Tag Archives: sonography

Getting Sonography Students Hands-on Experience

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As the Program Director of a Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited General sonography program, I have a request for all OB/GYN practices. Please open your practice to accept sonography students. The future of the OB sonographer depends upon it.

If schools cannot provide graduates with good entry-level OB skills, there will not be enough sonographers to fill the OB sonography positions within private practices and this includes the MFM specialties.

Student rotations are down because the sonographers are too busy to allow students to scan. I have been given the following reasons why they are too busy:

  1. Patients are scheduled every 30 minutes all day.
  2. Work-ins are expected to be added daily into the already booked schedule
  3. It is not uncommon for a single sonographer to perform 15–20 patients per day.
  4. There are usually no breaks except for lunch, maybe.
  5. Some practices have more than one sonographer but each performs the same amount of studies so there is no relief person to help out.

This type of scheduling (over-scheduling) sets up a whole new set of questions.

  1. How long can one sonographer sustain such a schedule without suffering from burn-out and choose to leave employment?
  2. How long can one sonographer sustain such a schedule without suffering from repetitive stress injuries that will force their retirement?
  3. If sonographers are having to rush through studies to get all of the patients through, what are they missing?
  4. What is the satisfaction level of the patient who feels they are on an assembly line when getting their sonogram?  I do believe this is one reason many “peek-a-boo -see your baby” businesses are flourishing; OB patients want to experience fetal bonding with their families, time for which the private practice schedules do not allow. (“The AIUM advocates the responsible use of diagnostic ultrasound and strongly discourages the non-medical use of ultrasound for entertainment purposes.” See The Issue with Keepsake Ultrasounds for more information.)

Although there is value in observation, which the students may be allowed to do, nothing can replace a hands-on experience with supervision and instruction. And, yes, labs help, but the accrediting bodies require our students to scan patients not models.

For at least 2 decades, educators have struggled to find OB clinical sites that would allow their students to gain the scanning skills needed to complete their clinical competency exams, which are required for graduation. With no resolution in sight, even the Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS) and CAAHEP have recognized that some General accredited programs could not meet all the standards and, therefore, have now provided us a way to separate out the specialties. This allows for the deletion of the OB specialty from their accredited programs. This is a way for educators to deal with the problem of not being able to gain access to 2nd- and 3rd-trimester OB patients for their students, but it will ultimately be bad news for the OB community in general.

I believe the sonography community is an intelligent and creative group. We can find ways to integrate students into a busy environment. I actually have some clinical sites that do a very good job of it. I encourage you to think outside of the box and let’s get creative so that the schools will be able to provide qualified graduates when they are needed. If we don’t, we will begin seeing private OB “cross-training” on the job, again.

Is that what we really want? Comments, opinions, rebuttals, suggestions are encouraged and I look forward to reading them all.

Kathy A. Gill, MS, RT, RDMS, is a Program Director of the Institute of Ultrasound Diagnostics in Spanish Fort, Alabama. Kathy has been a Registered Diagnostic Medical Sonographer since 1977 and has been involved in sonography education for 30+ years.

Interested in learning more about ultrasound in medical education? Check out the following posts from the Scan:

Are You Sonogenic?

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Most of us who do ultrasound commonly use the disclaimer that “the study is suboptimal because of the patient’s body habitus” (we stay away from the word “limited” because this word has specific billing implications). This phrase conveys to the referring physician that we are not getting the pictures we hope to get because of something we can’t control, namely the patient’s size. No matter how we tweak the transducer frequency, adjust the time-gain compensation curve, or simply press harder we cannot achieve optimal image quality.Lev

Sometimes, however, we are either pleasantly or unpleasantly surprised. A thin individual may have soft tissues that are difficult to penetrate, leading to an image of suboptimal quality.

Conversely, a patient with high body mass index may turn out to be a breeze to scan. Clearly, there is something more than simply patient size that is at work here. After all, echoes on ultrasound are created at interfaces between tissues that differ in acoustic impedance. A larger patient with relatively homogenous subcutaneous tissues (fewer interfaces) may reflect and scatter the beam less than a patient whose tissues are composed of a more varied mixture of fat, fibrosis, and/or edema (more interfaces).

