What One Winning Sonographer Has to Say

Posted on July 19, 2016 by aium14750

d_merton Established in 1997, the Distinguished Sonographer Award recognizes and honors current or retired AIUM members who have significantly contributed to the growth and development of medical ultrasound. This annual presentation honors an individual whose outstanding contributions to the development of medical ultrasound warrant special merit. This year’s winner is Daniel A. Merton, BS, RDMS, FSDMS, FAIUM, from New Jersey. Here is what he had to say about receiving this honor.

Congratulations on being named the 2016 Distinguished Sonographer. What does this award mean to you?

I appreciate being recognized for my contributions to the field and am honored to join the list of other sonographers who have received this award.

You are and have been very involved in several ultrasound societies. Why do you volunteer so much of your time?

I am passionate about the profession and want to contribute what I can to its future in terms of technology and its use to improve patient care.

How and why did you first get interested in medical ultrasound?

I learned of medical ultrasound in 1978 when I was a sonar technician in the US Navy. I was then, and am still, fascinated with the use of acoustic energy for many applications but particularly for diagnostic and therapeutic medical applications. After being discharged from the Navy I perused a degree in Diagnostic Medical Imaging. At that time (early 1980s) there were only 6 DMS programs in the country that awarded a degree so my options were limited.

When it comes to medical ultrasound, who do you look up to?

First and foremost, Dr. Barry B. Goldberg, FAIUM. He is a true pioneer with an insatiable appetite for investigating the unknown and attempting the untried. He is a mentor, colleague, and friend who provided the environment and support, without which I am quite sure I would not have accomplished what I have nor be receiving this prestigious award. I was fortunate to have worked with many other skilled and dedicated professionals, including Larry Waldroup, BS, RDMS, FAIUM and Dr. Fred Kremkau, FACR, FAIMBE, FAIUM, FASA, but the entire list would be too long to include here.

How did you first get interested in medical ultrasound? Who are your mentors? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Daniel A. Merton, BS, RDMS, FSDMS, FAIUM, in addition to being an AIUM award winner, is a Senior Project Officer at ECRI Institute, a nonprofit medical testing and patient safety organization in Plymouth Meeting, PA.

Rare and Sometimes Disappearing: The Tough Life of the Sonographic Expert

Posted on July 5, 2016 by aium14750

Everyday obstetricians hear the same questions: “Is my baby OK?” “Is there anything abnormal?” or, and this is may be the worst, “Should I be worried about anything?”

While innocent enough, these questions get for far more difficult when you consider that in the patient’s mind sonographic experts should be able to “see everything.” For Hershkovitz scan patients, ultrasound has become a routine obstetrical practice that experts should be able to use to perform every type of diagnosis at the earliest gestational age—with 100% accuracy. This perception, however, means that developmental anomalies or disappearing findings are very confusing for the patient and her spouse.
An example of such a confusing sonographic condition is prenatal diagnosis of congenital lung lesions. One of the rarest lung lesions is Congenital Lobar Emphysema (CLE). This is a rare developmental anomaly of the lower respiratory tract characterized by hyperinflation of one or more of the pulmonary lobes and subsequent air trapping. The main fetal sonographic features of CLE include a bright echogenic lung with or without cystic or mixed cystic lesions (see image) without abnormal blood flow. A mediastinal shift, polyhydramnios, and fetal hydrops can also be observed and are predictors of severe respiratory distress or mortality.

CLE can decrease in size during pregnancy and even disappear on prenatal sonography or become apparent at postnatal evaluation, even though it is not observed during pregnancy. This can, obviously, become confusing for the patient. The main differential diagnosis of CLE is with congenital cystic adenomatoid malformation, pulmonary sequestration, and congenital high airway obstruction syndrome (CHAOS).

Once such a diagnosis is suspected, the patient is usually invited to a multidisciplinary meeting with the pediatric pulmonologypulmonologist, geneticist, and surgeon. Evaluation of the fetus is usually performed every 2 weeks and sometimes prenatal MRI is also suggested.

In many cases, depending on the size of the CLE and whether the fetus is hydropic by the time the fetus is delivered, the neonate is not in respiratory distress immediately after birth. However, sometimes CLE can lead to neonatal respiratory distress, and these neonates need to undergo surgical resection of the affected lobe. In the past, this has meant open thoracotomy, although recent advances in minimally invasive thoracoscopic surgery have resulted in decreased morbidity associated with resection of these lesions.

While innocent enough, the question, “Should I be worried about anything?” can get confusing and difficult when dealing with conditions like CLE. How would you handle it?

In a case like this how would you answer the question, “Should I be worried about anything?” How and when do you provide counseling to patients? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Professor Reli Hershkovitz is the Head of the Ultrasound Unit at the Department of Obstetrics and Gynecology of the Soroka University Medical, located in Beer Sheva in the Southern part of Israel. This medical center serves nearly 2 million people, with an average of 16,000 deliveries a year.

