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ANNOUNCER:
Welcome to ASA’s Central Line, the official podcast of the American Society of Anesthesiologists, edited by Dr. Adam Striker.
DR. ADAM STRIKER (HOST):
Hi, everyone. Welcome back to Central Line. I'm Dr. Adam Striker, your editor and host.
Today, we're going to discuss the new Diagnostic Point of Care Ultrasound Certificate program with Dr. Yuri Bronshteyn, Assistant Professor at Duke University and also Editor in Chief of the ASA Editorial Board on Point of Care Ultrasound. Dr. Bronshteyn, welcome.
DR. YURI BRONSHTEYN:
Thanks for having me on, Adam.
DR. STRIKER:
Well, before we get started, Dr. Bronshteyn, can you tell us a little bit about your background and how you got your interest in diagnostic ultrasound?
DR. BRONSHTEYN:
Yeah, absolutely. So I am currently at intensivist, an anesthesiologist at Duke, where I'm also an Assistant Professor. I did my anesthesia residency and ICU fellowship at Mass General. And then I came to Duke in 2015 for my first job. And I've been here ever since. My interests personally in diagnostic ultrasound rose during my time as a resident and fellow in MGH’s ICUs. The foremost question that I encountered as a critical care provider was why is my patient dying? And I found that point of care ultrasound allowed me to answer that question quickly and accurately in a large percentage of cases. So that led me down a long rabbit hole. I then sought out and completed structured training in various aspects of ultrasound. During my anesthesiology residency, I took the basic TEE exam offered by the National Board of Echocardiography. Then during my ICU fellowship, I obtained board certification and advanced TEE. Shortly after I joined Duke as faculty, I completed a certificate of completion in Critical Care Point of Care ultrasound offered by the American College of Chest Physicians. Then I took and passed the echo boards that echocardiologists take. Then I started teaching POCUS locally and nationally, and along the way I learned a lot. Among other things, I learned that other specialties were far ahead of where anesthesiologists were in offering their physicians standardized training in this modality.
DR. STRIKER:
There's a couple of points in there that I'd like to elaborate on, but before we do, let's talk about the program in broad strokes. The acronym POCUS, which we’ve already alluded to, and then talk about the goals and the, and the benefits of the program.
DR. BRONSHTEYN:
Sure. So the acronym POCUS stands for Point of Care Ultrasound. And this term is defined differently depending on where you read. I, and the editorial board within the ASA, use POCUS to mean ultrasound that is performed and interpreted at the patient's bedside by the patient's primary treating provider. This is to distinguish POCUS from consultative ultrasound, which is an ultrasound exam that is requested by the patient's primary treating provider, but performed and interpreted by separate specialist teams, such as cardiology and radiology.
We can further subdivide POCUS into three additional categories, which are procedural, therapeutic and diagnostic POCUS. Coming back to the certificate of completion we're here to talk about today, that certificate will focus on diagnostic POCUS of the heart, lungs, and gastric antrum, the three POCUS organ systems that the ABA and the ACGME currently identify as core competencies for anesthesiologists.
The certificate has three main goals: to offer anesthesiologists standardize training and diagnostic POCUS, to allow anesthesiologists to broaden their skill sets and thus offer more value to their employers and patients, and to help anesthesiologists who need a national credential in order to obtain local privileges to practice diagnostic POCUS at their home institutions. Notably, this certificate is not intended to create new bureaucratic headaches for anesthesiologists. The certificate is not a certification and is not intended to be a requirement for anesthesiologists to practice diagnostic POCUS. Instead, it is an educational certificate of completion meant to help those anesthesiologists who just need a piece of paper to take back to their home institutions if those institutions are reluctant to grant anesthesiologists privileges to practice diagnostic POCUS.
In addition to everything else I've mentioned, the program also offers some additional continuing education benefits, specifically 40 hours of CME credits and 10 hours of MOCA Part 4 credits.
DR. STRIKER:
Who can benefit from this program?
DR. BRONSHTEYN:
The Editorial Board envisioned two general groups of people that could, would benefit. Each can be subdivided a little bit. So the two main groups are anesthesiology residents and fellows, and the second group being practicing anesthesiologists. Within that first group of anesthesiology residents and fellows, we think this certificate could be helpful for programs that currently have incomplete POCUS training programs and want an off the shelf complete solution to fill in gaps for trainees. Another category of anesthesiology residents and fellows that might benefit are programs that already have a robust POCUS training program, but want their trainees to graduate with a national credential in this particular skill set. For this group, the certificate will be valuable.
