Sarah R. Williams, MD, FACEP is the Program Director for the Emergency Medicine Residency and oversees the educational curriculum for the residents. She has been on faculty at Stanford since 2000 and has the rank of Clinical Associate Professor. Sarah went to Cal as an undergrad (Go Bears!) and then started drinking the Stanford cool-aid, going to medical school here, the EM residency from 1997-2000, and the chief residency in 2000-2001. During 2000-2001 Sarah also developed version 1 of the EM Ultrasound Fellowship and was its inaugural fellow, and then went on to become the founding director of the EM Ultrasound Program at Stanford.
Dr. Williams also has a strong interest in medical education and leadership, and has been working hard with the residency program since 2000. She has worn all of the "hats" of residency leadership: Chief Resident, Assistant Program Director (APD), Associate PD, and now Program Director. Sarah has also been active in helping coordinate and run several CME programs, including our national conference and developing a new series of interdisciplinary ultrasound CME courses. Sarah has both practical real-world experience in education as well as completing the ACEP Teaching Fellowship and is currently completing a Masters Program in Health Professions Education (while continuing to work at Stanford full-time). She also co-runs the multidisciplinary Stanford Clinical Teaching Scholars Program and chairs the Stanford GME Committee's Transitions of Care Task Force.
Sarah's areas of expertise are medical education, leadership in emergency medicine, and emergency ultrasound. Sarah also understands the challenges of combining an active academic career with family; she is a wife and mom of three school-aged boys. She was also the first member of her family to go to college and gets how hard the system can be... Sarah is happy to collaborate with colleagues with anything related to any of the above interests.
- Emergency Medicine
- Emergency Ultrasound
- Medical Education
Clinical Associate Professor, Emergency Medicine
Program Director, Stanford/Kaiser Emergency Medicine Residency (2015 - Present)
Chair, Transitions of Care Task Force, Stanford GME Committee (2014 - Present)
Course Director "21st Century Medicine: Utilizing Point-of-Care Ultrasound", Stanford School of Medicine (2012 - 2013)
Associate Residency Director, Stanford/Kaiser Emergency Medicine Residency (2011 - 2015)
National Board Examiner, American Board of Emergency Medicine (2010 - Present)
Assistant Residency Director, Stanford/Kaiser Emergency Medicine Residency (2007 - 2011)
Faculty, Monthly Medical Student/Rotating Housestaff Education Series, Stanford Division of Emergency Medicine (2006 - Present)
Course Director, "Xtreme Emergency Medicine" National CME Course, Stanford Division of Emergency Medicine (2006 - 2008)
Representative, Stanford/Kaiser Emergency Medicine Residency Program, Council of Residency Directors (National) (2005 - Present)
Fellowship Director, Emergency Medicine Ultrasound, Stanford Division of Emergency Medicine (2004 - 2013)
Director, Emergency Medicine Ultrasound Program, Stanford Division of Emergency Medicine (2002 - 2013)
Faculty, Surgery 220 (Introduction to Emergency Medicine), Stanford School of Medicine (2001 - Present)
Faculty, Emergency Medicine, Stanford Division of Emergency Medicine (2000 - Present)
Faculty, POM (Practice of Medicine), previously Surgery 221, Stanford School of Medicine (2000 - Present)
Honors & Awards
Educator of the Year Award, American College of Emergency Physicians, California Chapter (2014)
Bedside Teacher of the Quarter Award, Stanford Division of Emergency Medicine (2008, 2004)
Elected, Board of Directors, California Chapter of the American College of Emergency Physicians (2006)
Bedside Teacher of the Year Award, Stanford Division of Emergency Medicine (2005)
Chief Resident Appreciation Award, Stanford/Kaiser Emergency Medicine Residency Program (2001)
Award for Outstanding Commitment to Academic Endeavors and Research, 1997-2000, Stanford/Kaiser Emergency Medicine Residency Program (2000)
Elected, President, California Emergency Medicine Residents Association (1999-2000)
1st place, "Most Outstanding Senior Officer" in State of California, California Cadet Corps, California National Guard (1986)
Residency:Stanford University Emergency Medicine Residency (2000) CA
Medical Education:Stanford University School of Medicine Registrar (1997) CA
Fellowship, Stanford Emergency Medicine, Emergency Medicine Ultrasound (2001)
Board Certification: Emergency Medicine, American Board of Emergency Medicine (2003)
Fellowship, Stanford/Kaiser, Emergency Medicine Ultrasound (2001)
Chief Resident, Stanford/Kaiser, Emergency Medicine (2001)
Residency, Stanford/Kaiser, Emergency Medicine (2000)
MD, Stanford School of Medicine, Medicine (1997)
BA, U.C. Berkeley, Biology and Psychology double major (1991)
Current Research and Scholarly Interests
Investigating applications of clinician-performed point-of-care ultrasound for emergency and critical care patients.