Why I Volunteer for the AIUM

Posted on June 21, 2016 by aium14750

Bagley_6 One of my favorite “demotivational” posters says: “MEETINGS, none of us is dumb as all of us.” Except, in the case of working on an AIUM committee, that poster could not be further from the truth.

Not. Even. Close!

The opportunity to participate on an AIUM committee is both a privilege and a learning opportunity. I have so enjoyed the chance to serve on a committee, and would like to take this time to let you know what you can expect if you were to become a committee member.

The AIUM committees meet in person once a year at the Annual Convention, and then work by conference call and email during the rest of the year. Naturally, the biggest flurry of activity comes in the weeks preceding the Convention.

At that time, the committee chair or AIUM staff liaison will e-mail the minutes from the previous meeting to all the members. When the minutes arrive in our inbox, it is a reminder for us to check and see if we actually completed the assignments we were given at the last meeting!

Ideally, we would have completed them soon after the conclusion of the meeting, but hey, we are human! For many of us, the previous minutes are a reminder that we still have some work to do!

While we are working fast and furious to complete last year’s assignments, there is also a call for new business. When the liaison is notified of new business, he or she sends the information out to the members for review.

Aside from completing assigned tasks from the previous year, reading the new documentation prior to a committee meeting is probably the most important thing a committee member should do. In order to have meaningful discussion and/or resolution of the issues, the members must be informed and prepared to contribute to the conversation.

On the day of the meeting things run probably like all committees everywhere. We follow Robert’s Rules of Order when conducting business. (OK…only kind of-sort of—does anyone really know all of Robert’s rules?) The committee moves line by line on the agenda. Sometimes one topic may take 2 hours of conversation, and other times, we may move through the items much more expediently. All topics are important, and each gets the time and attention it deserves.

One thing that happens as we move through the agenda is, we ask each other to think about what the next steps might be. In some cases, people will volunteer to write something, look up old data, or reach out and solicit expert opinions from a field of study.

In some instances, some issues are too complex for the full committee to tackle them…a case of too many chefs spoil the soup. A subcommittee may be formed instead. Smaller groups are better suited to break the complex issue down into smaller parts, and then each person can work on a single task. When the work is complete, a more cohesive approach to the problem can be presented to the larger group.

Subcommittee work, like all committee work is voluntary. No one is expected to participate in every single facet of a committee, but in the spirit of shared governance, everyone should commit to serve in some manner.

And then you have the super committee members, who in spite of having a demanding career, they still manage to defy expectations and volunteer for everything and come through with outstanding levels of productivity! You have to realize they have superhero powers that most of us do not have, so you cannot compare yourself to them. If you can participate in a fair share of committee work, contribute your expertise, and be prepared for meetings, then you are exactly who an AIUM committee needs!

At the meeting’s conclusion, we all take our assignments for the next year, and ideally start working on them when we get home. This year the Bioeffects Committee has scheduled a mid-year conference call, and that will help those of us with assignments stay on task and pace our work. It will also be a nice time to catch up and converse with friends. Oh, I guess I forgot to mention, when you do committee work, you not only gain new colleagues, but also friends and even new mentors.

If you are interested in serving on a committee, my best recommendation is to match your talents and interests with a committee or a subcommittee that needs your expertise. That way, the work will seem more like fun, and the entire AIUM membership benefits from your contributions.

What have you learned from volunteering? What did you like or dislike? Would like to contribute to the AIUM? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer Bagley, MPH, RDMS, RVT, is an associate professor for the College of Allied Health at the University of Oklahoma Health Sciences Center, Schusterman Campus in Tulsa. She currently serves on the AIUM Bioeffects Committee and is a former member of the Technical Standards Committee.

Get Rid of That Pain in the Neck in 3 Easy Movements

Posted on June 7, 2016 by aium14750

Have you experienced any of these situations?

Your shoulders feel like they are on fire after the first few scans of the day.
You have a hard time finding a comfortable sitting position.
Your wrist and arms feel like an iron apron has been laid across them.

If so, you are not alone. Nearly 90% of sonographers scan in pain. And of that 90%, nearly 30% will experience so much pain that they will have to find another career. This is an epidemic that must be addressed.

Earlier this year, we posted our first blog that focused on lower body stretches. We did that first because we have found that upper body manifestations can, and often do, occur as a result of lower body issues. Many times, in order to fix shoulder, neck, and back pain, we start by looking at the legs and hips. As we like to say, “train movement, not muscles.” To stay in line with that concept of not just training a muscle and one area, we want to share 3 easy movements that can help with neck, shoulder, and back pain.

