Training Beyond Discipline – Developing Devotion in Ultrasound

Mathews Benji KA point-of-care ultrasound (POCUS) revolution is unfolding before our eyes, forever changing the way we interact with patients. It started with a revolution in specialties such as emergency medicine and critical care, and now it has entered into my sphere with internal medicine and hospital medicine. I see this whenever I’m on clinical service. A 3rd year medical student talks about diffuse B-lines as we stop antibiotics and start diuretics on a patient with pulmonary edema; a 3rd year resident asks to look at a patient’s kidney with ultrasound as we manage undifferentiated acute kidney injury; nursing staff curiously looking on as a patient is shown their weak heart as goals of care are discussed.

At the same time, we in internal medicine and hospital medicine are living in a medical world filled with many challenges towards implementation of POCUS. Though there are many devices in the emergency rooms and some in the critical care wards, there are not many in the inpatient wards nor in the clinics. Though numerous workshops and courses abound in POCUS, many attendees do not continue to use this skillset after training. Those that received initial training find it too challenging to discipline themselves to continue to scan.

It is that latter sentiment that caught my attention this last year. The concept of discipline and viewing POCUS through its lens. A quote by Luciano Pavarotti comes to mind,

“People think I’m disciplined. It is not discipline. It is devotion. There is a great difference.”

I’ve often heard the sentiments:

“It is so hard to learn POCUS, how do you find the time for it on a busy clinical service to get images?”

“I find it hard to set aside time during my non-clinical work days as other work and life piles up.”

I’m not sure about you, but the word discipline does not often carry an inspirational tone to it. There is a sense of drudgery, lack of passion surrounding the word. As an ultrasound director, that is the farthest from what I want my learners to experience with POCUS.

When I looked up the word discipline in the Oxford Dictionary there it was as well:

dis·ci·pline
noun
1.
the practice of training people to obey rules or a code of behavior, using punishment to correct disobedience.
“a lack of proper parental and school discipline”

2.
a branch of knowledge, typically one studied in higher education.
“sociology is a fairly new discipline”

Is it #1 that we were aiming for? Or at the very least, is that what people are sensing? Hopefully, we’re not using punishment to correct disobedience. The Pavorotti quote struck a chord in me. As a contrast to discipline, we have devotion.

The word “devotion” is defined by Oxford Dictionary as follows:

de·vo·tion
noun
1.  love, loyalty, or enthusiasm for a person, activity, or cause.
“Eleanor’s devotion to her husband”
synonyms: loyalty, faithfulness, fidelity, constancy, commitment, adherence, allegiance, dedication; More

•  religious worship or observance.
“the order’s aim was to live a life of devotion”
synonyms: devoutness, piety, religiousness, spirituality, godliness, holiness, sanctity
“a life of devotion”

•  prayers or religious observances.
plural noun: devotions
synonyms: religious worship, worship, religious observance

Devotion does have some concepts borne from religion or worship but that doesn’t make it an irrelevant word for the POCUS learner or teacher. The first definition of love, loyalty, or enthusiasm captures the essence of what most of us are hoping POCUS to be for our learners. As my good friend and POCUS enthusiast, Dr. Gordy Johnson, from Portland, Oregon, says, we need to remember “our first kiss.” What was the moment that grasped us with POCUS?

Don’t get me wrong, I’m not completely opposed to the word discipline, but it move beyond that if we’re going to develop fully devoted clinicians in the realm of bedside ultrasound. Those that are equipped with the cognitive elements know when POCUS should be used, why it should be used, how to acquire images, and then how to clinically integrate it.

This post was originally intended as a follow-up of the AIUM webinar on the Comprehensive Hospitalist Assessment & Mentorship with Portfolios (CHAMP) Ultrasound Program with hopes to continue the conversation surrounding what makes for an effective training program. The program involved online modules, an in-person course with assessments, portfolio development, refresher training, and final assessments. The key lesson we have learned is that longitudinal training with deliberate practice of POCUS skills with individualized performance feedback is critical for skill acquisition. However, the intangible pieces of how people continued to scan was developing an enthusiasm and love surrounding ultrasound by seeing its impact in the marketplace. As they were continuing to scan, their patients, their students, the many nursing staff were partnering in a stronger way with this diagnostic powerhouse in their hands.

