Tag Archives: AIUM

A Word of Encouragement

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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

Wake Course 5

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?

  1. 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.
  2. 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

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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_59669332A 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

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sarto

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

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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 classHe 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 3rd 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

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aium16Last 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—sonoslamIn 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 epostere-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 sessionAs 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.

Life Hacks for the 2016 AIUM Annual Convention

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The 2016 AIUM Annual Convention is less than a week away. Although it was about six months ago that we opened registration, that time just cruised by much too quickly. We here at the AIUM office just said goodbye to the truck full of convention goodies. Next time we see all that stuff, we will be in New York City.

For those meeting us there, here is what you need to know.

  1. Plan Now.

Final_Program-cover
If you haven’t started planning, what are you waiting for? The proceedings are online now so get busy.

  1. Get Slammed.

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AIUM is proud and excited to host its inaugural SonoSlam student competition. Teams from medical schools from across the country are competing for bragging rights and the Peter Arger Cup. If you have time, come check it out on Thursday, March 17.

  1. Speaking of Thursday, March 17…

st pat
Yep, it’s St. Patrick’s Day. And in New York City that means there is a parade. If you are coming in that day or trying to get around please allow yourself extra time. The parade starts at 11:00 AM.

  1. Give Me Internet.

wifi
There will be complimentary internet access on the exhibit hall floor. Select “Hilton Meeting Room Wifi” and enter code AIUM16. This only works on the exhibit hall floor.

  1. Now Get Social.

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Follow and participate in all the action by using#AIUM16. We will be on Periscope, live tweeting the event, and sharing photos and videos.

  1. Stay Informed.

email
In addition to social media, the AIUM will be sending a daily eblast to all Convention registrants letting them know of any room changes and sharing the next day’s highlights. Keep a look out!

  1. Get Your Ribbons.

ribbon
You might notice that getting your Convention ribbons will be a bit different this year. While some might be in your materials, the AIUM has created a ribbon station where you can select those that pertain to you.

  1. Cases Go Digital.

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One of the most popular aspects of the AIUM Annual Convention is the Case-of-the-day Challenge. This year you will find these on dedicated computer kiosks on the Exhibit Hall Floor! Test your diagnostic skills!

  1. Run, For Fun

run
Join us on Friday, March 18 and Saturday, March 19 for a group run. Meet in the hotel lobby at 5:45 AM. Runners will leave promptly at 6:00 AM. Just one more way to see the city—plus you can network with fellow runners. All abilities welcomed!

We can’t wait to see you in New York City! Don’t forget to tag and share #AIUM16 on all your social media platforms.

Ultrasound Set to Transform Occupational Medicine

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There is no question that medical ultrasound is quickly becoming a valuable tool in musculoskeletal (MSK) medicine. Providers are realizing that this modality allows for quick evaluation in the office and even has a higher resolution than MRI. Research shows, for example, that scanning a shoulder to evaluate for a rotator cuff tear is faster, cheaper, and at least as sensitive and specific as ordering an MRI.

dr sayeedWhere using this modality for MSK medicine will have a huge impact is within occupational medicine.

In occupational medicine, we are tasked with providing quality care for patients while simultaneously enabling patients, institutions, corporations, and the overall health care system to save money. For practitioners, MSK ultrasound allows us to accomplish both of these goals. Widely utilized by our counterparts in European medical schools and hospitals, MSK ultrasound’s use in occupational medicine is still in its early stages in the United States. This means that occupational medicine is one specialty that stands to reap significant clinical benefits from its use.

But in order to understand the potential, and to position MSK ultrasound at the forefront of occupational medicine education, I conducted a little research.

Last year, I conducted a survey to learn how many occupational medicine program directors and residents were using MSK ultrasound and how many wanted to use it. The survey results confirmed that it was not widely used in occupational medicine residency programs. In fact, only a couple of programs use it and they do so cursorily.  The results also showed that most had a sincere interest in learning to use it, but there was not a program in place.

Since residency programs produce the field’s future physicians, I designed a multidisciplinary MSK ultrasound course to teach the basics to attendings and residents. Weekly sessions focused on specific anatomic regions to help provide a foundation for identifying pathology and improve interventional skills. This “how to” manuscript was recently published in the Journal of Occupational and Environmental Medicine.

Moving forward, I am presenting an introductory level lecture at the occupational medicine national conference (AOHC) to further demonstrate how MSK ultrasound could potentially be widely used in our field. I hope to introduce “hands-on” workshops over the course of the next few years to give the field a chance to learn this modality and implement it into practice. My goals are to see occupational medicine practitioners provide the highest standard of health care for this unique hardworking population of patients, while concurrently reducing costs for workers’ compensation claims.