Improving safety of transitions of care between providers during sign-out.
Investigating modalities to formalize medical education training for residents and faculty across specialties.
- Introduction to Medical Education
SOMGEN 219 (Win)
Independent Studies (7)
- Directed Reading in Surgery
SURG 299 (Aut, Sum)
- Early Clinical Experience in Emergency Medicine
EMED 280 (Aut, Win)
- Graduate Research
SURG 399 (Aut, Sum)
- Medical Scholars Research
EMED 370 (Win, Spr)
- Medical Scholars Research
SURG 370 (Aut, Sum)
- Undergraduate Research
EMED 199 (Win)
- Undergraduate Research
SURG 199 (Aut, Sum)
- Directed Reading in Surgery
Prior Year Courses
- Clinical Teaching Seminar Series
SURG 257 (Aut, Win, Spr, Sum)
- Clinical Teaching Seminar Series
- Confirmation of endotracheal intubation using color-Doppler ultrasound. 2nd World Congress in Emergency and Critical Care Ultrasound, Abstract Book, 2006. Abstract 4
Pitfalls in the Use of Ocular Ultrasound for Evaluation of Acute Vision Loss.
journal of emergency medicine
2013; 44 (6): 1136-1139
Retinal detachment is a true medical emergency. It is a time-critical, vision-threatening disease often first evaluated in the Emergency Department (ED). Diagnosis can be extremely challenging and confused with other ocular pathology. Several entities can mimic retinal detachment, including posterior vitreous detachment and vitreous hemorrhage. Ocular ultrasound can assist the emergency physician in evaluating intraocular pathology, and it is especially useful in situations where fundoscopic examination is technically difficult or impossible. Accurate and rapid diagnosis of retinal detachment can lead to urgent consultation and increase the likelihood of timely vision-sparing treatment.This case demonstrates both the utility of ocular ultrasound in the accurate and timely diagnosis of retinal detachment and potential pitfalls in the evaluation of intraocular pathology in the ED.A 38-year-old woman presented with acute onset of bilateral visual loss that was concerning for retinal detachment. Rapid evaluation of the intraocular space was performed using bedside ocular ultrasound. Bedside ocular ultrasound correctly diagnosed retinal detachment in the right eye. Posterior vitreous detachment in the left eye was incorrectly diagnosed as retinal detachment.This case illustrates the importance of bedside ocular ultrasound and highlights some of the pitfalls that can occur when evaluating for retinal detachment. Following is a discussion regarding methods to distinguish retinal detachment from vitreous hemorrhage and posterior vitreous detachment.
View details for DOI 10.1016/j.jemermed.2012.11.079
View details for PubMedID 23522956
FOCUSED CARDIAC ULTRASOUND TRAINING: HOW MUCH IS ENOUGH?
JOURNAL OF EMERGENCY MEDICINE
2013; 44 (4): 818-822
Focused transthoracic echocardiography (F-TTE) is an important tool to assess hemodynamically unstable patients in the Emergency Department. Although its scope has been defined by the American College of Emergency Physicians, more research is needed to define an optimal F-TTE training program, including assessment of proficiency.The goal of this study was to determine the effectiveness of current standards in post-residency training to reach proficiency in F-TTE.Fourteen staff Emergency Physicians were enrolled in a standardized teaching curriculum specifically designed to meet the 2008 American College of Emergency Physicians' guidelines for general ultrasound training applied to echocardiography. This training program consisted of 6 h of didactics and 6 h of scanning training, followed by independent scanning over a 5-month period. Acquisition of echocardiographic knowledge was assessed by an online pre- and post-test. At the conclusion of the study, a hands-on skills test assessed the trainees' ability to perform and interpret F-TTE.Ninety percent of trainees passed the written post-test. Two views, the parasternal long and short axis, were easily obtainable, regardless of the level of training or the number of ultrasounds completed. Other views were more difficult to master, but strong trends toward increased competency were evident after 10 h of mixed didactic and scanning training and > 45 ultrasounds.A short, 12-h didactic training in F-TTE provided proficiency in image interpretation and in obtaining adequate images from the parasternal window. More extensive training is needed to master the apical and subcostal windows in a timely manner.