With all this, I cannot help but be optimistic when I see the commitment of many in the POCUS movement already. I would urge all of us to evaluate how we develop devotion in ultrasound, how to tap into the dynamism of the POCUS movement coming up the pipeline with our medical students and residents. They have the potential to disrupt inertia and be an impactful force to integrate POCUS more into internal medicine and hospital medicine.

 

If you are an ultrasound educator, how do you inspire devotion? What are some of your best practices surrounding training in POCUS? Which do you think is most important: dedication or devotion? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Benji K. Mathews, MD, FACP, SFHM, is the Ultrasound Director of the Department of Hospital Medicine at HealthPartners in St. Paul, Minnesota.

Storing Blood as a Dry Powder

Did you know that blood can only be stored for up to 6 weeks when refrigerated? Because synthetic blood is not available in the clinic, blood supplies must be continually replenished from healthy donors. Even if there is a surge in blood donations at one point in time, 6 weeks later there could be shortages if continued donations do not meet the current demand. Blood can be frozen for a decade or more but significant challenges in processing blood for frozen storage limit this option to specific situations such as for rare blood types or military use. The freezing process currently utilizes high concentrations of glycerol to protect red blood cells during frozen storage but this compound must be removed prior to transfusion, and the de-glycerolization process is very sensitive and time-consuming. Therefore, most hospitals and medical centers utilize refrigeration for blood storage.

What if, instead of refrigerating or freezing blood, there was a method to freeze-dry blood for long-term storage as a dry powder, similar to the process used for astronaut food? This could enable long-term blood storage at room temperature, and when the blood is needed for transfusion the cells could be quickly re-constituted simply by adding sterile water. Not only would this offer another option for long-term storage, it would be particularly useful in situations where refrigeration or freezing is not available, such as in some remote medical centers or for the military in far-forward settings. In addition, this method could enable stockpiles of strategic blood reserves in order to maintain an adequate blood supply during disasters such as hurricanes, which disrupt blood donations.

Blood cells dried

Electron microscopy image of red blood cells after drying/rehydration following ultrasound-mediated loading with preservative compounds.

The idea of turning blood into a dry powder and then rehydrating it for transfusion may sound like science fiction, but could it become a reality? Can nature provide clues to help us solve this problem? There are many cases in history where significant scientific breakthroughs were achieved by studying nature. For example, the Wright brothers studied the characteristics of birds’ wings during flight to discover an effective design for airplane wings. Also, Alessandro Volta invented the battery after carefully studying the electric organ in torpedo fish. In the context of cell preservation, it has been found that some organisms can survive complete desiccation for long periods of time. For example, tardigrades and brine shrimp (“water bears” and “sea monkeys”) can be dried out and remain in a state that approaches “suspended animation” for decades, but when they are rehydrated they return to normal physiological function and can even reproduce. This led us to ask the question, if these complex multicellular animals can survive desiccation, why not individual red blood cells? Scientists have found that these organisms produce protective compounds, including certain sugars and proteins, which prevent damage to their membranes during drying and rehydration.

Unfortunately, human cells do not have the transporters in their membranes that enable internalization of the protective compounds found in organisms that can survive desiccation. Therefore, an active loading method is required. We realized that the process of ultrasound-mediated drug delivery via sonoporation could potentially be applied to solve this problem and enable delivery of protective compounds into human red blood cells. In the past, most ultrasound research has either ignored red blood cells or attempted to minimize sonoporation in these cells. But what if we could intentionally sonoporate red blood cells outside of the body in order to actively load them with protective compounds so that they could be stored as a dry powder at room temperature until needed for transfusion?

