A Novel Model for Teaching and Performing Focused Sonographyhysician-performed focused sonography is an emerging field within medicine and has potential for a range of diagnostic and therapeutic indications. 1 In 1999, the American Medical Association approved policy H-230.960, asserting that physician-performed focused sonographic examinations should be performed if within the scope of the physician's specialty. 2 American Medical Association policy H-385.934 later stated that physician-performed focused sonographic examinations are billable procedures in patient care. 3 Although there have been few efforts by medical specialties to formally define the scope of practice for physicians within their field, physician training programs have undertaken substantial efforts to implement ultrasound education programs. [4][5][6][7][8][9][10][11][12][13] Ultrasound education programs for physicians are currently designed to develop knowledge and skills in specialty-specific applications of focused sonography. Unlike comprehensive sonography, typically performed by either a sonographer or radiologist and assessing multiple clinical questions, focused sonography generally answers a focused clinical question. [4][5][6] Early physician training programs in focused sonography have been tested across the spectrum of medical school, residency, and fellow levels. [4][5][6][7][8][9][10][11][12][13] For example, focused transthoracic echocardiography, which seeks to determine the presence of a pericardial effusion and estimate cardiac contractility, was shown to be feasible in a training program for early medical student, resident, fellow, and attending cohorts. [14][15][16] Although the discussion of where focused sonography training is best suited within the physician training paradigm persists, the main issue re-
TECHNICAL INNOVATIONThis project was designed to use existing evidence in education and clinical quality improvement to design an educational and clinical model specific for physician-performed focused sonography. The I-AIM model (indication, acquisition, interpretation, and medical decision making) was created to serve as both a mnemonic and checklist. The model follows a stepwise logic for performing focused sonographic examinations and contains detailed subcomponent listings that cover specific areas to improve use and performance. Although validation and reliability studies will be required before implementation, the I-AIM model represents the first effort to standardize and improve clinical and educational focused-sonography.