When people consistently look great in photographs, we call them “photogenic”. The implication of this word is that somehow the camera loves the subject so much that their still image “overachieves” compared to the expected output. When you think about it, that may be a subtle insult, but it is usually used as a compliment. Conversely, a person we find attractive may, for reasons that are unclear, not be at their best in photographs.

In light of the above, I would like to coin a new word, “sonogenic”. A sonogenic person is one who transmits sound so well that their ultrasound images consistently exceed expectations. A patient that frustrates us because their images are of lower quality than expected would be characterized as “non-sonogenic”.

Using this word can potentially facilitate communication. The sonographer could say to the reading physician: “Sorry for these images; the patient wasn’t sonogenic”. The physician’s reports can become shorter: “The study is suboptimal because of patient’s body habitus” becomes “the patient is not sonogenic”. The noun form would be “sonogenicity” (yes, “photogenicity is a word”). A simple grading system may even become part of the ultrasound report, i.e., sonogenicity is above average, average, or below average.

In conclusion, I hereby propose that the word “sonogenic” be added to the formal ultrasound lexicon. What do you think?

 

Would you use the term sonogenic? Do you have any other suggested new terms that could better describe an aspect of an ultrasound examination? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

Connect_digital_graphics_E-NEWSLETTER

 

Levon N. Nazarian, MD, FAIUM, FACR, is Professor and Vice Chairman for Education in the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.

The Place of POCUS in Prevention of Physician Burnout

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Doctors’ jobs, in the hospital or clinic, have been getting more demanding and less rewarding in the last several years. Well-meaning changes including the rise of electronic medical records and attempts to improve how we do our jobs through quality measures have made us sad and tired and supply none of the joy that we can get from a satisfied patient or a diagnostic puzzle cleverly solved. We may find ourselves aging, with multiplying frown lines and receding hairlines, sitting at our computers finishing our documentation, while our families have vacations and parties without us. Although we make enough money, strangely, it doesn’t buy happiness.

When we are tired and sad; we lack the creativity to make job changes. Fear eclipses courage.

IMG_9919Sometimes we do stupid things involving alcohol or indiscretions, or buying something expensive on credit… family members give us “that look.”

We feel inadequate.

We get grumpy and stop doing that extra little bit to connect with the patient or unravel the mysterious illness. The precious little job satisfactions of working well with our team or taking our patients’ point of view become rarer.

We are burning out. There’s that telltale smell of smoke as our soul shrivels and our dreams fry.

What do we need? Probably a vacation, maybe even a stint working in global medicine, to change our perspective. Counseling and confiding in friends can help. If we keep doing the same job, perhaps we need a scribe to take care of the paperwork. Also learning a new skill could make us wake up and love medicine again. Enter point-of-care ultrasound.

I don’t want to trivialize the pain of burnout. It can be devastating, making us depressed, ending marriages, wrecking careers and friendship, collapsing us inward, and sometimes leading to suicide. Somehow we need to jump off of that horrific course and better sooner than later. I got close to burning out early in my career and ever since that time I’ve done everything I can to stay in love with my job. For me, learning to do point-of-care ultrasound enriched my practice and, along with a major career adjustment, kept me from getting all charred and crispy.

Doing point-of-care ultrasound, for a physician who is already skilled in practice but has no ultrasound experience, can be life-altering. As I matured in my practice, some of my physical exam skills improved but others atrophied for lack of use and because I knew that I couldn’t trust them. A fluid wave doesn’t predict ascites. Dullness in the base of the lung doesn’t lead me to suspect a pleural effusion. Splenomegaly, if not massive, is so hard to detect in my super-adequately nourished patients. Learning basic point-of-care ultrasound brought me back to paying good attention to my patients’ bodies. And they were fascinated and appreciated the extra care. I also was able to more quickly solve their medical mysteries and shorten previously prolonged evaluations. Seeing patients got more fun.