The second big category I mentioned, practicing anesthesiologists, we can also subdivide that into four groups of practicing anesthesiologists that we think might want to seek out the certificate. First, anesthesiologists who are completely unfamiliar with diagnostic POCUS, who wish to learn this skill set. Second, anesthesiologists who have completed a CME POCUS course but are still uncomfortable using the skill set without further training. Third, anesthesiologists comfortable with POCUS who wish to cement their skills in order to supervise trainees or become a local POCUS Director in their department. And finally, anesthesiologists who are already expert at diagnostic POCUS who need a national certificate to gain privileges to use this skill set at their home institutions.
DR. STRIKER:
So the program pretty much will benefit anybody across the spectrum that has some interest in point of care ultrasound. So it's not simply just to offer a formal certificate, that can be a use of it. That is certainly a benefit. But if you really practically want the experience or to improve upon your experience, this program will, will assist in that as well.
DR. BRONSHTEYN:
Exactly.
DR. STRIKER:
OK, well, you already mentioned certificate of completion versus certification. Do you mind elaborating on the difference?
DR. BRONSHTEYN:
Yeah, absolutely. And a lot of what I'm going to be talking about in this podcast is going to sound like splitting hairs to many people. But for me, all of these distinctions are really important, and for the ASA this is a really critical distinction.
So we're offering an educational certificate of completion, not a certification. And when you look up differences between these two terms, certificate versus certification, it's a very abstract conceptual difference. And it's the sum of many small features that are unique to each term. So a certificate is the result of an educational process, whereas a certification is the result of an assessment process. A certificate indicates completion of a course, whereas certification indicates competence or mastery. A certificate can be, among the things listed on a resume. A certification, in addition to being listable on a resume can result in a designation that you can use after your name as an additional title for yourself. A certificate has no ongoing continuing education requirements, whereas a certification typically has ongoing educational requirements.
So the distinction matters because the ASA didn't want to impose new requirements on ASA members. And also the ASA is not a certifying body like the ABA. But the ASA has loads of experience creating educational programs. So the certificate of completion is meant to be an optional pathway to help anesthesiologists who feel they’re swimming against the current and can't get privileges or don't feel as qualified as they like to be in this skill set.
DR. STRIKER:
When you say they can’t get privileges, where is that barrier specifically? Is there resistance from a certain area of the hospital or is it generally the same across the board? For instance, where I practice, the radiology department pretty much is in charge of anything that involves imaging of, of any modality when it comes to privileging for other staff, they have to sign off on it. Is that the same everywhere? Where are the barriers?
DR. BRONSHTEYN:
Yeah, it's, it’s a great question. I, I don't think I have a, a handle on the global situation at every institution, but I've dealt with this quite a bit at Duke and I've spoken anecdotally with, with some people around the country and the barriers are a little bit unique in each institution because the, the credentialing and privileging process is somewhat unique to each institution. But in general, I, I think that the consultative ultrasound specialties like radiology and cardiology are very protective of this space for a lot of reasons, one of which is patient safety. And it's un, understandable that both these consultive ultrasound specialists in the hospitals themselves want to ensure that for any, any privilege that they're granting out to providers, that there is a backing to the provider being able to perform in that skill set. And currently, there's nothing available to, to anesthesiologists that is an anesthesiology specific national credential that they can take back to their home institutions. The best that anesthesiologists currently have are CME courses that culminate in a certificate. But it's not, it's not a rigorous certificate. It's basically just a piece of paper saying you completed some, x hours of CME and most hospital credentialing and privledging committees aren't super excited about that. Not nearly as much as they are by something that has the stamp of approval of a national professional society and has some rigor to it, including components that show the provider has completed training and image acquisition, image interpretation has completed a, a final exam of some sort.
And that's what this certificate offers. It's a, it's an attempt to address some of the, the problems with current CME courses just not being rigorous enough for many hospital credentialing and privileging bodies. And, and also, anecdotally, the ASA, through the message boards that the ASA has, has received inquiries from providers from around the country specifically asking for this product. In the past six months or so, we've seen an increase in providers basically demanding that the ASA offer some solution to this because they, they as anesthesiologists are being denied privileges in this particular domain of diagnostic point of care ultrasound for, by any number of other stakeholders.
DR. STRIKER:
Gotcha. Well, let's go ahead and talk about the process specifics a little bit. First, how did the program come about?
