FOAMed Made Me A Better Lecturer

My glossy, relentless smile slowly began to sag. My enthusiasm waned. I asked myself, “Why are you even here?

Although that was the first time I actually asked the question, truth be told, it had been germinating in my brain for the past few months.FullSizeRender

It was during one particularly bland and unprepared lecture in my first year of medical school when I found it nearly impossible to read the deluge of text on the PowerPoint slide and listen to the speaker. Not only was I quickly losing interest, but the speaker appeared to be caught off guard by the content of his own slides.  The phrase “Why did I put that in this slide?” was uttered over and over again. Unfortunately, my despair was not limited to this one professor or this one lecture. In fact, getting a good lecture was more outlier than standard.

It was at that moment I decided to stop attending lectures. I figured since the speakers gave me access to their slides and all they were doing in class was reading the slides, I could stay at home and do just as well. As validation for this theory, my grades improved.

Shortly after graduating medical school, I was asked to give my first lecture as an intern. What did I do? I created a PowerPoint with bullets. That lecture went over about as well as those medical school lectures did: horribly.

While the content was acceptable, the presentation wasn’t engaging, and worst of all, it was boring. I found myself perpetuating the cycle and becoming a part of the problem rather than a solution.

For my next lecture, instead of focusing on the required content, I focused on my audience. Luckily I had a group of mentors who had grappled with this so I began to study not only the content of their lectures but also how they lectured.

Soon after, I discovered podcasts and the #FOAMed (Free Open Access Medical Education) movement. Inexplicably, I found I could watch an entire 20-minute talk online without checking my phone. For someone with the attention span of a small bird, this was no small feat.

I tried to emulate what I had been learning and observing for my next talk, and when I gave my next lecture to the residents, I found they were spending less time on their phones and computers and more time engaged in my lecture. After that experience, I immediately asked for more opportunities to lecture because I knew the only way to improve was to do more of them. While the residency was very accommodating, they were only able to give me a lecture every couple of months, and I needed more.

Since I couldn’t give lectures to our residents as frequently as I desired, I thought maybe I could practice on my computer. Initially, I figured I could record a few lectures and put them on YouTube. But the more I thought about it, the more I wasn’t sure this is how I wanted to distribute my content. I always got distracted when I went on YouTube. I would start looking for ultrasound videos and then somehow end up watching an hour of compilations of cats falling asleep and rollerbladers falling.

That’s when I thought about creating a website. I wanted a place where I could upload all of my lectures in an easy-to-navigate format, with minimal distractions. I remember reading somewhere that the average student attention span was approximately 10 minutes, so decided I was going to try and make my videos 5 minutes long to increase the likelihood that people would actually watch the whole video. That’s where 5-minute sono was born.

Eventually I purchased a USB microphone and paid for good screen capture software and began recording. Initially I wanted to focus on purely instructional videos without any mention of the evidence or current literature. This made it much easier to keep my content as short as possible, with the long-term plan to create a podcast where I could talk about literature as much as I wanted. Setting up a website to look good and work seamlessly is very difficult. Thankfully the ultrasound director where I went to residency is kind of a genius on that front. There have definitely been a few hiccups along the way, but overall the experience of been pretty amazing. This has taken a tremendous amount of work, but viewership has been steadily increasing, which is encouraging.  I still have a large amount of instructional 5-minute sono videos to create, but decided to start introducing more literature reviews in the form of a blog and podcasts. Soon I’ll begin my faculty position at the University of Tennessee in Chattanooga, Tennessee, Department of Emergency Medicine, and anticipate I’ll be able to lecture to the residents to my heart’s content. But that won’t stop me from continuing the steady stream of ultrasound instructional videos and supporting the FOAMed movement.

How do you make your talks more engaging? What are your favorite FOAMed resources? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jacob Avila, MD, is Co-fellowship and Ultrasound Director, Clinical Assistant Professor at the University of Tennessee in Chattanooga, Tennessee. To check out some of his FOAMed material, visit 5 Min Sono.

How to Obtain Focused Cardiac Ultrasound Images

My first exposure to handheld ultrasound was as a first-year medical student. I was assigned to a cardiology clinic with an attending that pioneered handheld ultrasound examinations. Watching him move from patient to patient and use ultrasound to simultaneously diagnose and teach inspired me to learn how to use ultrasound and incorporate it into my practice.

cardiac_pic2

Parasternal long axis demonstrating a dilated left ventricle.