Burnout is an awful feeling and is preventable. It happens when we get ourselves into situations that are not sustainable and don’t feed our souls. We physicians have vast options and we need to recognize when we are trying to do a job that is wrong for us. And before we quit the profession entirely, we need to try learning something that makes it fun again. Point-of-care ultrasound, for instance.

 

How do you avoid burnout? Do you have your own experience to share? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.

Connect_digital_graphics_E-NEWSLETTER

 

Janice Boughton MD, FACP, RDMS, is an internist  Moscow, Idaho. She practices hospital medicine and rural primary care as well as teaching point of care ultrasound techniques in the US and Africa. She also writes about healthcare economics in her blog (www.whyisamericanhealthcaresoexpensive.blogspot.com.)

Dr. Boughton graduated from the Johns Hopkins School of Medicine in 1986 and completed residency training at the Johns Hopkins Hospital and the University of Washington. She started doing bedside ultrasound in 2011.

Ultrasound at 18,000 ft.

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A brief history of the making of Solar‐Powered Point‐of‐Care Sonography: Our Himalayan Experience (J Ultrasound Med 2019 doi.org/10.1002/jum.14923).

Dr Mark Kushinka and Dr Rob Razick are sitting at camp in Phirste La Pass at 18,208 ft. The camp is designated by banners of alternating color flags attached to the top of a pole and pinned to the ground. Mountains are shown around them with blue sky.

Dr Marc Kushinka (left) and Dr Rob Razick (right)
 in Phirste La Pass at 18,208 ft.

Full disclosure… I wasn’t actually there.  Anyone who knows me knows I am not the “sleeping with yaks, no shower for a month” kinda girl. I also have no shame in admitting that I had no chance of surviving the 80+-mile trek 3 miles high amongst the clouds. Fortunately for me, and the people who inhabit the Zanskar Mountain Range, I had 4 residents who wanted to spend several months hiking through a mostly impassable mountain trail providing care to those who live in this spectacular part of the world. Our Lumify’s passport had already amassed an impressive collection of stamps, but none of them as remote as the Himalayas. There is no electrical infrastructure in this region, and all sources of energy come from kerosene, dung briquettes, or solar power. As Dan and Zac departed for India, we had no idea if this crazy plan to operate the ultrasound solely off of a portable solar pad was going to work. Frankly, I was a bit worried that I was adding a few extra pounds to their pack for no good reason. But, after spending 30 days in one of the most remote locations on this Earth, the guys returned with some great stories, good images, and a ton more facial hair.

Dr Daniel Baker and Dr Zac Hardy are shown standing together in Phirste La Pass by a snow-tipped mountain peak.

Dr Daniel Baker (left) and Dr Zac Hardy (right) 

 As I sat curled up in my leather chair with a supple cabernet, I reviewed the data from their trip and realized just how awesome this was. There had never before been medical imaging accessible at this elevation, and its availability had a direct impact on patient care. We repeated the adventure the following year with a new set of residents and the same cheap solar pad from Amazon. After some minor modifications based on our lessons learned from our inaugural year, Marc and Rob yielded more consistent scan times and reliable use.

I truly believe solar powered POCUS can change the face of austere medicine. All you need is a solar pad, a portable ultrasound, and the desire and willingness to leave the comfort of home. Or at least have a few residents up for the adventure.

Cheers from Kashmir!

Have you performed ultrasound examinations in remote regions? What was your experience? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community. Visit the Journal of Ultrasound in Medicine online.

Laura Nolting, MD, FACEP, is the Director of Emergency Ultrasound and the Ultrasound Fellowship Director for the Department of Emergency Medicine at Palmetto Health Richland in Columbia, South Carolina.

My Chilean Experience

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Earlier this year, I had the opportunity to travel to Chile to present at the 18th Congress of Medical Technology meeting in Santiago. It was an amazing experience that I will never forget! The total travel time was about 14 hours, which began in Orlando with a flight delay and an emergency change to an earlier flight that had one seat left and was just about to
close its doors!Chile

Sonographers, as well as other allied health professionals, begin their education in the Colegio de Tecnologos Medicos (College of Medical Technologies); and the Capitulo de Ecografia (Sonography Chapter) is an arm of the College.  It is estimated that there are about 300 sonographers in the country of Chile. I was invited to speak at the meeting of the congress and the preconference, which was the inaugural meeting of the Sonography Chapter.