Our initial efforts to load red blood cells with protective compounds for storage as a dry powder have been promising. We prepared solutions containing red blood cells, preservative compounds, and microbubbles followed by treatment with B-mode ultrasound for ~60 seconds. After ultrasound treatment, the cells were freeze-dried and stored as a dried powder at room temperature (21–23 °C) for 6 weeks or longer. Cells were rehydrated with water and we measured up to 30% recovery of viable red blood cells. In addition, we performed electron microscopy imaging of the rehydrated red blood cells and observed evidence of normal biconcave-discoid shape. Our next steps involve testing the rehydrated cells in an animal model of acute hemorrhage in order to assess the function and safety of the red blood cells in vivo after dry storage at room temperature.

Research studies are currently ongoing and much more work remains to be done before clinical translation is possible, but if it is successful this approach could have a significant impact on blood supply, particularly in locations where refrigeration and freezing is not available. In addition, this approach could potentially enable dry storage of other cell products. As I consider the possibilities of this approach, I wonder if there are other things that we can learn from nature that could also transform medical practice.

 

Have you learned something else from nature that has been incorporated into your medical practice? Do you have any ideas that could potentially transform medical practice? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jonathan Kopechek is an Assistant Professor of Bioengineering at the University of Louisville. His Twitter handle is @ProfKope.

 

 

Sonographers and Contrast-Enhanced Ultrasound

Now that contrast-enhanced ultrasound (CEUS) has been approved in the United States for several abdominal applications in adults and pediatrics, I decided to take a deeper look into the sonographer’s role in CEUS. Traditionally, sonographers perform ultrasound examinations based on a protocol, construct a preliminary ultrasound findings worksheet, and perhaps discuss the findings with a radiologist. And now CEUS has transformed traditional ultrasound and gives physicians and sonographers additional diagnostic information related to the presence and patterns of contrast enhancement.DSC00125

Based on sonographers’ traditional scope of practice, some questions came to mind. What is the training process for sonographers to learn CEUS? How should CEUS images be obtained and stored? How should CEUS findings be communicated?

I envision CEUS training for sonographers broken down into stages, where they begin by learning the basics and eventually transition to where they can perform and record the studies independently. The first stage for sonographers is the ‘CEUS learning curve.’ In this stage, sonographers become familiar with basic CEUS concepts, eg, understanding physics of contrast agents and contrast-specific image acquisition modes, CEUS protocols, and typical patterns of contrast enhancement seen in various organs. In addition, an important part of the training is recognizing contrast reactions, and learning IV placement, documentation and billing related to CEUS.

The next stage involves sonographers performing more patient care and gaining scanning responsibilities. Sonographers place the IV and prepare the contrast agent. The scope of sonographer responsibilities does not generally include contrast injection (although it is reasonable since CT, MR, nuclear medicine, and echocardiography technologists routinely place IV lines and inject contrast). It should be noted that CEUS examination usually requires an additional person (physician, nurse, or another sonographer) to assist with contrast injection while the sonographer performs the ultrasound examination. In the beginning of sonographer training, it is very beneficial to have a radiologist present in the room to guide scanning and appropriate image recording.

In the third stage, a well-trained sonographer is more independent. At the completion of the examination, the sonographer will either send clips or still images to a physician to document the CEUS findings and discuss the procedure. Ideally a worksheet is filled out, comparable to what is done today with “regular” ultrasound.

The majority of CEUS examinations are performed based on pre-determined protocols, usually requiring a 30–60-sec cineloop to document contrast wash-in and arterial phase enhancement. After that continuous scanning should be terminated and replaced with intermittent acquisition of short 5–10-sec cineloops obtained every 30–60 sec to document late phase contrast enhancement. These short clips have the advantage of limiting stored data while providing the interpreting physician with real-time imaging information. Detailed information on liver imaging CEUS protocols could be found in the recently published technical guidelines of the ACR CEUS LI-RADS committee.[i] Some new users might acquire long 2–3-minute cineloops instead, producing massive amounts of CEUS data. As a result, studies can slow down a PACS system if departments are not equipped to deal with large amounts of data. In addition, prolonged continuous insonation of large areas of vascular tissue could result in significant ultrasound contrast agent degradation limiting our ability to detect late wash-out, a critical diagnostic parameter required to diagnose well differentiated HCC. Any solution requires identifying and capturing critical moments, which will be determined by a sonographer’s expertise. Exactly how sonographers can ensure CEUS will successfully capture the most important images is a critical question that must be answered and standardized.