DR. BRONSHTEYN:
Sure. So like many things within the ASA and, and any national institution, it's been a long time coming. This particular program has been at least three years in the making, starting in 2018, a group of about 23 point of care ultrasound experts from around North America wrote a petition to, at that time, ASA President Dr. James Grant, asking the ASA to provide guidance to members about diagnostic POCUS, noting that other professional medical societies had already provided guidance to their members on this topic.
Dr. Grant then very kindly chartered the creation of an Ad Hoc Committee on POCUS to explore these issues. The committee was created in February of 2019 and spent the following year developing recommendations to the ASA's governing bodies, resulting in two deliverables. One was a recommendation for the ASA to create a standing POCUS Editorial Board that should be charged with the creation of a POCUS Educational Certificate Program, and two, the Ad Hoc drafted a committee work product consisting of expert consensus recommendations on things like anesthesia relevant scope of practice and minimum training recommendations for POCUS. This document is currently available on the ASA website and is also in a long queue of documents within the ASA that will eventually be considered for conversion into a practice parameter.
Then, in October of 2019, the Board of Delegates dissolved the Ad Hoc Committee and approved the creation of a standing Editorial Board in charge of that Editorial Board with the creation of an Educational Certificate of Completion in POCUS. A little over a year later, we're finally ready to launch the program.
DR. STRIKER:
Well, as far as the program specifics, what does it entail?
DR. BRONSHTEYN:
So after enrollment and payment, the program consists of five parts. First, the creation of a Performance Improvement Action Plan, and the purpose of this step is both for personal enrichment for the learner, and also to make this whole exercise eligible for MOCA Part 4 credit for the learner.
Second, the learner needs to submit evidence of recent prior diagnostic POCUS training, meaning training that they've received in the three years preceding their date of enrollment and can also be obtained up to two years after their initial date of enrollment. That prior POCUS training should consist of at least 10 hours of either CME or ACGME time dedicated to the topics covered by the certificate, which are physics of ultrasound and diagnostic ultrasound of the heart, lungs and gastric antrum.
The third part of the certificate consists of Image Interpretation Training, which in this case involves the learner completing an online curriculum that teaches image interpretation skills and includes 140 case based image interpretation exercises.
The fourth part of the certificate is Image Acquisition Training. We ask learner to build a portfolio of studies, 50 cardiac, 30 lung, and 30 gastric exams, and that a subset of the portfolio be over-read and attested by either a local mentor or by the ASA Editorial Board.
Finally, the fifth step in this certificate program is a web based final exam.
DR. STRIKER:
And how long does it take to complete the program?
DR. BRONSHTEYN:
We designed the program to maximize flexibility for the learner and allow it to be self-paced. Notably, many of the parts of the program can be attempted concurrently, for instance, the Image Acquisition and Image Interpretation portions. And ultimately learners will have a maximum of two years from their date of enrollment to complete all components of the certificate. We anticipate that on average, the program will take between four to twelve months to complete.
DR. STRIKER:
And I understand the program is focused on heart, lung and gastric, which I'm sure makes sense to a lot of us, but let's tell our listeners why you chose that focus specifically.
DR. BRONSHTEYN:
Yeah, I, I think some people will find it somewhat arbitrary, but I'll say that we initially had, had sought to include additional POCUS organ systems. However, the ASA asked us to only include topics that were already considered core competencies for anesthesiologists by the ACGME and ABA. So we very carefully reviewed the content outlines published by both organizations and found that both organizations already included point of care ultrasound of the heart, lungs and gastric antrum as core competencies for anesthesia providers.
DR. STRIKER:
OK, and the certificate also covers Focused Cardiac Ultrasound rather than TTE or Transthoracic Echocardiography. Can you clarify the distinction and tell us why it matters?
DR. BRONSHTEYN:
Yeah, this is another one where I think many people will think I'm splitting hairs, but this is a really important distinction in my mind and, and one that, that is often glossed over, I would say in everyday parlance and, in health care. But the distinction is important because it has bearing on all aspects of the clinical use of transthoracic cardiac ultrasound, including credentialing/privileging, billing, training, intra provider communication and ultimately patient safety.
So the, the big fork in the road that I want to draw is between echocardiography and FoCUS Cardiac Ultrasound. In order to contextualize those two terms, though, I’m going to need to add a little bit of extra nuance, because in 2019, the National Board of Echocardiography coined a new term called Critical Care Echocardiography, which complicates things a little bit. And so I'm going to go through a hierarchy, if you will, of, of how these terms all fit together.