Overhead Reach
1. Sitting at your desk, or standing behind your chair, take both arms and reach overhead as high as possible, with palms facing in and thumbs pointing behind you.
2. As you extend your arms overhead, push your shoulders back (think pinching a pencil between your shoulder blades!).
3. Now keep reaching as high as you can while exhaling as if you are blowing out a huge candle, actually 5 huge candles. Inhale through your nose and exhale through your mouth.
4. This should open up your chest, allowing you to breathe easier while at the same time relieving stress and strain from your neck and shoulders.
Thumbs Back Reach
1. Again, sitting at your desk, or standing behind your chair, take both arms and extend them down by your side.
2. This time, open the palms to the outside, rotating the hands so the thumb is again pointing behind you.
3. Again, pinch the shoulders back (think of pinching that pencil between the shoulder blades!) and sit or stand as tall as possible..
4. Now keep reaching back as far as you can while at the same time blowing out those five huge candles! Inhale through your nose and exhale through your mouth.
5. This is another great movement to open up your chest and allow you to breathe easier while at the same time relieving stress and strain from your neck and shoulders.
Head To Shoulder Reach
1. In a seated or standing position, simply make yourself as tall as possible. With this movement, think that someone is taking you by the hair and pulling straight up!
2. At the same time, push the shoulders down and back – pinch that pencil!
3. Slowly tilt your head toward the top of your shoulder. Try to place your ear on top of your shoulder.
4. Now, slowly and gently, rotate your head, working to bring your chin up toward the ceiling, while still trying to keep your ear on your shoulder.
5. Make sure to do both right and left side to use this movement to get great neck relief and release tension in the muscles in the upper neck/shoulder area!

You can do these movements 2-3 times a day, doing each one, two or three times at a setting (workout!) or any time you start to feel tension build throughout the day!

What stretches do you do? How do you improve your posture? What other areas would you like to see covered? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Doug Wuebben, BA, AS, RDCS, (Adult and Pediatric), FASE, is a registered echocardiographer and also a consultant, international presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers.

Mark Roozen, M.Ed, CSCS*D, NSCA-CPT, FNSCA, is a strength and performance coach and also the owner and president of Coach Rozy Performance Centers.

Mark and Doug are co-owners of Live Pain Free-The Right Moves consulting company. They can be contacted at livepainfree4u@gmail.com.

Kindred Spirits

Posted on May 24, 2016 by aium14750

The Peter H. Arger, MD, Excellence in Medical Student Education Award honors an AIUM member whose outstanding contributions to the development of medical ultrasound education warrant special merit. At the 2016 AIUM Annual Convention, John Christian Fox, MD, RDMS, FACEP, FAAEM, FAIUM, was presented with this award. Here’s what he had to say about this honor and the future of medical ultrasound education.

J Christian Fox 1

What does it mean to you to be named the recipient of the Peter H. Arger Excellence in Medical Student Education Award winner?

After I did some research about Dr Arger and spoke with others who know him well, I began to realize that he and I are kindred spirits. Even though we are from different generations and different specialties, we are actually very much aligned. His work in the 1990s, while disruptive at the time, paved the way for multi-specialty performance of quality ultrasound examinations through practice accreditation. Furthermore, he initiated the Endowment for Education and Research (EER) which had a tremendous impact on ultrasound in medical education. From this fund, the AIUM was able to finance the highly successful 2nd Annual Dean’s Forum on Ultrasound in Medical Education held at UC Irvine in June 2015. Specifically, EER provided support to bring deans from more than 40 medical schools to my campus where we broke into small groups and developed a 4-year curriculum of ultrasound in medical education.

Why have you volunteered so much of your time to the AIUM?

When I was a fellow in emergency ultrasound in 2001, I first heard about the AIUM and flew down to Orlando to check out the annual meeting. We kicked off the emergency ultrasound section with a small group of people and from that early experience I was struck by how people from various specialties would do their best to check their politics at the door and get to work on what our combined passion was: Ultrasound. The point-of-care ultrasound revolution that ensued would never have happened in my opinion if it wasn’t for the multi-specialty collaboration that AIUM so vehemently catalyzes. While we may be facing local battles, once we put that AIUM badge around our necks, everyone is great at collaborating in the name of research and education rather than engaging in politics. Maybe that sounds a bit rosy for some reading this but it’s my honest assessment of what brings me back to the AIUM year after year! Where else can I go to see world-class multi-specialty ultrasound research? So many cool projects have come from ideas that were created during these sessions. Where else can I learn from international masters teaching me the nuances of the art of ultrasound?

What do you see as the biggest barrier(s) to having ultrasound integrated into the medical education curriculum?