The evening before the preconference, I was invited to meet with a group of sonographers at a reception to discuss professional issues, certification, and education. The reception was hosted by the President of the College of Medical Technologies, Veronica Rosales, and the President of the Sonography Chapter and AIUM member, Mario Gonzalez Quiroz. At the reception, I was introduced to Fernando Lopez, known as the first sonographer in Chile with about 30 years of experience. I found the sonographers of Chile to be very welcoming and gracious, as well as curious about the role of sonographers in the U.S. They are also eager for educational opportunities to expand their knowledge and expertise.

I gave a total of 6 lectures during the 2 meetings on a variety of topics, including point-of-care, acute abdomen, obstetrical pathology, and pediatric sonography. Oh…did I mention that I don’t speak Spanish? I had synchronous translation of my lectures, and then I was able to enjoy other lectures that were then translated into English for me. As I was developing my lectures, I learned that with asynchronous translation, presentations should be shorter and you need to speak slowly. For me, that meant I had to reduce my typical image-heavy 100-120 slide presentation down to 70-80 slides. Luckily that worked within the time I was given.

This was my first time having lectures translated, my first international lectures, and my first time in Chile (actually my first time in South America)…lots of firsts! It was a true honor to present at this meeting and to meet the sonographers of Chile. I feel like I have made lifelong friendships, expanded my professional family, and experienced the beauty of a new country.

Have you given talks to an international audience? What was your experience? How can U.S.-based physicians and sonographers support their counterparts in other countries? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Charlotte Henningsen, MS, RT(R), RDMS, RVT, is the Chair & Professor of the Sonography Department at Adventist University of Health Sciences and the Director of the Center for Advanced Ultrasound Education. She currently serves as the AIUM 2nd Vice President.

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.

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.

Simulators Role in Ultrasound Training

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I believe the future of health care will involve the expanded use of diagnostic ultrasound, which will be accomplished through the use of an enhanced version of today’s handheld ultrasound scanner. I envision this “sono-scope” to be a wireless, lightweight, handheld imaging device with a long battery life and high-quality image capture that will expand the capabilities of the stethoscope.

The compact, portable ultrasoundpedersen_image scanners began entering the medical imaging marketplace around year 2000. Since then the market has grown dramatically, and the portable scanners have bifurcated into two broad groups: (i) The pocket-sized or handheld scanners (HHUS) and (ii) the larger, full-featured point-of-care ultrasound systems (POCUS).

These devices provide doctors with an extension of their senses and augment existing tools. But to be truly transformational, users need to receive ultrasound training from the beginning of their medical career, which will allow them quickly to “rule in” and “rule out” possible diagnoses and lead to earlier treatment decisions and/or more relevant further tests.

I maintain that the main barrier for making the HHUS (and POCUS) every clinician’s examination tool of choice, is not the technology, but rather the lack of opportunity to acquire and develop the needed scanning skills.

Thus, finding training strategies that enable the integration of ultrasound into medical schools is an essential step in overcoming this barrier. If the next generation of doctors had ultrasound for diagnosis and guided procedures as a vital part of their training, they would quickly develop a natural comfort with this tool and, with time, increasing sophistication. A parallel can be drawn regarding the attitude toward acquiring computer skills. As recent as 40 years ago, the operation of computers was thought to be limited to a select, carefully trained group of specialists. Today, nearly everyone is able to operate computers at some level.

Effective training in medical ultrasound requires both clinical knowledge (understanding of anatomy, physiology, and pathology) and scanning skills (psycho-motor skills, which are the integration of motion and the mental processes of recognizing anatomic structures in 3D from the 2D images). While both clinical knowledge and scanning skills are essential, the former is often emphasized at the expense of the latter because clinical knowledge can be delivered cost effectively and in flexible formats through online courses (including MOOCs), self-study, and in traditional classroom courses. Scanning skills, on the other hand, are acquired through hands-on experience, by examining patients, preferably both healthy and with symptoms, under the guidance of an experienced sonographer. Here, the medical educational enterprise does not currently have the capacity to meet this training need. There are too few scanners available for learners to use. There are too few patients or human subjects in general available for scanning. Last but not least, there are too few qualified instructors who can guide the learning.