So at first bifurcation, or the first fork in this hierarchy, we have two terms: Point of Care Cardiac Ultrasound and Consultative Transthoracic Echocardiography. Okay? So focusing on the Point of Care Cardiac Ultrasound first. That one has two sub-components or two, two variations, if you will. So Point of Care Critical Ultrasound is a cardiac ultrasound exam that is performed and interpreted at the bedside by the patient's primary treating team. The two flavors of that are focused cardiac ultrasound and transthoracic critical care echocardiography, which is a mouthful admittedly. Focused cardiac ultrasound is a surface cardiac ultrasound exam that requires only simple equipment, i.e. greyscale imaging. The exam is performed and interpreted by somebody with training and at minimum a subset of cardiac ultrasound pathologies to answer questions qualitatively. Questions like, is the patient's left ventricle failing or mostly normal? Is the patient's right ventricle failing or mostly normal? More, more or less, binary questions about key cardiac pathologies.
The second category of Point of Care Cardiac Ultrasound is transthoracic critical care echocardiography. This is a surface ultrasound exam performed by a bedside physician, typically an intensivist, but, but sometimes other specialties with board certification in the space or equivalent training. And, and equivalent training would mean basically a year's worth of time dedicated to learning this advanced skill set.
So both of those terms focused cardiac ultrasound, a transthoracic critical care echo fit under the umbrella of Point of Care Cardiac Ultrasound because both these exams are performed and interpreted by the primary treating provider of the patient. In contrast, consultative transthoracic echo is a surface cardiac ultrasound exam requested by the patient's primary team but performed by a consulting team trained in this advanced skill set called echocardiography. In most US institutions, the consultative team would be cardiology. But in some institutions, anesthesiologists with specialized training perform this role.
So lastly, I, I want to spend a minute on the term transthoracic echo to, to explain that a little bit more clearly. Transthoracic echo identifies a surface cardiac ultrasound exam employing advanced equipment, for instance in addition to greyscale imaging, it should include color and spectral Doppler and EKG gating. This is an exam performed by providers with comprehensive training in thoracic cardiac image acquisition and interpreted by providers with comprehensive training in transthoracic cardiac image interpretation to answer questions quantitatively.
So when, when you call something the terms that make no sense, when you, when you think about this hierarchy that I'm explaining, the terms that make no sense are things like an informal echo or formal echo. The reason these terms are problematic is that they sort of blur the lines between these terms and make it unclear what the qualifications of the provider actually are, and what the scope of practice of what they're doing is. And basically, it, it sort of undermines the, the value of, of both echocardiography and, and focused cardiac ultrasound. So if at all possible, we want to encourage providers to use the terms that have been developed very thoughtfully by national professional medical societies and multiple guideline statements, even if there is a prevailing culture of, of blending these terms and using them inappropriately.
DR. STRIKER:
Give me an example of the inappropriate use, for instance, just using the term transthoracic echocardiography?
DR. BRONSHTEYN:
I, I think transthoracic echocardiography is perfectly acceptable as long as the provider doing that exam has comprehensive training in image acquisition, comprehensive training in image interpretation and is doing a quantitative exam. An appropriate term would be formal echo. Formal echo implies that there is something in, inverse to that, like an informal echo or a sloppy echo. What we, what we don't want people doing is basically performing anything informally. You either perform focused cardiac ultrasound formally, systematically and within the very narrow scope of practice of that term. Or you perform echocardiography formally and systematically within the very broad scope of practice of that term. And the one that you perform depends on your level of training and the equipment that you're using, basically.
In order to call it echo, the standard is very, very high. Most things that anesthesiologists are going to be doing are, 99% I would argue, are going to be focused cardiac ultrasound. And by using that term, if you miss a, a very nuanced, complex finding that falls outside the scope of practice of focused cardiac ultrasound, you, you have no ability to be liable for that because it falls outside of the well defined scope of practice of focused cardiac ultrasound, if you miss an (SIC). Whereas, if you call what you're doing a bedside echo, well, that, there are high standards expected of that. And, and if you're billing for something as a bedside echo using CBT based billing, but you're actually performing a very low level exam that should, is better described as focused cardiac ultrasound, there are billing problems with that that might be considered, you know, medical legally problematic.
DR. STRIKER:
But you, you can acquire these skills without necessarily having the intent to bill for them if you just want to make it part of your practice.
