“I think the sense I’ve been getting,” Greg Schmidt, MD, said, “is one of immense relief to be back.” Schmidt, the director of the Midwest Fellows Critical Care Ultrasound Symposium, was discussing the mood of the attendees at the eighth gathering of faculty and fellows and the fifth time that the University of Iowa has hosted.

Because of the pandemic, last year’s symposium had been cancelled. Two institutions, which normally send a complement of faculty and first-year critical care fellows to participate, were still under travel restrictions and could not attend this year either. Even with those missing schools, attendance swelled this year from about 60 fellows in 2019 to close to 80. Schmidt noted that one reason for the increase was that some second-year fellows who would have come last year were also enrolled.

Just under 20 faculty members were also in attendance to deliver didactic lectures and to observe and guide hands-on training in the use of point-of-care ultrasound (POCUS) as a diagnostic bedside tool. Faculty and fellows from as far away as University of New Mexico, National Jewish Health in Denver, Colorado, and University of Kentucky stretch the definition of “Midwest,” but were nonetheless still welcome. The other participating schools were University of Kansas, Creighton University, University of Nebraska, University of Minnesota, Loyola University, University of Chicago, and Northwestern University.

As the symposium has grown, the acceptability and use of bedside ultrasound as a diagnostic tool has also grown. Factors include decreasing costs of equipment, but also a compelling body of peer-reviewed evidence that POCUS provides clinicians with more accurate assessments and can be easily incorporated into a clinician’s toolkit.

That growth, Schmidt and other faculty members noted, means that the skill levels of fellows are also increasing. “We used to train fellows who had almost never held the wand,” Schmidt said. More residency programs, including here at Iowa, are now adding ultrasound curriculum. “Each class of fellows, every year, is slightly better than the last.”

Though instructors can increase their expectations, the structure of the two-day symposium has remained largely the same. Groups divide between a lecture hall for instruction on finer points of ultrasound use and the variety of situations in which it can be beneficial.

While other groups divide up into clinical instruction labs down the hall for hands-on practice with simulated patients. Instructors in each room supervise fellows as they take turns manipulating the machines and practicing the mix of three-dimensional thinking required to produce and interpret the two-dimensional image.

Also a tradition, the first day concludes with an organized bike ride along the Clear Creek Trail running alongside the Iowa River. The ride offers attendees a firsthand glimpse of how easily nature is incorporated into life in the Iowa City area. Stormy weather earlier in the day threatened the tradition, and a couple of attendees implored organizers to not cancel. Fortunately, the clouds blew over and the dewpoint dipped into that sweet spot of warmth and low humidity that equals the perfect Iowa evening.

The ride concluded and guests next went to Schmidt’s home where a local pizzeria had set up an outdoor wood-fired stove. While the pizzas cooked, attendees played games and basked in the “group-ness” that so many had missed for so long.

The second day offered more of the same, building on the previous day’s instruction. Before the last set of activities, Schmidt offered his thanks to all the attendees, everyone who had traveled to be there, and to the Division of Pulmonary, Critical Care, and Occupational Medicine, whose continuing support has made the event possible for each of the last five years.