Almost FAMUS

If you’re struggling to get your cases organised, you can download our special modified takeAIM version of the logbook below:

Today’s blog is all about how to get signed off for FAMUS. This is mostly aimed at AIM ST4s who are starting off with their accreditation process and feel a bit lost, but it may be of use to IMTs who are looking to get ahead of the game.

There are a few introductory steps to getting signed off, which I won’t cover in detail here. Basically you need to:

  1. Register with SAM
  2. Attend an approved FAMUS course
  3. Identify a local supervisor
  4. Complete your logbook of cases
  5. ????
  6. Get signed off

Finding a supervisor seems to be the rate-limiting step for most people. I think this is going to become dramatically easier over the next two years as more or more trainees accredit and ultimately become supervisors themselves. You can search the database to find a local supervisor here.

Your supervisor should lead you through the process of getting your logbook done, but there are a few tricks which will make this a lot easier.

The first thing to know is that there are two different kinds of scans you’ll need for your logbook: supervised scans and mentored scans. Supervised scans are directly overseen by your FAMUS supervisor, who can watch you and confirm you’re using the right technique. You’ll need to do a total of 25 directly supervised scans:

  • 10 supervised thoracic scans
  • 10 supervised abdominal scans
  • 5 supervised DVT scans

Your supervisor will guide you as to how they would like this to be done. Some supervisors arrange teaching sessions for larger groups of trainees, whereas others will do 1:1 scanning on the ward. Either is suitable – it really comes down to whatever works for the person signing you off.

Mentored scans are a little different. These are scans you do independently and have reviewed at a later date by your supervisor. You’ll need to do a total of 70 mentored scans:

  • 30 mentored thoracic scans
  • 30 mentored abdominal scans
  • 5 mentored DVT scans
  • 5 mentored US-guided cannulas

This sounds like a lot, but I think a lot of people think this process will be more arduous than it actually is. The key is to be purposeful in how you approach the process. There are sets number of certain pathologies you need to cover – scanning haphazardly on the take will eventually get you what you need, but dedicating a session a week to tracking down specific cases and getting them done will get you signed off much quicker.

(As a side note, the pathology numbers specified in FAMUS guidance are intended – I believe – as a guideline. Your supervisor may not be strict and may not need you to get exactly 20 pleural effusions, for example. But for the purpose of today’s blog, I’ve done things to the letter of the law, so that you can too if you need to.)

The first thing you need to do is get access to a machine. Many deaneries now give AIM trainees access to a Butterfly probe, but you can also use a cart-based machine. Many units have one that spends a lot of its time gathering dust and – provided you let people know where you’re off to – it’s not too tricky to steal it away for an hour.

The next thing you need to do is figure out how you’re going to store your mentored scans. If you’re an AIM trainee using a Butterfly probe, you can save your scans direct to the SAM Education cloud. If you’re using a cart-based machine, you can save clips (anonymously) to a memory stick and share these with your supervisor at a later date.

If you do this, I’d strongly advise you to back your scans up to a desktop or laptop – you’d be shocked at how many people lost their memory sticks in my cohort!

Here’s how to save a clip to a memory stick using a standard GE machine.

So how should you approach this scary-looking mountain of mentored scans you need? Well feel free to download takeAIM’s modified version of the FAMUS logbook at the top of this blog. This version of the logbook tracks the requisite pathologies you need automatically. It also keeps track of how many supervised and mentored scans you’ve done, and tells you how many you have left to get.

I love Excel.

Now let’s talk through each module in turn.

Thoracic Module

For the thoracic module, you need to roughly capture the following:

  • 20 x pleural effusions
  • 5 x increased lung water
  • 5 x consolidation

You’ll note that this adds up to 30, so if your ten supervised scans were all on healthy volunteers, your 30 mentored scans all need to contain some kind of pathology. It’s not enough to scan every patient on take, as you may then end up with 25 normal looking lungs with a logbook that is somehow both full and incomplete.

Obviously some patients have consolidation and a parapneumonic effusion, and most patients with increased lung water will have effusions too. The takeAIM logbook takes this into account when calculating how many scans you have left. So you may be able to include some normal scans after all.

So as I said above – this is all about being purposeful. If you have scanning time, have a look at the AMU patient list – you’ll find plenty of patients with lobar pneumonia or pulmonary oedema or a suspicious effusion. These are the patients you need to be attacking with your ultrasound machine.

Respiratory wards are also – inevitably – a goldmine for stuff like this. Even if you find just two effusions per scanning session, you’d only need ten sessions to get this one done and dusted.

Abdominal Module

For the abdominal module, you need to roughly capture the following:

  • 10 x free fluid
  • 5 x hydronephrosis​
  • 5 x distended bladders

You’ll note that this adds up to 20, so even if your ten supervised scans were on healthy volunteers, your 30 mentored scans can include up to 10 scans without any pathology on them. That makes this module a little easier than the thoracic module.

In terms of where to look – your free fluid is likely to be all be ascites. I included someone with haemopertioneum but I stumbled across this by pure luck. Plenty of ascites on the medical take but you can make up any missing scans by taking a few trips to your friendly local gastro ward.

Hydronephrosis may be a bit trickier to come by – I found myself scrolling through the patients on the Urology ward to find anyone with obstructive pathology and managed to tick off five cases this way in just a couple of afternoons.

Distended bladders don’t have to be in full blown urinary retention. A big full bladder is sufficient. You’ll find plenty of these if you’re scanning regularly on the take.

DVT / Vascular Module

For the DVT module, you need to do a total of 10 DVT scans, of which only one needs to actually have a DVT. This should be pretty straightforward if you’re working in Ambulatory Care regularly – most patients don’t mind having an extra scan after their confirmatory Doppler if you ask nicely, and you only need to do this once. The other four can be normal – easy to do that in one AEC clinic if you’re smart.

You also need to insert five peripheral cannulae under ultrasound guidance. Some supervisors will sign you off if you capture pictures of the vein before and after, but some may be more exacting. Most machines are defaulted to capture a few seconds of cine before they stop, so you’ll need to extend the default cine length if your supervisor wants to see the whole process in glorious detail.

Here’s how you do this on a standard GE machine:

I probably do a few PVCs a week, so if you start using ultrasound today, you could be done with this part of the logbook very quickly.

I hope that shines a bit of light on the process, and that you find the takeAIM logbook useful. I think if you were really desperate to get signed off, you could complete the logbook in just a few weeks. But provided you’re organised and purposeful in your approach, anyone could easily get their mentored scans done in 2-3 months.

If you have any questions about the process, we’d love to hear from you.