DR. BRONSHTEYN:
Yeah, absolutely. That's, that's exactly right. We, we make no comment about how people should use the skills from a billing perspective. But if, we do emphasize that the skills that we teach in the certificate is focused cardiac ultrasound, so that if all the knowledge that you have of surface cardiac ultrasound comes from our certificate, we don't want you calling what you're doing a bedside echo. We don't want you calling it an informal echo. We want you calling it a focused cardiac ultrasound, because that's what we've taught you. And we want you to stay within the scope of practice of, of what you've learned.
DR. STRIKER:
Let me throw another term at you. FATE. F-A-T-E. Are, are you familiar with that one?
DR. BRONSHTEYN:
Very familiar. Yeah. So the problem with some of these acronyms that have been developed is FATE and several others, people came up with catchy acronyms that, and mnemonics that they found to be useful for getting their particular version of a protocol into a publication. But when you look at professional guideline statements on the space, it is unequivocal that, that the term echocardiography should not be used to describe what these protocols are doing. All these protocols, 99% of them, actually are using focused cardiac ultrasound rather than echocardiography. So even though somebody has published a protocol that in order, in order to get some recognition and they've called it echocardiography, their use of that term is not supported by professional, multiple professional guideline statements that, that basically make a clear distinction between focused cardiac ultrasound and echo, and echo being very, very high standard that requires essentially a year's worth of training to achieve. It's an inappropriate use of the term echo to call these protocols echocardiography.
That being said, what acronyms people use to, to describe what they're doing, you know, ultimately is up to you. But if you want to practice in adherence with multiple professional guideline statements, not, not from the ASA, but from the American Society of Echocardiography guideline statements that were endorsed by a dozen professional other medical societies, they make it very clear that protocol like FATE, is actually describing focused cardiac ultrasound.
DR. STRIKER:
So theoretically, you know, that may be a problem. Realistically, can that present problems for anesthesiologists if they're using that terminology technically and appropriately?
DR. BRONSHTEYN:
I, I personally don't use that terminology to, to describe focused cardiac ultrasound exams. I think that, you know, I have no legal background. I can imagine a creative plaintiff's attorney doing some bizarre things. I, I, I don't think it would be a very credible case against an anesthesiologist to say that they're misrepresenting what they're doing by calling their exam FATE when it's actually focused cardiac ultrasound because, like you said, there is this, this misnomer is widespread in, in health care. But I think as a, as a, just a general principle, it's, it’s easy enough to just avoid terms that have been basically rejected by, by the national professional society level. So I, I don't think there's going to be legal consequences to people doing it. But I just think it's a sloppy practice to call something that's focused cardiac ultrasound very clearly, to call that echocardiography.
DR. STRIKER:
Certainly. Always a good idea to, to try to be as accurate as possible in the description of what it is we're doing.
DR. BRONSHTEYN:
Yeah, yeah. And, and I mean, an analogy I, I want to give people, and some people might find this a problematic one is, we don't call a chest X-ray an informal CT scan. A chest X-ray has a very narrow form of scope of practice, but it, within that scope of practice, it is interpreted by radiologists very formally, rigidly and systematically as a CT scan also is a very formal, rigid, systematic thing that's interpreted by radiologists. And so that's, that's very analogous, the distinction between focused cardiac ultrasound and echocardiography. Echo provides a robust set of data points that are not available by focused cardiac ultrasound exam. There doesn't make sense to use them, kind of, as one, as an informal version of the other.
DR. STRIKER:
Circling back just a little bit on the, the focus areas of the ultrasound, many of the anesthesiologists that are listening, a lot of this may be familiar, but we can assume that some aren’t, and say I'm a practicing anesthesiologist out there somewhere. I trained without this, I don't, I don’t really, not as familiar, but I would like to understand this a little more. But what fundamentally am I gaining by doing this? Like, give me an example of examining the heart, or the, or the antrum, or the lungs. Like, what can I do that I wasn't able to do before? Perhaps just take us through a little bit of that for anesthesiologists that may not be quite as versed on all this.
DR. BRONSHTEYN:
Yeah, absolutely. First, I, I want to really seriously acknowledge that our, our goal is not to diminish the enormous skill and experience of practice anesthesiologists who don't use POCUS. Us emphasizing this skill set is not meant to diminish any of that. The value of this is basically just an incremental added skill. Just like in each department, everybody has kind of additional, some skill sets that they are particularly expert at, that can be useful in certain situations. POCUS is, is one such skill set. So like, for instance, you might, each department might have the airway guy or gal and they might now have a POCUS guy or gal and situations where this is useful in a preoperative setting.