What can AIUM provide occupational medicine to help further the use of ultrasound? What other areas are on the verge of being transformed by ultrasound? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Yusef Sayeed, MD, MPH, MEng, CPH, is an occupational medicine Chief Resident at West Virginia University in Morgantown, WV.

Our Accreditation Experience

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Ultrasound accreditation.

I’m sure you’ve heard about it, but you may be wondering: what does it really mean? Does it really matter if my practice site is accredited?

At one point I know that I wondered this myself! However, as a 17-year chief sonographer, and as the Ultrasound Technical Consultant for Allina Health Clinics, I can now tell you that for our sites, it absolutely does.

As a quality measure to ensure all ultrasound examinations are being performed and reported with the same standards of excellence, we decided to seek accreditation with the AIUM. Included under one AIUM accreditation, we have multiple clinic sites where the OB/GYN physicians read the ultrasound studies. It is a strict policy in our organization that any OB/GYN physician who wishes to read and bill for ultrasound exams must be added to our current AIUM accreditation.

With so many employees included in our accreditation, we knew that we needed to come up with a way to be able to facilitate new additions in a proficient manner, so that all sites received the same information and training. Thus (cue the climactic music), the “AIUM Physician Orientation and Mentoring” program was born!

We created this program for our organization as a virtual checklist of education and documentation needs, report over-reads, and competencies for the new physicians wishing to be added to our accreditation. We have a similar program for the sonographers that incorporates information and requirements for protocols, procedures, processes, and safety.

The Process

When I first started working with site accreditations everything was done on paper and case studies were submitted either on film or CDs. Now this process has been streamlined and all information that is required is easily uploaded to the AIUM site for their review.

For an accreditation such as ours that includes multiple sites, it was essential that we create a timeline to help us stay on track of what needed to be done and by when. The truth is, this is a very good way for any size site to make sure it stays on task and on time.
AIUM Accred Timeline

For us, this time around was a reaccreditation. So it is good to note that our information and supporting documents were due to the AIUM 6 months before the end of our current accreditation cycle. As you can see by the timeline, I set a goal of submitting 1 month before the due date. And that ended up being a good call because our actual submission date was only one week before the AIUM deadline.

Once all of our information was submitted, the Accreditation Team at the AIUM responded to us with any items that needed tweaking or were not quite hitting the mark. We replied to the AIUM on the changes that we would make and the education that we would provide our staff, and have been able to improve our services even more based on what we learned from those responses.

As one item of note, for us, the case submission selection and preparation was the longest and most time-consuming aspect of the process. Next time, we will start this task even earlier than outlined. Live and learn!

The Questions, Oh the Questions!
I had gone through an accreditation process before, but not with the AIUM. Since this was the first time for me, I had a ton of questions. I can’t even count how many times I emailed or called the AIUM staff, but I am sure they were groaning every time they heard from me.

However, each person that I spoke with was very understanding, helpful, and friendly. In fact, we communicated on such a regular basis that by the time I had submitted all of our information, they felt like good friends to me and I was tempted to invite them over for Thanksgiving dinner!

So Was It Worth It?
We expect our multiple sites to operate as one to ensure that patients are getting the same level of high-quality care when they go to site “A” for an OB/GYN  ultrasound, as when they go to site “B” for an OB/GYN ultrasound. For us accreditation has helped us accomplish that. The result has been higher patient satisfaction levels and improved quality and proficiency of our work.

Continuity of care. Improved quality. Higher patient satisfaction levels. Is accreditation worth it?

You bet it is!

Thinking about going through the AIUM practice accreditation process? Have any insights, tips, or ideas to share? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Laura M. Johnson, RDMS, RVT, is an Ultrasound Technical Consultant with Allina Health.

It’s All About The Students

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A relatively new AIUM award, 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 2015 AIUM Annual Convention, David Bahner, MD, RDMS, was presented with this award. Here’s what he had to say about this honor and the future of medical ultrasound education.David Bahner

What does it mean to you to be named only the second recipient of the Peter H. Arger Excellence in Medical Student Education Award winner?
I am very honored to be recognized by the AIUM and feel it is an honor to receive this award named after a pioneer in imaging, Dr Peter H. Arger.  Dr Arger’s passion for medical education and his commitment to ultrasound is well known.  It is my hope to continue those activities in medical education that Dr Arger pioneered in his work with the AIUM. Watching the first award winner, Dr Richard Hoppmann, receive this award last year was a thrill because it meant that the AIUM was recognizing the importance of medical ultrasound education. I am grateful for this great honor and hope to live up to the substantial role model Dr Peter Arger has been for this important area in ultrasound.