View details for DOI 10.1016/j.jemermed.2012.07.092
View details for PubMedID 23351569
Developing and Assessing Initiatives Designed to Improve Clinical Teaching Performance
ACADEMIC EMERGENCY MEDICINE
2012; 19 (12): 1350-1353
To improve the teaching performance of emergency physicians, it is necessary to understand the attributes of expert teachers and the optimal methods to deliver faculty development. A working group of medical educators was formed to review the literature, summarize what is known on the topic, and provide recommendations for future research. This occurred as a track of the 2012 Academic Emergency Medicine (AEM) consensus conference "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success." The group concluded that the current state of research on these topics is limited. Improvement in understanding will come through research focusing on Kirkpatrick's higher levels of evaluation (behavior and results).
View details for DOI 10.1111/acem.12029
View details for Web of Science ID 000312740100007
USE OF CADAVER MODELS IN POINT-OF-CARE EMERGENCY ULTRASOUND EDUCATION FOR DIAGNOSTIC APPLICATIONS
JOURNAL OF EMERGENCY MEDICINE
2012; 43 (4): 683-691
As the use of bedside emergency ultrasound (US) increases, so does the need for effective US education.To determine 1) what pathology can be reliably simulated and identified by US in human cadavers, and 2) feasibility of using cadavers to improve the comfort of emergency medicine (EM) residents with specific US applications.This descriptive, cross-sectional survey study assessed utility of cadaver simulation to train EM residents in diagnostic US. First, the following pathologies were simulated in a cadaver: orbital foreign body (FB), retrobulbar (RB) hematoma, bone fracture, joint effusion, and pleural effusion. Second, we assessed residents' change in comfort level with US after using this cadaver model. Residents were surveyed regarding their comfort level with various US applications. After brief didactic sessions on the study's US applications, participants attempted to identify the simulated pathology using US. A post-lab survey assessed for change in comfort level after the training.Orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion were readily modeled in a cadaver in ways typical of a live patient. Twenty-two residents completed the pre- and post-lab surveys. After training with cadavers, residents' comfort improved significantly for orbital FB and RB hematoma (mean increase 1.6, p<0.001), bone fracture (mean increase 2.12, p<0.001), and joint effusion (1.6, p<0.001); 100% of residents reported that they found US education using cadavers helpful.Cadavers can simulate orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion, and in our center improved the comfort of residents in identifying all but pleural effusion.
View details for DOI 10.1016/j.jemermed.2012.01.057
View details for PubMedID 22504086
D-Dimer Is Not Elevated in Asymptomatic High Altitude Climbers after Descent to 5340 m: The Mount Everest Deep Venous Thrombosis Study (Ev-DVT)
HIGH ALTITUDE MEDICINE & BIOLOGY
2011; 12 (3): 223-227
We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340 m (17,500 ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.
View details for DOI 10.1089/ham.2010.1101
View details for PubMedID 21962065
Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humans
HIGH ALTITUDE MEDICINE & BIOLOGY
2008; 9 (3): 209-216
In this randomized, double-blind placebo controlled trial our objectives were to determine if acetazolamide is capable of preventing high altitude pulmonary edema (HAPE) in trekkers traveling between 4250 m (Pheriche)\4350 m (Dingboche) and 5000 m (Lobuje) in Nepal; to determine if acetazolamide decreases pulmonary artery systolic pressures (PASP) at high altitude; and to determine if there is an association with PASP and signs and symptoms of HAPE. Participants received either acetazolamide 250 mg PO BID or placebo at Pheriche\Dingboche and were reassessed in Lobuje. The Lake Louise Consensus Criteria were used for the diagnosis of HAPE, and cardiac ultrasonography was used to measure the velocity of tricuspid regurgitation and estimate PASP. Complete measurements were performed on 339 of the 364 subjects (164 in the placebo group, 175 in the acetazolamide group). No cases of HAPE were observed in either study group nor were differences in the signs and symptoms of HAPE found between the two groups. Mean PASP values did not differ significantly between the acetazolamide and placebo groups (31.3 and 32.6 mmHg, respectively). An increasing number of signs and symptoms of HAPE was associated with elevated PASP (p < 0.01). The efficacy of acetazolamide against acute mountain sickness, however, was significant with a 21.9% incidence in the placebo group compared to 10.2 % in the acetazolamide group (p < 0.01). Given the lack of cases of HAPE in either group, we can draw no conclusions about the efficacy of acetazolamide in preventing HAPE, but the absence of effect on PASP suggests that any effect may be minor possibly owing to partial acclimatization during the trek up to 4200 m.