As a budding cardiologist, examining and triaging patients with handheld ultrasound is a part of my daily work. Although handheld ultrasound and the stethoscope differ vastly in their technology, at the bedside, both are limited by the user’s interpretation of the examination findings. I have found when using handheld ultrasound, as with the stethoscope, perhaps the most important tool is “between the ears.”

The “Introduction to Focused Cardiac Ultrasound” set of lectures provide an overview to focused cardiac ultrasound views and a guide to obtain them. The main goal is to develop an understanding of the scope of focused cardiac ultrasound and to “get the heart on the screen” when scanning. The first lecture focuses on the parasternal long axis and subcostal views of the heart. In practice these views will often be the most helpful and accessible. The second lecture reviews the parasternal and subcostal views and introduces the apical views of the heart. Each lecture includes sample diagnoses.

My rationale for reviewing all the basic views of the heart is to provide a broad survey of all the windows and probe orientations. When a formal cardiac echo is ordered, these are the views and windows obtained by the sonographer. In practice with handheld ultrasound, one or two of these views can be utilized to answer the question at hand. Based on patient positioning and body habitus, however, certain windows may provide a better view of the heart.

My hope in sharing all the views in the second lecture is to not overwhelm the learner but rather provide a strong foundation in understanding the anatomical relationships of the ventricles and atria in the body and see how one window builds off the next. The views in this lecture are directly applicable to structured bedside ultrasound examinations, such as the “CLUE examination.”

At our home institution, we utilize these lectures in a continuously rolling small-group lecture series for our medical students and house staff. The cardiology fellow leads the lecture and the hands-on scanning portion, rotating every third week on the step-down cardiology unit. Overall the feedback has been positive with many of the trainees spreading the skills to other rotations. We are happy to share this resource and welcome feedback.

What resources are invaluable to you? What tools do you use to continually learn? Where do you find the information you need? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Colin Phillips, MD, is Fellow, Division of Cardiovascular Disease at Beth Israel Deaconess Medical Center.

What One Winning Sonographer Has to Say

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why I Volunteer for the AIUM

Bagley_6One of my favorite “demotivational” posters says:  “MEETINGS, none of us is dumb as all of us.” Except, in the case of working on an AIUM committee, that poster could not be further from the truth.

Not. Even. Close!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

Have you experienced any of these situations?

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

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

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

  1. Overhead Reach
    1. Sitting at your desk, or standing behind your chair, take both arms and reach overhead as high as possible, with palms facing in and thumbs pointing behind you.
    2. As you extend your arms overhead, push your shoulders back (think pinching a pencil between your shoulder blades!).
    3. Now keep reaching as high as you can while exhaling as if you are blowing out a huge candle, actually 5 huge candles. Inhale through your nose and exhale through your mouth.
    4. This should open up your chest, allowing you to breathe easier while at the same time relieving stress and strain from your neck and shoulders.#3
  2. Thumbs Back Reach
    1. Again, sitting at your desk, or standing behind your chair, take both arms and extend them down by your side.
    2. This time, open the palms to the outside, rotating the hands so the thumb is again pointing behind you.
    3. Again, pinch the shoulders back (think of pinching that pencil between the shoulder blades!) and sit or stand as tall as possible.#6.
    4. Now keep reaching back as far as you can while at the same time blowing out those five huge candles! Inhale through your nose and exhale through your mouth.
    5. This is another great movement to open up your chest and allow you to breathe easier while at the same time relieving stress and strain from your neck and shoulders.
  3.  Head To Shoulder Reach
    1. In a seated or standing position, simply make yourself as tall as possible. With this movement, think that someone is taking you by the hair and pulling straight up!
    2. At the same time, push the shoulders down and back – pinch that pencil!
    3. Slowly tilt your head toward the top of your shoulder. Try to place your ear on top of your shoulder.
    4.  Now, slowly and gently, rotate your head, working to bring your chin up toward the ceiling, while still trying to keep your ear on your shoulder.
    5. Make sure to do both right and left side to use this movement to get great neck relief and release tension in the muscles in the upper neck/shoulder area!

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

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

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

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

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

Kindred Spirits

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

J Christian Fox 1

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

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

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

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

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

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

Tell us a little about your TED talk experience.

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

Who is your mentor and why?

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