Ideally, leading academic institutions should provide CEUS training for physicians and sonographers. I have seen and attended CEUS continuing medical education courses and they are a great way for physicians and sonographers to learn CEUS imaging. CEUS is a step forward for sonographers and will potentially transform our scope of practice. The technology will advance the importance of sonographers and diagnostic ultrasound, and importantly it will improve the care of our patients.

Acknowledgements:
Dr. Laurence Needleman, MD
Dr. Andrej Lyshchik, MD
Dr. John Eisenbrey, PhD
Joanna Imle, RDMS, RVT

[i] Lyshchik A, Kono Y, Dietrich CF, Jang HJ, Kim TK, Piscaglia F, Vezeridis A, Willmann JK, Wilson SR. Contrast-enhanced ultrasound of the liver: technical and lexicon recommendations from the ACR CEUS LI-RADS working group. Abdom Radiol (NY). 2017 Nov 18. doi: 10.1007/s00261-017-1392-0. [Epub ahead of print]

Has CEUS helped your sonography career? How do you envision CEUS being incorporated in your work? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Corinne Wessner BS, RDMS, RVT is the Research Sonographer for Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Corinne has an interest in contrast-enhanced ultrasound, ultrasound research, medical education, and sonographer advocacy.

Bigger and Better in the Big Apple

Last week a near-record 1,500 physicians, sonographers, scientists, students, and educators from across the country and around the world gathered in New York City to network, share, and learn. It was, by all accounts, one of the biggest and best AIUM Conventions yet!

What it made so great? A variety of educational opportunities covering a wide range of topics addressing at least 19 different specialties is just the start. More interaction across disciplines to share techniques, more hands-on learning labs, new product releases, and collaborative learning events added to the excitement and collegiality.

If you were in New York City, we hope you shared your feedback in the follow-up surveys. If you were unable to make it this year, here are a few of the highlights:

New Offerings—As if putting on the AIUM Convention weren’t enough, we decided to make a host of changes. We doubled the number of hands-on learning labs (most sold out), we added the more intimate Meet-the-Professor sessions (again, most sold out), we enhanced networking by adding exhibit hall receptions, we brought back the mobile app to make navigating the event easier, and we invited our corporate partners to host Industry Symposia, which included education, networking, and food. Whew!

New Offerings

SonoSlam—In its third year, a record number of medical schools (21) sent teams to compete for the coveted Peter Arger Cup. This year’s winning team, F.A.S.T. and Furious, is from the University of Connecticut. They competed last year and had so much fun they returned and were triumphant! Save the date for next year—April 6. Big thanks to headline sponsor CoapTech.

SonoSlam 2018

Global Plenary—AIUM President Brian Coley, MD, hosted the Plenary session that featured a lecture on global health from John Lawrence, MD, President of the Board of Directors for Doctors Without Borders-USA. This was followed by Roberto Romero, MD DMedSci, who presented the William J. Fry Memorial Lecture on ultrasound imaging and computational methods to improve the diagnosis and care of pregnant women and their unborn children. The entire Plenary Session is available on the AIUM Facebook Page.

Social Media—This year was the most active social media convention ever for the AIUM. StatsFrom streaming live videos on Facebook to more than 754 individuals participating and sharing on Twitter (a 50% increase over last year), the social media scene was active and engaging.