View details for DOI 10.1089/ham.2007.1073
View details for Web of Science ID 000259759600004
View details for PubMedID 18800957
- Airway Ultrasound: Confirming Endotracheal Intubation with Color Doppler Ultrasound Academic Emergency Medicine 2008; May (abstract)
- Ultrasonographic diagnosis of retinal detachment in the emergency department Ann Emerg Med. 2005; 45 (1): 97-8
- Reply. Journal of ultrasound in medicine 2016; 35 (2): 456-457
- Reply. Journal of ultrasound in medicine 2016; 35 (2): 458-459
Optic Nerve Sheath Diameter Increase on Ascent to High Altitude Correlation With Acute Mountain Sickness
JOURNAL OF ULTRASOUND IN MEDICINE
2015; 34 (9): 1677-1682
Elevated optic nerve sheath diameter on sonography is known to correlate with increased intracranial pressure and is observed in acute mountain sickness. This study aimed to determine whether optic nerve sheath diameter changes on ascent to high altitude are associated with acute mountain sickness incidence.Eighty-six healthy adults enrolled at 1240 m (4100 ft), drove to 3545 m (11,700 ft) and then hiked to and slept at 3810 m (12,500 ft). Lake Louise Questionnaire scores and optic nerve sheath diameter measurements were taken before, the evening of, and the morning after ascent.The incidence of acute mountain sickness was 55.8%, with a mean Lake Louise Questionnaire score ± SD of 3.81 ± 2.5. The mean maximum optic nerve sheath diameter increased on ascent from 5.58 ± 0.79 to 6.13 ± 0.73 mm, a difference of 0.91 ± 0.55 mm (P = .09). Optic nerve sheath diameter increased at high altitude regardless of acute mountain sickness diagnosis; however, compared to baseline values, we observed a significant increase in diameter only in those with a diagnosis of acute mountain sickness (0.57 ± 0.77 versus 0.21 ± 0.76 mm; P = .04). This change from baseline, or Δ optic nerve sheath diameter, was associated with twice the odds of developing acute mountain sickness (95% confidence interval, 1.08-3.93).The mean optic nerve sheath diameter increased on ascent to high altitude compared to baseline values, but not to a statistically significant degree. The magnitude of the observed Δ optic nerve sheath diameter was positively associated with acute mountain sickness diagnosis. No such significant association was found between acute mountain sickness and diameter elevation above standard cutoff values, limiting the utility of sonography as a diagnostic tool.
View details for DOI 10.7863/ultra.15.14.10060
View details for Web of Science ID 000360777600021
Development and Evaluation of Standardized Narrative Cases Depicting the General Surgery Professionalism Milestones.
2015; 90 (8): 1109-1115
Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones.In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties.The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case.The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.
View details for DOI 10.1097/ACM.0000000000000739
View details for PubMedID 25922918
Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS): Point-of-care Ultrasound in Emergency Medical Services.
The western journal of emergency medicine
2015; 16 (4): 503-509
In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images.We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties. Participants completed a pre-test of sonographic imaging of normal findings and three pathologic findings: pericardial effusion, pneumothorax, and cardiac standstill. A focused one-hour lecture on emergency US imaging followed. Post-tests were given to all EMS providers immediately following the lecture and to a subgroup one week later.We enrolled 57 prehospital providers (19 EMT-B students, 16 EMT-P students, 18 certified EMT-B, and 4 certified EMT-P). The mean pre-test score was 65.2%±12.7% with mean immediate post-test score of 91.1%±7.9% (95% CI [22%-30%], p<0.001). Scores significantly improved for all three pathologic findings. Nineteen subjects took the one-week post-test. Their mean score remained significantly higher: pre-test 65.8%±10.7%; immediate post-test 90.5%±7.0% (95% CI [19%-31%], p<0.001), one-week post-test 93.1%±8.3% (95% CI [21%-34%], p<0.001).Using a small sample of EMS providers and students, this study shows the potential feasibility for educating prehospital providers to accurately identify images of pericardial effusion, pneumothorax, and cardiac standstill after a focused lecture.
View details for DOI 10.5811/westjem.2015.5.25414
View details for PubMedID 26265961
CRITICAL CARE CLINICS
2014; 30 (1): 47-?