It’s funny because these barriers are not static. Initially I saw a lot of people struggling to justify ultrasound’s role in the curriculum. It takes a few deep discussions, and even some hands-on scanning, to get the Deans to reframe their concept of ultrasound. Well, now that’s ancient history (like 2 years ago) and now we face other burdens. I get the sense the Deans are frothing now to not be the last school to incorporate this, and now they need to find the cash and prizes. They need the funding to support the curriculum administratively and they need to get machines and simulation all dialed in. That’s no simple task as you can imagine, but they are Deans and that’s their job – to fund initiatives that have the most impact on the curriculum.

Tell us a little about your TED talk experience.

Oh it was intense. Hardest thing I’ve ever done for sure. As much as I’m kind of a ham and love public speaking, this was very difficult for me. I had to really get out of my comfort zone and become a perfectionist. Lots of rules, which required weekly meetings with my two coaches. One was helping me perfect the content while the other was working on my performance. Every sentence has to land perfectly. Too much pressure to put on someone who is more of a big picture kinda person than a detail-oriented person. But all that being said, it stands as my proudest speaking moment.

Who is your mentor and why?

I’ve had so many mentors over the years it’s really hard to answer this question because I firmly believe that mentorship relationships should really form organically, and not be assigned or they lack authenticity. I’ll start with my residency director who later became my Chair, Mark Langdorf. He single-handedly taught me emergency medicine and then gave me the idea to do an ultrasound fellowship. I remember packing my moving truck, and wondering to myself exactly why I was moving from Laguna Beach to Chicago but his guidance proved critical. Then my fellowship director Mike Lambert is the guy who I really sync’d up with and spent a ton of time emulating his laid back approach to life and work. To this day, every time I’m around him, my blood pressure drops. But what he taught me was the importance of image quality and instilled in me a love, or an obsession really, for all things piezoelectric. The other mentor that really helped shape my approach to edutainment and social media is not one person but a duo. It’s the ultrasoundpodcast.com guys Mike Mallin and Matt Dawson. I really look up to them and what they’ve done for point-of-care and their tenacity to keep all their content (books and media) Free and Open Access Medical Education (FOAM).

A Word of Encouragement

Posted on May 10, 2016 by aium14750

One excellent online teaching tool for emergency ultrasound states that “scientists have been fascinated by the mechanism of acoustics, echoes and sound waves for many

Attendees get hands-on experience at AIUM’s Wake Forest

centuries.”

I am not one of those scientists.

Frankly, I don’t like physics. I find it challenging to understand things I can’t see. Take gravity, for example. I know and can tell quite distinctly that it exists. The scar on my shin following a childhood attempt at flight is a faithful reminder of its existence. It still remains hard for me to understand the intricacies of this force because of its invisibility. To me, this is similar to a lot of physics concepts.

It’s therefore hilarious that I was somehow drawn to ultrasound. It must have been the enticement of being able to see more, although the ability to “see” is granted by what is unseen—ultrasound waves. The joke was definitely on me.

So how did I get here?

My journey with point-of-care ultrasound (POCUS) started with a remark by a friend of mine. At the time, she was an emergency medicine resident and she told me about a trauma patient that she had performed a “FAST” on. Close to completing 3 years of Pediatric residency, I had never heard of such a thing. I remained intrigued with the idea of quick decision-making scans performed by the provider actively involved in the patient care. Who wouldn’t want this given the chance? The challenge of course lies in acquiring the knowledge.

Things now got interesting.

During my Pediatric Emergency Medicine (PEM) fellowship, I sought to learn more about POCUS. My initiation was not spectacular to say the least. The words of my instructors bounced off the surface of my brain with very little being absorbed. This would have been OK if I were an ultrasound machine. It wasn’t very good when trying to learn how to obtain and interpret ultrasound images however.

By the second and third lesson, I was convinced that I would never learn ultrasound. But as in the majority of love stories, persistence paid off.

Gradually my images changed from what resembled a 1970s television screen after midnight to recognizable structures. By the end of my PEM fellowship, I had acquired a few rudimentary skills. I took an opportunity to pursue an Emergency ultrasound fellowship immediately after my PEM fellowship and the dread of my early ultrasound learning days came upon me again. So many applications, so little understanding.

One day as I scanned a patient, “Eureka!” I finally understood the parasternal long axis. There was hope for me yet.

How did I finally get here?

Persistence – The old adage holds true. If at first you don’t succeed, try, try again.When the words or explanation didn’t make sense, I would try a video (YouTube has some great videos). I would get models of structures to understand the anatomy and relate to them to my scans. I would seek out others to explain concepts in different ways to help my understanding.
Memorization – This provided a foundation and served as the means to the end. When using POCUS, there is a lot to remember and you have to put in the necessary study time.

Finally, I was able to understand what was going on and what the picture was telling or NOT telling me. I also learned not to beat myself up for not understanding everything. That is what colleagues, mentors, online resources, and practice are for.