Fun Activities—Not only was #AIUM18 educational, it was also fun. This year attendees could participate in a morning jog through Central Park; do a scavenger hunt with the AIUM app (Congrats to Offir Ben-David, RDMS, from Stamford, CT, and Jefferson Svengsouk, MD, MBA, RDMS, from Rochester, NY, for winning prizes by completing the scavenger hunt); network during 3 different AIUM receptions and the new Industry Symposia; and win prizes at the AIUM booth (Congrats to Jenna Rothblat who won a free 2019 AIUM Convention registration).

Fun Activities

Sold-out Exhibit Hall—This year’s exhibit hall was the most exciting and active it has ever been. At least 3 companies unveiled new ultrasound machines and several others shared their insights with live video feeds. Combine that with networking receptions and New York street fare at lunch time, and the exhibit hall was always the place to be.

Award Winners—AIUM was proud to recognize the following award winners (look for upcoming blog posts and videos from some of these individuals):

Wesley Lee, MD, FAIUM—Joseph H. Holmes Clinical Pioneer Award

William D. Middleton, MD—Joseph H. Holmes Clinical Pioneer Award

Thomas R. Yellen-Nelson, PhD, FAAPM, FAIUM—Joseph H. Holmes Basic Science Pioneer Award

Tracy Anton, BS, RDMS, RDCS, FAIUM—Distinguished Sonographer Award

Alfred Abuhamad, MD, FAIUM—Peter H. Arger, MD Excellence in Medical Student Education Award

Creagh Boulger—Carmine M. Valente Distinguished Service Award

Rachel Liu—Carmine M. Valente Distinguished Service Award

Lexie Cowger—Carmine M. Valente Distinguished Service Award

Adriana Suely de Oliveira Melo, MD, PhD—AIUM Honorary Fellow

Simcha Yagel, MD, FAIUM—AIUM Honorary Fellow

E-poster winners—Every year, the AIUM supports an e-poster program. This year, a record number of abstracts were submitted and the AIUM recognized the following e-poster winners:

  • First place, Basic Science: Construction and Characterization of an Economical PVDF Membrane Hydrophone for Medical Ultrasound, presented by Yunbo Liu, PhD, from the FDA, Silver Spring, MD.
  • First place, Education: Investigation into the Role of Novel Anthropomorphic Breast Ultrasound Phantoms in Radiology Resident Education, presented by Donald Tradup, RDMS, RT, from Mayo Clinic-Department of Radiology, University of Pittsburgh Medical Center-Department of Radiology, Dublin Institute of Technology, Ireland.
  • First place, Clinical Science: Sonography of Pediatric Superficial Lumps and Bumps: Illustrative Examples from Head to Toe presented by Anmol Bansal, MD, Mount Sinai Hospital, Icahn School of Medicine.
  • Second place, Basic Science: Strain Rate Imaging for Visualization of Mechanical Contraction, presented by Martin V. Andersen, MS, from Duke University.
  • Second place, Education: Tommy HeyneSonography in Internal Medicine, Baseline Assessment (MGH SIMBA Study), presented by Tommy Heyne, MD, MSt, Massachusetts General Hospital-Department of Internal Medicine and Department of Emergency Medicine.
  • Second place, Clinical Science: Serial Cervical Consistency Index Measurements and Prediction of Preterm Birth < 34 Weeks in Twin Pregnancies, presented by Vasilica Stratulat, CRGS, ARDMS, MD, Sunnybrook Health Sciences.

Up and Comers—In addition to our national awards and our eposter winners, the AIUM also recognizes its New Investigators, which this year were sponsored by Canon.

Nonclinical
Winner— Ivan M. Rosado-Mendez, PhD, for “Quantitative Ultrasound Assessment of Neurotoxicity of Anesthetics in the Young Rhesus Macaque Brain.”

Clinical Ultrasound
Winner— Ping Gong, PhD, for “Ultra-Sensitive Microvessel Imaging for Breast Tumors:  Initial Experiences.”

Honorable Mentions
Juvenal Ormachea, MS,
for “Reverberant Shear Wave Elastography: Implementation and Feasibility Studies.”

Kathryn Lupez, MD, for “Goal Directed Echo and Cardiac Biomarker Prediction of 5-Day Clinical Deterioration in Pulmonary Embolism.”

