Traditionally, ultrasound (US) scanning has been considered a hands-on skill requiring in-person training. However, there are numerous situations in which such training is not feasible. The COVID-19 pandemic highlighted the necessity of occasionally limiting exposure to patients, faculty, and staff, prompting a shift toward remote learning. Additional factors, such as patient inability to attend in-person appointments, resource limitations, and an imbalance between the number of learners and clinical opportunities, further underscore the need for innovative teaching methods. In global health settings, geographic barriers sometimes prevent instructors from providing in-person training, making remote solutions indispensable.
Despite these challenges, tele-ultrasound (tele-US) teaching presents unique opportunities to bridge the gap. Yet, one major obstacle remains: teaching image acquisition. As noted in the literature, image acquisition during tele-US instruction is a key difficulty. Challenges include explaining transducer manipulation without instructors’ physical presence, as well as accounting for variables like transducer position, transducer angles, patient positioning, and breathing. These concerns have been documented by Recker et al. in their review of ultrasound in telemedicine (Recker F, Höhne E, Damjanovic D, Schäfer VS. “Ultrasound in Telemedicine: A Brief Overview.” Applied Sciences. 2022; 12(3):958. https://doi.org/10.3390/app12030958).
Interestingly, some studies suggest that tele-US training can achieve comparable outcomes to in-person methods. Research by Soni et al. during the COVID-19 pandemic found no significant difference in post-test knowledge between tele-US and in-person training groups (Soni, Nilam J., et al. “Comparison of In-Person versus Tele-Ultrasound Point-of-Care Ultrasound Training during the COVID-19 Pandemic.” The Ultrasound Journal. 2021; 13;article 39. https://link.springer.com/article/10.1186/s13089-021-00242-6). Faculty expressed frustration with the inability to physically demonstrate transducer control. The barriers cited by faculty were echoed in a study by Schroeder et al., which addressed the challenges of teaching sports ultrasound remotely during the pandemic (Schroeder AN, Hall MM, Kruse RC. “Sports Ultrasound Training During a Pandemic: Developing a “Hands-on” Skill Through Distance Learning.” Am J Phys Med Rehabil. 2020; 99(9):860–862. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363391/). Interestingly though, in Soni’s study, learners often preferred troubleshooting their own images without physical intervention. This finding suggests that “hands-off” instruction might foster autonomy and deeper learning.
Adopting a “hands-off” approach to teaching ultrasound image acquisition is not only possible but can also be highly effective. This method involves avoiding direct contact with the transducer after an initial demonstration, and instead guiding learners through verbal instructions. Many learners find this approach advantageous, as it empowers them to develop their transducer manipulation skills independently. For instructors, the key lies in shifting focus from “What is the probe doing?” to “What is the image doing?”. To teach image acquisition without physical guidance, break the question “What is the image doing?” into manageable components:
- Is the near field moving?
- Is the far field moving?
- Are you moving through a structure (x-axis), or is the structure moving in relation to the leading edge (y-axis)?
Use the following images to further understand these concepts:
By analyzing these aspects, instructors can provide precise feedback and help learners make necessary adjustments. This technique is versatile and can be applied in both in-person and remote settings. It is particularly useful during retrospective image reviews, where instructors can guide learners in interpreting images and refining their transducer manipulation skills.
The “hands-off” teaching method not only adapts to the constraints of remote learning but also encourages learners to develop critical thinking and self-sufficiency. By practicing this approach, instructors can enhance their ability to guide students effectively, even in challenging circumstances. Whether teaching remotely or in person, this method offers a valuable framework for ultrasound education. Try it with your learners today!
Lauren D. Branditz, MD, FACEP, AEMUS FPD, is a Clinical Assistant Professor of Emergency Medicine and Assistant Director of the Emergency Medicine Division of Ultrasound at The Ohio State University. Dr. Branditz is also the Vice Chair of the AIUM’s Ultrasound in Medical Education community of practice.
The graphics included in this blog post were created via modification of images originally published in the following article:
David P. Bahner, et al. Language of transducer manipulation: codifying terms for effective teaching. J Ultrasound Med 2016; 34:183–188. https://doi.org/10.7863/ultra.15.02036.
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