I now understand a lot of POCUS–more than I ever imagined or thought possible. I didn’t let my dislike of physics or the challenge of image recognition stop me. I figured if others could learn this, I should at least give it a decent shot. And that’s what I ask of those I teach or anyone interested in learning.

What would you tell someone starting to learn ultrasound? What aspect was most difficult for you? How did you overcome it? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Atim Uya, MD, is the Point of Care Ultrasound Director, Division of Emergency Medicine, Department of Pediatrics, University of California, San Diego/Rady Children’s Hospital, San Diego, California.

Pediatric Emergency Ultrasound: We’ve Come a Long Way, Baby

Posted on April 26, 2016 by aium14750

My first rotation as a pediatric emergency medicine (PEM) fellow was on the adult trauma service. It was 2006 and in West Philadelphia there was no shortage of patients with gun shot wounds, stabbings, and motor vehicle crashes. The trauma surgeons were hard on the surgery trainees, and generally nice to the PEM fellows. We weren’t training to be surgeons on the front line after all. One attending, however, was indiscriminate in his wrath and unbiased in his intent to humiliate.

dreamstime_xs_59669332 A few days into the rotation, during a trauma alert, he chose me: “Jennifer, the FAST, do the FAST!” I was completely puzzled and looked at him blankly. This, of course, made him angrier. “Do the FAST exam!”

Unable to admit at the time that I had never heard of the FAST exam, I remained silent. Seeking to avoid any fear, shame, or humiliation that would certainly accompany future traumas, I immediately read everything I could about it, and the surgery fellows taught me at the bedside.

I returned to the children’s hospital wanting to learn more about ultrasound. Unfortunately, at the time, no one in PEM knew much about it. In fact, none of my colleagues or mentors had any experience with it. I sought guidance from my general emergency medicine colleagues next door who welcomed me and trained me as one of their own.

In time, I proposed a research study in the pediatric emergency department: point-of-care ultrasound for pediatric soft tissue infections. At the time, the radiology faculty weren’t keen on this. They were unaware of non-radiologists using ultrasound and didn’t understand why emergency physicians would need to use it. It was a slippery slope, they argued, and might result in indiscriminate and “unregulated” usage. We compromised–I could use ultrasound in the emergency department solely for research purposes. The machine, literally under lock and key, was off limits to anyone but those involved in the study.

As I found out, my experience was not unique. Many of my PEM colleagues around the country faced similar obstacles from specialists outside of the emergency department. Point-of-care ultrasound at that time was simply not the standard of care.

Nearly a decade later, I practice in a very different climate. Point-of-care ultrasound is a mainstay in my patient care practice; and I now have the support (and collaboration) of my radiology colleagues and others outside of emergency medicine.

More broadly, PEM ultrasound is a recognized subspecialty. Notably:

There are approximately 10 dedicated 1-year fellowships in pediatric point-of-care ultrasound.
Pediatric point-of-care ultrasound is part of the American Board of Pediatrics core content for pediatric emergency medicine fellowship training, and has been incorporated into the PEM subspecialty board examination.
Landmark publications include the American Academy of Pediatrics Policy Statement and Technical Report for PEM point-of-care ultrasound.
There is a PEM ultrasound international organization (www.p2network.com).
AIUM invited me to write this blog.

We certainly have come a long way.

Do you have a similar ultrasound story? What other areas have come a long way when it comes to ultrasound? What areas are poised to be next? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer R. Marin, MD, MSc, is Director of Emergency Ultrasound in the Division of Pediatric Emergency Medicine as well as Quality Director, Point-of-Care Ultrasound at Children’s Hospital of Pittsburgh of UPMC.

Cadaver Lab Isn’t Just for First Years

Posted on April 12, 2016 by aium14750

Credit: Rob Swatski

Of all the things people say they remember learning in medical school, the location and function of the sartorius muscle is usually not one of them. For me, I can still see the muscle lying diagonally across the dissected thigh—small but purposeful, leaving me to wonder how this tiny thing so miraculously and perfectly made it from one side of the leg to the other through evolution and use.

This memory is representative of how thought-provoking and educational cadaveric dissection was for me as a novice clinician. The sight of the
cadaver on the gurney, along with the smells, the noises, and the presence of a real human being in front of me, were my first clinical experiences of bedside learning from a patient, and it had a significant effect on me.

Despite living in the digital age where extraordinary feats in medical technology have occurred over such a short period of time, cadavers remain a fundamental part of medical education. Training and educating students with human cadavers is not just a pedagogical exercise. Cadaveric dissection emphasizes understanding of a structure’s spatial orientation and function, but perhaps more importantly, it provides a contextual environment that differs from rote memorization that often accompanies anatomical learning. Additionally, cadaveric education has gained wider importance at the post-graduate level as a training element for surgical and emergent ultrasound-guided procedures.