There exists a potentially effective approach to overcoming this limitation in delivering scanning skills training: The use of ultrasound training simulators. Simulation provides a controlled and safe practice environment to promote learning. The efficacy of the simulator-based training is well-established. For example, human errors related to airline accidents have decreased in large part due to flight simulator training. Likewise, high-fidelity medical simulations have been shown to be educationally effective, as evidenced by the strong correlation between surgical simulator training and improved outcomes. Several studies have demonstrated the learning value of simulator-based training in diagnostic ultrasound.

Just as HHUS and POCUS have proliferated over the last 15 years, so have ultrasound simulator products. Some training simulators cover multiple clinical specialties, while others are designed for a specific application. Typically, the learner scans a physical manikin with a realistic-looking sham transducer, which produces an image on the display corresponding to the position and orientation of the sham transducer on the manikin, along with an anatomy display of the location of the image plane through the body.

An important component of the simulator design is the degree to which the simulator provides structured learning with guidance, interaction, and assessment. While all simulators include educational modules, only a few offer self-paced learning and competence verification. All in all, today’s ultrasound simulators are sophisticated devices that are capable of meeting training needs on basic and even intermediate levels. However, because the purchase price is sufficiently high (from $10K to more than $100K) sonography programs and simulation centers at larger hospitals are typically the only facilities able to acquire this technology.

When the medical community is ready to embrace ultrasound as an imaging modality of first choice for doctors from all specialties, I am convinced that technological innovation will lead to affordable, yet customizable and realistic training simulators. In particular, what is needed are portable and lightweight simulators that run on ordinary, modern PC/laptops, making personal ownership of a simulator possible as well as allowing medical schools to purchase such simulators in large quantities. For individualized training, it is essential that the simulator be task-based and able to verify the acquired skills level. To deliver the best realism, the image material should preferably be acquired directly from human subjects, and to provide the optimal development and assessment of psychomotor skills, the scanning practice on the simulator should resemble actual patient scanning as closely as possible. Such low-cost training simulators can lay the groundwork for building up such ultrasound skills both among practicing specialists and students enrolled in medical schools.

Have you/do you use simulators in your ultrasound training? What are the advantages or disadvantages? What would make simulation training better? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Peder C. Pedersen is Professor of Electrical and Computer Engineering at Worcester Polytechnic Institute.

5 Questions with Dr Lee

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Every year, the AIUM William J. Fry Memorial Lecture Award recognizes an AIUM member who has significantly contributed in his or her particular field to the scientific progress of medical ultrasound.

Wesley Lee MDAt the 2015 AIUM Convention, Wesley Lee, MD received this award.

  1. What did being named the William J. Fry Memorial Lecture Award winner mean to you?

The William J. Fry Memorial Lecture Award was an unexpected surprise because all of my professional accomplishments simply reflect who I am and what I enjoy doing.  I am truly honored and feel privileged to have received this special recognition among my special friends and colleagues.

  1. You have been involved with the AIUM for more than 3 decades. From your perspective, how has the AIUM changed over that span?

Over the past 3 decades, I have seen enthusiastic growth within our membership and more diversified multidisciplinary collaborations between many specialties for various areas of diagnostic and therapeutic ultrasonography. The AIUM has certainly raised the bar for technical and clinical practice standards that are now often developed with other professional organizations. The AIUM plays an pivotal role for political advocacy involving important issues that may impact how cost-effective and health care is delivered.

  1. You have written extensively and currently serve on the editorial board for Ultrasound in Obstetrics and Gynecology, as well as deputy editor of the Journal of Ultrasound in Medicine. Based on what you are seeing and writing, where is medical ultrasound headed?

