enough for them to support trainees attending sonographer sessions. We’ve got lots of literature on the website”
Nick’s other top tip is proactivity: “with those two things (persistence and proactivity), you will succeed”
Some final words of advice:
Thank you again to @NHSmallwood for sharing your experience of FAMUS. We'll be sharing more FAMUS experience, this time from current AIM trainee @damian_dooey, tomorrow