Dr. Demetrios Demetriades, Chief of Trauma and Surgical Intensive Care at Los Angeles County Medical Center in Los Angeles, understood the value of this type of training, and in 2006 worked with the County of Los Angeles to create a cadaveric procedural training lab for post-graduate trainees. The lab was designed to be used by residents and fellows for procedural education, practice, and anatomical dissection. There is a dedicated, full-time staff that includes a perfusionist, a technical assistant, and an administrative team through the Department of Surgery. The lab is used 2 to 3 times a day by various surgical specialties, anesthesia, and the emergency medicine residency, which includes our ultrasound division. The emergency ultrasound division uses the lab once a month to train residents and ultrasound fellows how to perform various point-of-care ultrasound-guided procedures, such as ultrasound-guided central and peripheral line placement.

Unlike other simulation modalities such as gel phantoms, human tissue phantoms, or simulators, performing ultrasound-guided procedures in the cadaver lab allows the trainee to have the tactile experience, where (s)he is touching skin, performing the procedure, and using real procedural tools on human tissue. The importance of this from a training and educational standpoint is that the trainee is in a controlled setting, has time to reflect upon the learning as it occurs, can discuss procedural technique openly with the attending, and can perform the procedure repeatedly in a safe environment.

For emergency medicine providers, the impact of using the procedural cadaver lab for ultrasound-guided procedures and anatomical learning cannot be underestimated. John James (2013) estimated that more than 400,000 deaths occurred in a 3-year span due to medical errors in the hospital setting, making it the third leading cause of death in the U.S. The conditions by which we practice our specialty are always under the auspices of being emergent. Although it has been well documented that ultrasound makes care safer and more efficient, ultrasound as a modality warrants the same practice and repetition as the procedures it provides assistance to. The cadaver lab provides this exposure to openly learn in an inaugural fashion and by one’s mistakes. It seems fitting, then, to make the cadaver lab a more central part of medical education—a place we can come back to on a regular basis as we learn and improve our skill. Just think of the memories we’ll make.

What learning experience had the most impact on you? What other experiences should we ensure continue? Have a cadaver lab story to share? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Tarina Lee Kang, MD, is Assistant Professor of Clinical Emergency Medicine and Division Chief of Emergency Medicine Ultrasound at the Keck School of Medicine of USC.

I’m Tired of Falling Asleep During Lectures

Posted on April 5, 2016 by aium14750

I remember the first test I failed. It was an immunology exam that I took about halfway through my first year of medical school. Seeking some solace, I asked a classmate for advice. His snarky response was, “Why don’t you try NOT sleeping through the class?”

sleeping in class He did have a point, but I couldn’t help it. The professor was so incredibly boring. I couldn’t understand why he would spend so long talking about a study performed decades ago involving injecting mice with bacteria. How would this make me a good doctor?

I quickly found the solution to my problem: I had to stop going to class. Imagine that? The best way for me to get a medical education was NOT attending the courses–at least this particular course. It turns out I learned a lot better reading by the pool in sunny Southern California than in that big lecture hall. I soon discovered that many of my classmates were doing the same thing. Some read the textbooks at home or at a coffee shop. Some bought entirely different textbooks on the same subject. Some bought audio tapes for a particular subject. Of course some did prefer the classroom. In the end, we all passed.

Spending 4 years in college and 4 more in medical school makes you extremely sensitive to the lecturer’s delivery of the material. We spend years sitting in large groups in dark rooms quietly listening to someone on some stage talking at us. These days, most lecturers are reading off slides and within the first minute, you know what you’ve got yourself into.

Why do we subject our learners to someone standing behind a podium reading slides for an hour? Why do we think this works? Most likely it’s because very few people know there is a better way of doing things.

Our ultrasound instructor in medical school, Dr Chris Fox, likes to talk about “flipping the classroom.” Prior to our ultrasound didactics, he would give us access to an online podcast for the scanning technique of the day. We could watch it in pieces or all at once and we could watch it at any time and however many times we wanted. Best of all, we could pause, rewind and fast forward. We would then show up for a brief lecture consisting of a 5- to 10-minute review of the podcast where we could ask questions. Then we split up into groups to practice scanning.

That’s what I call efficient. And fun.

I’m now in charge of teaching my co-residents the same ultrasound skills I learned in medical school. Problem is, I don’t have a podcast series of lectures. In fact, I started with no lectures at all. Truth is, I could have devoted hours creating engaging, interesting, and effective PowerPoint slides. But, why should I reinvent the wheel when colleagues of mine from around the world have already developed these presentations? If I could use those, then I could focus on what I do best, which is teach the hands-on components.