Why is ultrasound in medical education so important?
In the past, the feeling that ultrasound is operator dependent has been a drag on its impact within medicine. However, since medical education has been changing at many institutions because of electronic medical records, changes in curricula, and changes in technology, opportunities for point-of-care ultrasound now abound. Add to that the fact that ultrasound has become portable and affordable, and we see more operators embracing this modality. Unfortunately, the training for this device many times doesn’t starts until residency or even after clinicians have completed their medical training. By that time, however, the technology has outpaced the education. If the future can be planned to prepare 21st century clinicians to use this ultrasound tool, implementing this within medical school allows “pluripotent” students the ability to learn the foundations of ultrasound before entering residency.

What do you see as the biggest barrier to having ultrasound integrated into the medical education curriculum?
The lack of trained faculty either funded or supported in this process of training medical students is the biggest barrier to implementing ultrasound training in medical school. This lack of faculty is coupled with a “crowded’ curriculum where medical educators don’t see the benefit of adding ultrasound at the expense of removing other parts of the curriculum. The true insight is that ultrasound can be integrated into many parts of the medical student curriculum when both teachers and students embrace learning how to use ultrasound.  For example, anatomists learning how to scan or family practitioners working with ultrasound to guide procedures are possible solutions to these barriers.

You are a born and bred Ohioan. Why are people from Ohio so proud of Ohio?
It probably has something to do with the history of the state and how that has played into innovation, politics and competitiveness. Ohio is best known for the Wright Brothers who hailed from Dayton and used their hard work and innovation to change the 20th century with the discovery of lift and flight. Politically it has been an influential state in most presidential elections. Plus, 6 presidents are from Ohio. Ohioans are fierce competitors and extremely proud of the 16 national football championships earned by The Ohio State University. Oh, and the Pro Football Hall of Fame and Rock and Roll Hall of Fame are located within Ohio. We have a lot to be proud of.

Personally, my family grew up in Ohio and I feel a bond with the change of seasons, the geography, the history, the people, and the culture of hard work and helping others. I am an American, an Ohioan, a doctor, an educator, an innovator, and a Buckeye.

What role does or should ultrasound play in medical education? What are you proud of? Where did you learn your ultrasound skills? Comment below or let us know on Twitter: @AIUM_Ultrasound.

David Bahner, MD, RDMS, is Professor and Director of Ultrasound in the Department of Emergency Medicine at The Ohio State University College of Medicine.

3 Stretches All Sonographers Should Do

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Have you ever thought about how you stand? Or how you hold a transducer? Or how you position yourself over your patient? Incorrect positioning in any form could increase your risk of pain and injury. Here are three easy exercises sonographers can do—even on the job—to reduce anterior pelvic tilt.

  1. 90/90 Hip Flexor Stretch
    On a mat, kneel down with the front leg up, with the knee at 90 degrees, the back leg is on the ground, but also bent at 90 degrees.  Make sure to tightening up the Hip flexorabdominal area. Then move your hips forward, maintaining shoulders back. You are looking for a stretch in front of the hip.You will feel the stretch in the front of your hip and the thigh. You are looking for a light stretch. You are not trying to rip the muscle apart. Hold that for about 20 to 30 seconds twice on each side, first the right leg, then the left. Alternate back and forth for the two sets.
  1. Side Lying Quad Stretch
    Lying on your side, reach back and grab the foot of the top leg with the same arm as the leg you are bending (i.e., right hand grabs right foot). As you grab the foot, bring the heel towards the butt. The key here is not to just pull the heel to the butt, but bring the thigh back a little bit in order to intensify the stretch in the front of the thigh and the front of the hip.stretch 2Think: Hold for 20 seconds as a light stretch and do it twice on each side alternating. Right leg first, then roll to the other side and do the left leg. Repeat.
  1. Deep Squat Stretch
    Stand up tall with a wider stance than shoulder width. From that position, squat down with hips below the knees. In the bottom position, place the elbows between the squatknees and then push the knees out with the elbows. You are looking for a stretch in the inner thigh and hips.This position and pressure will end up changing the position in the lower back and in the pelvis from an anterior tilt to a posterior tilt.  Doing just like the other stretches: 20- to 30-second hold, twice.

No matter what your occupation, a certain level of stretching and regular exercise will help reduce your risk of injury. This is especially true for sonographers. Please consult your physician (even if you are one) before beginning an exercise program.

What stretches do you do? How do you improve your posture? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Doug Wuebben BA, AS, RDCS (Adult and Pediatric) is a registered echocardiographer and also a consultant, national 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 Performance Edge Training Systems (PETS).