Enjoy the next Thomas Jefferson Point-of-Care Ultrasound Educator of the Month Series!  This post is brought to you by Regan Tuder, MD, MS, second-year resident in Emergency Medicine at Thomas Jefferson University Hospital in Philadelphia, PA.

Developing a Career in PEM POCUS: Reflections and Lessons Learned

Dr. Jennifer Marin is an Associate Professor of Pediatrics and Emergency Medicine at the University of Pittsburgh School of Medicine. She is the Director of Emergency Ultrasound and the Medical Director for Point-of-Care Ultrasound for UPMC  Children’s Hospital of Pittsburgh. She is a health services researcher with a focus on diagnostic imaging utilization.  

When Dr. Marin was a first year pediatric  EM fellow rotating on adult trauma, the trauma attending told her to do a FAST exam on an acutely hypotensive patient. She stared blankly at the chief. She had never heard of a FAST exam. The shame of that moment, of being exposed for what was to the surgeons a basic procedure, motivated her to research the FAST and learn to perform it well. 

That initial interest bloomed into incorporating ultrasound more broadly into her pediatric emergency medicine practice. She initially met resistance from the radiology department. So, she negotiated a compromise. She was permitted to conduct a study for which she was allocated one ultrasound machine. This machine could only be used for research and when not in use, it had to be kept under lock and key.

As a junior faculty member at Pitt, Jen was determined to have all practitioners incorporate ultrasound into routine use in the emergency department. This time, the radiology department was receptive. Her initial challenge was to train other faculty members and fellows. None had been exposed to ultrasound in any part of training. For advice on how to meet this challenge, she turned to colleagues outside her institution.  She noted there were no published PEM specific guidelines.  She contacted Resa E. Lewiss, the then President of the Academy of Emergency Ultrasound of SAEM. Together, they led the writing of pediatric-specific guidelines for the use of ultrasound in pediatric emergency medicine. The project took 4 years and is now the American Academy of Pediatrics policy statement. 

Jen was simultaneously motivated to increase the visibility of pediatric emergency medicine ultrasound in the published literature. She sought to create a space for authors to highlight novel applications and interesting cases in PEM ultrasound. She contacted the Pediatric Emergency Care journal editors and was quickly named the section editor for the journal, which is one of the most popular sections of the journal. Dr. Marin offered advice for those physicians wanting to improve the institutional support of ultrasound in their daily practice. She suggested championing billing, so that the financial benefits of ultrasound examinations could be tracked. She also recommended working with the radiology department for practice guidelines for ultrasounds, and working with subspecialties to build trust in the accuracy and usefulness of EM ultrasound exams. Dr. Marin is glad to be contacted jennifer.marin@chp.edu.