Thank goodness for FOAM (Free Online Access Meducation). The term was coined in 2012 in the emergency medicine community and Life in the Fastlane has a whole page dedicated to its history and explanation.

Essentially, FOAM is a growing movement to provide high-quality and FREE medical education materials online for anyone to use. It’s a dream come true for any educator. Time to give a lecture? You could spend hours throwing together 60 slides for a lecture, but somebody else has already done it, and they’re REALLY good at it. Let them teach the lecture so you can use your time to practice and reinforce. Whether it’s an ultrasound technique or reviewing how to work up and treat chest pain, the principle is the same.

For me, using FOAM to teach residents is a lifesaver. Walking a learner through the machine and the exam technique comes natural to those with experience. Putting together a presentation to introduce it all to a big group requires time that I don’t always have. Plus, my proficiency in PowerPoint is limited and producing high-quality videos and images with overlaid anatomy takes considerable time, assuming you know how to do it.

Many of us know about FOAM resources already, probably just not the name. The Ultrasound Podcast is a fantastic resource with educational videos and challenges. There is also a smartphone app called One Minute Ultrasound for Apple and Android phones, which is a great on-the-go resource. The American Academy of Emergency Medicine (ACEP) runs Sonoguide.com with a whole host of resources. Another great resource is Sonomojo.org, which is a collection of FOAM resources for ultrasound. AIUM offers free resources and practice guidelines as well as teaching tools for members.

So let’s stop putting our students to sleep and start engaging them on their own terms. Give them the resources then use your time more effectively to get practical and work on procedural skills or problem solving. FOAM is there to guide the way.

How do you make your presentations engaging? Do you use any FOAM resources with teaching? If so, have you found it useful? Have questions about the future of FOAM? Comment below or let us know on Twitter: @AIUM_Ultrasound.

David Flick is a 3^rd year family medicine resident at Tripler Army Medical Center. He received 4 years of ultrasound training at the University of California, Irvine School of Medicine. He currently runs the resident ultrasound curriculum and is an outspoken proponent for ultrasound training in the primary care specialties.

AIUM Annual Convention Rocks NYC

Posted on March 28, 2016 by aium14750

aium16 Last week, physicians, sonographers, scientists, and educators from across the country and around the world left New York City and the AIUM Annual Convention to return home. They left with new contacts, tips, tricks, techniques, research, technology, and information that will help them improve patient care. If you were unable to attend, or if you want to relive another amazing AIUM Annual Convention, here are the highlights as well as a summary of attendee feedback.

The Highlights

SonoSlam—In its inaugural year, this student competition had 16 teams sign up to compete for the Peter Arger Cup. This year’s winning team, “Baby Don’t Hertz Me,” hails from The Ohio State University. Plans are already underway to increase this event next year.
Awesome Plenary—The ballroom was packed for the Opening Plenary session that featured an engaging talk by Alfred Abuhamad, MD, titled, “Global Maternal Health: Ultrasound and Access to Care.” Attendees also heard from William J. Fry Memorial Lecturer Dirk Timmerman, MD, PhD, FRCOG, on “Tips and Tricks of Successfully Ultrasound Studies.”
Sold-out Exhibit Hall—Spread over two floors, this year’s exhibit hall featured a wide variety of companies that collectively addressed nearly every ultrasound need. This year several exhibitors offered great deals and amazing drawings.
Ultrasound for Every Specialty—Attendees raved about the mix of specialty sessions throughout the Annual Convention. In fact, this year the content included sessions from 18 different ultrasound specialties.
Award Winners—AIUM was proud to recognize the following award winners (look for upcoming blog posts from these individuals):
- Alfred Abuhamad, MD—Joseph H. Holmes Clinical Pioneer Award
- Michael Kolios, PhD—Joseph H. Holmes Basic Science Award
- Christian Fox, MD, RDMS—Peter Arger Excellence in Medical Student Education Award
- Daniel Merton, BS, RDMS—Distinguished Sonographer Award
- Aris Papageorghiou, MD—Honorary Fellow
- Paul Sidhu, BSc, MBBS, MRCP, FRCR—Honorary Fellow
Social Media—This year was by far the most active year for #AIUM16 on social media. On Twitter alone there were double the number of impressions over last year, with nearly 500 people participating.
E-poster winners—Every year, the AIUM supports an e-poster program. This year, the winners were (look for upcoming videos from them):
- First place:A Comparison Of Different Hydrophones In High Intensity Ultrasound Pressure Measurements by Yunbo Liu and Keith Wear
- Second place: Sonographic Evaluation of Ligaments and Tendons of the Hands by Jonelle M. Thomas, Cristy Gustas, and Dylan Simmons.
- Third place: Can You Give Me a Hand? Diagnosing and Understanding the Clinical Significance of Fetal Hand Anomalies in Obstetric Ultrasound by Karen Oh, Thomas Gibson, Kathryn Snyder, Ryan Meek, and Roya Sohaey.
- Honorable Mention: The Neck is More than the Thyroid Alone: 3-D Ultrasound of Cervical Lymph Nodes, Salivary, and Parathyroid Glands, Palpable/Visible Abnormalities by Susan Judith Frank, David Gutman, and Tova Koenigsberg.
Up and Comers—AIUM recognized 4 outstanding papers in its New Investigator Program.
- Basic Science Winner: Aiguo Han for Structure Function for Quantitative Ultrasound Tissue Characterization
- Clinical Ultrasound Winner: Margaret Dziadosz for Uterocervical Angle: A Novel Ultrasound Marker to Predict Spontaneous Preterm Birth
- Honorable Mention: Mahdi Bayat for Comb-Push Shear Elastography on a Clinical Ultrasound Machine: First Report on Differentiation of Breast Masses
- Honorable Mention: Xueqing Cheng for Effect of Percutaneous Ultrasound-Guided Subacromial Bursography With Microbubbles for Assessment of Rotator Cuff Tears