The quality of medical ultrasound research has improved with the use of standard writing guidelines and detailed imaging protocols, as well as the application of evidenced-based medicine. We are seeing many novel applications of ultrasound technology that can now be delivered or used in combination with other imaging modalities in our patients. The Journal of Ultrasound in Medicine has become an important international resource with submissions from all over the world.  Original research articles constitute approximately 60% of the total papers submitted.

  1. What medical ultrasound question or concern keeps you up at night?

We use ultrasound imaging technology every day in our clinical practices. I am constantly trying to understand how diagnostic ultrasonography practice can be improved for patient care through development/application of new technologies, better education, and innovative research initiatives.

  1. Finish this sentence…”It’s best to use ultrasound first when…”

It’s best to use ultrasound first when providing obstetrical care to pregnant women because of its cost-effectiveness as a screening tool, established benefit for the prenatal diagnosis of fetal anomalies/complications, and long safety record in pregnant women.

Do you have any questions for Dr Lee? Comment below or let us know on Twitter: @AIUM_Ultrasound. Learn more about the AIUM Awards Program at www.aium.org/aboutUs/awards.aspx.

Wesley Lee, MD, is Co-Director, Texas Children’s Fetal Center at Texas Children’s Hospital Pavilion for Women. He is also Professor, Department of Obstetrics and Gynecology; Section Chief, Women’s and Fetal Imaging; and Director of Fetal Imaging Research all at Baylor College of Medicine.

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Because Adults Need to Play

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One of my favorite TedMed 2014 talks is by Jill Vialet, CEO and Founder of Playworks titled “The Power of Play”.  In it Jill describes how people and circumstances are transformed through play. There is actually a physical and mental function which play serves in our daily lives. When I first began educating health care providers in ultrasound internationally, I noticed this. Amidst directing and organizing courses–alternating lectures first, then lectures last; hands-on stations first with flipped classroom pre-class; a half-day course; a two-day course; or even a three-day course. The combination matrix never really mattered and the post-course evaluations never varied.

SonoGames 3However, one key piece of each course always ensured a winning recipe for sealing the learners’ knowledge and ending on a greatly positive note.

That was the final day’s game of Jeopardy®.

Yes, splitting the adult course attendants in two competing teams and having them play a game. Despite the relatively benign prize of candy, having them play promised a room full of noise, laughter, positive feelings, and raving post-course evaluations.

From India, Ireland, Sri Lanka, and Ghana, it didn’t matter the country. It didn’t even matter if they knew the rules of the game. What mattered, and what made the course, was play. This was true for the learners as well as the educators.

As the president of the Academy of Emergency Ultrasound (AEUS) of the Society for Academic Emergency Medicine (SAEM) in 2011, I was allotted 4 hours of conference time to plan as I wished. I immediately saw this as an opportunity to create and innovate. I envisioned a 4-hour game event of fun, focused ultrasound education, and resident competition. My friend Y. Teresa Liu, M.D. (Harbor-UCLA Medical Center) had told me about running an ultrasound game event with our mutual good friend David Bahner, MD. (the Ohio State University Medical Center).  I conferred with my education officer Andrew Liteplo, MD. (Massachusetts General Hospital).  He loved the idea.

The SonoGames® was born.

Since that first year, we have increased the aspects and the intensity of play. This past year, the organizing committee dressed in costume commensurate with the conference city. There was a best team costume competition, a best team name award, and the teams competed for medals and for the opportunity to bring the SonoCup to their home institution.

I am convinced that the success of this event is due to its focus on play and fun. We are now planning for the 2016 SonoGames® and I suspect there will be even more play, fun, laughter, and learning.  If you want to learn more about the details of how we structured the games, check out the article that appeared in the Journal of Ultrasound in Medicine. And, if you think you are up to the challenge, get your 3-member ultrasound-savvy team ready to compete!

How do you play? What other ideas do you have to incorporate play and ultrasound? Have you ever competed in an ultrasound event? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Resa E. Lewiss (@ultrasoundREL) is the Director of Point-of-Care Ultrasound at the University of Colorado. She has published on medical education and Point-of-Care Ultrasound. Check out her TedMed2014 talk.