Focused cardiac echocardiography has become a critical diagnostic tool for the emergency physician and critical care physician caring for patients in shock and following trauma to the chest, and those presenting with chest pain and shortness of breath,. Cardiac echocardiography allows for immediate diagnosis of pericardial effusions and cardiac tamponade, evaluation of cardiac contractility and volume status, and detection of right ventricular strain possibly seen with a significant pulmonary embolus. This article addresses how to perform cardiac echocardiography using the standard windows, how to interpret a focused goal-directed examination, and how to apply this information clinically at the bedside.
View details for DOI 10.1016/j.ccc.2013.08.003
View details for PubMedID 24295841
CRITICAL CARE CLINICS
2014; 30 (1): 93-?
Thoracic ultrasonography (US) has proved to be a valuable tool in the evaluation of the patient with shortness of breath, chest pain, hypoxia, or after chest trauma. Its sensitivity and specificity for detecting disease is higher than that of a chest radiograph, and it can expedite the diagnosis for many emergent conditions. This article describes the technique of each thoracic US application, illustrating both normal and abnormal findings, as well as discussing the literature. Bedside thoracic US has defined imaging benefits in a wide range of thoracic disease, and US guidance has been shown to facilitate thoracic and airway procedures.
View details for DOI 10.1016/j.ccc.2013.08.002
View details for PubMedID 24295842
The FAST and E-FAST in 2013: Trauma Ultrasonography Overview, Practical Techniques, Controversies, and New Frontiers
CRITICAL CARE CLINICS
2014; 30 (1): 119-?
This article reviews important literature on the FAST and E-FAST examinations in adults. It also reviews key pitfalls, limitations, and controversies. A practical "how-to" guide is presented. Lastly, new frontiers are explored.
View details for DOI 10.1016/j.ccc.2013.08.005
View details for PubMedID 24295843
- Drug storage and stability (revised), Paul S. Auerbach, editor Wilderness Medicine, Management of Wilderness and Environmental Emergencies, 5th edition 2007
Regional vs systemic antivenom administration in the treatment of snake venom poisoning in a rabbit model: A pilot study
Research Forum of the American-College-of-Emergency-Physicians
ALLIANCE COMMUNICATIONS GROUP DIVISION ALLEN PRESS. 2003: 231–35
To develop a model that compares 2 different routes of antivenom administration (standard intravenous [IV] administration vs regional administration below a tourniquet) to assess their ability to limit muscle necrosis in a rabbit model of rattlesnake venom poisoning.New Zealand white rabbits were randomly assigned to 4 groups. All animals underwent general anesthesia and were then injected intramuscularly (IM) with a sublethal dose of western diamond-back rattlesnake (Crotalus atrox) venom in the right thigh and a similar volume of normal saline (NS) control in the left thigh. Thirty minutes later, standard treatment group animals (n = 4) received 1 vial of reconstituted Antivenin (Crotalidae) Polyvalent (ACP) and 10 mL of NS through an ear vein. Experimental treatment group animals (n = 4) had their lower extremities exsanguinated and isolated by arterial tourniquets. One vial of ACP was then given through a distal IV in the envenomed extremity, and 10 mL of NS was given through an IV in the sham extremity. Tourniquets were removed 30 minutes later. Positive control group animals (n = 2) similarly had their lower extremities exsanguinated and isolated by tourniquets. They then received 10 mL of NS through distal IVs in each lower extremity. Tourniquets were again removed after 30 minutes. Negative control group animals (n = 2) received 2 doses of NS only (10 mL each) through an ear vein. Serum creatinine phosphokinase (CPK) levels were drawn at baseline and 48 hours following venom injection. At 48 hours, the animals were injected with technetium pyrophosphate. Two hours later, they were euthanized, and the lower extremities were scanned to determine levels of radionucleotide uptake in envenomed muscles compared to contralateral sham-injected muscles. The anterior thigh muscle groups were then removed, fixed, stained, sectioned, and analyzed in a blinded fashion by a veterinary pathologist for muscle necrosis grading.There was no evidence of statistically significant differences in changes in serum CPK levels (from baseline to 48 hours), technetium pyrophosphate uptake ratios (right leg/left leg), or muscle necrosis indices in any 2-group analysis.Results of this pilot study do not suggest any beneficial effect of ACP, in the dose and routes used, in limiting local muscle necrosis following IM rattlesnake venom poisoning in the rabbit model.
View details for PubMedID 14719857
- Please see full list of publications on attached CV (1992-present). (Under photo above) 1992