You know, tell me if this has ever happened to you. It’s, it’s 7:00 a.m. on a Saturday morning and you're showing up for a full day of, of trauma cases, first of which is a patient like, 80 year old patient with a hip fracture, with an unknown past medical history, don't, they don't like to see a doctor very often, but you dust off your stethoscope, or, or the nurse that saw the patient before you dusted off theirs and they hear a very clear systolic murmur, and you're faced with a, a quandary, echocardiography, consultative echocardiography services, aren't available on a Saturday at your institution, let's say, not on an urgent basis for this particular case. And you're faced with the question of whether to proceed with the case or try to obtain information some other way. And focused cardiac ultrasound in a preoperative setting can provide some information. If, if you see the aortic valve and you have illustration quality images that show it's opening widely. Well, you know that that systolic murmur is due to something other than aortic stenosis, you know that this is either, you know, maybe they have some degree of MR or TR or they have a flow murmur from a high flow state, or what have you. That's diagnostically useful information, because otherwise, this patient that has a very time sensitive problem that needs to be addressed within forty-eight hours of a hip fracture may have their surgery delayed for no reason.
That's one situation, another situation where the heart ultrasound, you know, or lung ultrasound are helpful are in crisis management, intra- and postoperatively. How many times has a patient developed acute onset refractory hypotension or hypoxemia? When faced with either of those problems, the heart exam helps to narrow the differential diagnosis of hypotension and basically sorts the possibilities into four, four categories and moves those four categories up or down, the differential diagnosis, those four categories being low preload, low systemic vascular resistance, obstructive and cardiogenic processes.
The lung portion helps you in situations where you have acute onset refractory respiratory failure or refractory hypoxia. It helps you evaluate for things like a gross pneumothorax, gross pulmonary edema, things like hemothorax, that's a little bit rare in the anesthesiology world, things like pneumonia. These are all things that one can diagnose with ultrasound probes that are now ubiquitously available in most health care settings, in most perioperative settings. So the, the, the idea is that the Point of Ultrasound Exam gives you X-ray vision into the patient's anatomy and physiology to make your life easier, to narrow the differential diagnosis of acute organ failure. And it may not be useful in every patient's care, but in certain situations it may expedite care that would otherwise take longer. And sometimes it, it provides skills that would be completely unavailable at off hours and weekends, etc.
DR. STRIKER:
So perfect. That's on the micro level. Now, let's broaden this out to the macro level and tell us how does the POCUS Certificate of Completion Program benefit patient care on the overall?
DR. BRONSHTEYN:
Yeah, we hope that this program will allow learners to get up to speed on this skillset by getting standardized instruction that represents the collective wisdom of our entire twelve person Editorial Board of, consisting of twelve experts. Whereas many providers may currently lack the local resources to learn the skill set on their own, this program should thus enable learners to gain knowledge in a short period of time that the members of the POCUS Editorial Board have amassed over many years. And we hope the patients will receive the benefit of this collective knowledge being shared with their providers.
DR. STRIKER:
All right, so I'm sold on it. I want to take advantage of it. How do I do it?
DR. BRONSHTEYN:
So the main requirement is that you must be an anesthesiologist. And if you are, you can go to ASA, H as in Harry, Q as in queen dot org slash POCUS – P-O-C-U-S for more info. Notably, this is also an early bird discount available through May, which is a, a limited introductory offer from the ASA.
DR. STRIKER:
Excellent. Well, Dr. Bronshteyn, thank you so much for joining us and not only giving us your insight, but giving us the lay of the land as far as this program is concerned, it sounds like a great program and certainly a valuable tool for members of the ASA to take advantage of.
DR. BRONSHTEYN:
Thanks so much for having me, Adam. I really enjoyed it.
DR. STRIKER:
This is Adam Striker thanking everybody for joining us again on ASA’s Central Line. Please join us again next time.
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ANNOUNCER:
Expand your skills and validate your diagnostic point-of-care ultrasound expertise for hospital credentialing and privileging committees with the Diagnostic POCUS Certificate Program. Learn more about this flexible, self-paced program and sign up today at asahq.org/pocus.
Subscribe to Central Line today, wherever you get your podcasts, or visit asahq.org/podcasts for more.