We know that everyone has their own highlights from this event. If you want to share yours, please do so on Twitter @AIUM_Ultrasound.

The Feedback

The AIUM Annual Convention is the largest event supported by the organization. full session As such, we realize that while most things go well and according to plan, some do not. Here then is
the feedback attendees have shared with the AIUM.

94% said overall the Convention was Good or Excellent. This was the same as the past 2 years.
56% of attendees said the registration and pre-registration process was Good or Excellent.
Nearly 90% of attendees said they would make at least some modification to how they practice ultrasound as a result of what they learned at the AIUM Annual Convention. This was up from the 70% that said the same last year.
96% of attendees said they would recommend the AIUM Annual Convention to a colleague. Again, this was an increase over last year’s 91%.
91% of attendees said the AIUM Convention was either on par or better than other ultrasound courses/events they have attended. This is another increase over last year’s 90%
More than 80% of attendees said it was highly likely they would attend another AIUM Annual Convention.

As for the areas that need more attention and work, here is where the pain points were:

Elevators—Some floors experienced long wait times for elevators. Several attendees expressed frustration at having to make choices based on how long the elevator would take. We completely understand and all hotel-related comments will be shared with the hotel staff.
Cost—This continues to be an issue and is one that the AIUM Executive Committee is taking very seriously. The AIUM is exploring a number of models and programs to help reduce the cost of attending this event.
Overlap of sessions—Many attendees shared that sessions they wanted to attend were overlapping. With such a diverse offering of sessions, this is bound to happen to some extent. This year, the AIUM did record all the lectures. We will be making them some of them available through the online communities and other available for CME credit. These videos will be released over the next couple of months.
Technological issues—Some presentations experienced technical difficulties. Much of this was related to the fact that our service provider was operating a newer version of software than most of our presenters were using. In the future, the AIUM will share that information with presenters in an effort to reduce these issues.

The Praise

Despite some of the hiccups, most attendees spoke glowingly of the 2016 AIUM Annual Convention. Here is just a sampling of the comments we received:

“The courses were excellent in OB/GYN — all fantastic!!!”
“Excellent sessions, great speakers, tremendous choice”
“The 30-minute lectures; presentation of cases. Lunch was great! Loved the special sessions.”
“I was very impressed with the content, subject matter, and quality of the presentations of the conference. I’d never planned to come to AIUM before and came only because it was close to where I practice. I will be back!”
“I am new to this field so was just excited to hear all the exciting work going on. I liked the size of the convention in general.”
“Seems culture is changing to become more welcoming of new ideas and collaborative.”
“The opportunity to learn ultrasound from multiple specialties with their different areas of focus and expertise. Courses run by speakers from multiple specialties provided different insights and perspectives.”
“Great people involved, SonoSlam was super fun, I enjoyed several of the didactic sessions.”
“The hands-on fetal echo course with Dr. Solomon was excellent. Wish I could work with her for several weeks.”
“I really liked that this conference could bring together many disciplines. I like the way the format was laid out by interest. Worked very, very well.”

The great thing about the Annual Convention is that we all learn. Attendees learn tips, techniques and resources that help them succeed and the AIUM learns how it can make this event even better. While the 2016 Annual Convention is over, we are already hard at work on the 2017 Annual Convention that will be held March 25-29 in Orlando.

Did you attend this year’s event? If so, share your thoughts and feedback. Going next year? Let us know what you want to learn! Comment below or let us know on Twitter: @AIUM_Ultrasound.

Peter Magnuson is AIUM’s Director of Communications and Member Services.

The Scan

The official blog of the AIUM

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