2019

 

 

Life Hacks for the 2018 AIUM Annual Convention

Plan
View the full program online and, to keep on top of all things #AIUM18, download the eventScribe app now from the Apple store or Google Play store and search for AIUM 2018. imageBefore and during the convention, use the app to plan your schedule, read about sessions, take notes, learn about exhibitors, and engage with other attendees.

Learn all about the app by checking out these videos on using the app: Quick Navigation Guide, Browsing Style, Taking and Sending Notes, E-mailed Notes, Messages, and Events.

Go
Travel to the convention via plane, train, or automobile. The hotel, New York Hilton Midtown, is located on Avenue of the Americas (6th Ave) between West 53rd and West 54th Streets. To get to the hotel from 1 of the 3 nearby airports, or Grand Central station, Penn Station, or Port Authority, which are all within approximately 20 minutes of the hotel, you can take a taxi or rideshare service. To get around the city, walk or take the subway, a taxi, or a rideshare.

 

Follow
Stay in the know by following the AIUM and the Convention on Twitter (#AIUM18), Instagram (AIUMultrasound), vimeo, LinkedIn, and Facebook as we share news and events, as well as photos and videos.

Learn and Network

  • Two preconvention postgraduate courses will be offered on Saturday, March 24. Additional fees apply.
  • We doubled the number of hands-on Learning Labs. Our Learning Labs provide an up-close and personal learning experience while earning CME credit.
  • Learn from leading ultrasound experts in small group settings in Meet-the-Professor sessions. There are a dozen Meet-the-Professor events to choose from. Each comes with lunch. Separate registration fee is required. If you haven’t registered, act quickly because more than half the sessions are sold out.
  • The AIUM has added 2 networking receptions to the Convention schedule. Plan to meet up with colleagues, explore the latest technology, and ask questions you may have during these cocktail and hors d’oeuvre events on the Exhibit Hall floor.
  • The AIUM received a record number of research abstracts for the 2018 AIUM Convention. This research will be shared by AIUM’s new investigators, abstract presenters, and e-poster submitters throughout the event.
  • Community and Interest Group Meetings: Meet with other ultrasound professionals who share your interests, plan future AIUM educational programs, and discuss the issues in your specialty.

 

Exercise
Start your day off with some exercise: join your colleagues and AIUM staff each morning from 6:30–7:15 am for a 3-mile run/walk around New York City’s Central Park. You’ll meet up in the Main Lobby at 6:30.

Hunt
Join the Scavenger Hunt at the convention: download the eventScribe app (search AIUM18) to get started on your chance to win one of several prizes that will be awarded upon completion of the game. A grand prize winner will be announced Tuesday afternoon.

Earn

CME      Earn up to 6.5 CME credits during the Preconvention and 29.5 CME credits during the Convention.

ARRT    Earn up to 6.5 ARRT credits during the Preconvention and 29.5 ARRT credits during the Convention.

SAMs     The American Board of Radiology (ABR) has approved 7 Self-Assessment Modules (SAMs) activities from our upcoming 2018 Convention.

UGRA    One session at the Preconvention and 8 sessions at the Convention have been added to the UGRA Portfolio program’s course offerings.

Please note that although the AIUM provides CME certificates to those who have participated in an AIUM educational activity, the AIUM does not submit credits to regulating bodies or certifying organizations on behalf of the participant. It is the participant’s responsibility to submit proof of credits on his or her own behalf.

Explore

Lid5nyGET

When you’re not attending the convention, check out some of what New York has to offer. Here is a short list of just a small portion of what is out there, including museums, parks, iconic buildings, and more. And, don’t forget to check out minus5° in the hotel’s lobby, where everything in the bar is made of ice, including the glasses.

The Expeditious Evolution of Emergency Ultrasound Fellowships

RJG Photo 2

Access to the internet was dial up through AOL, Bill Clinton was President, and ultrasound machines were big, clunky, and new to the emergency department. It was 1999 and I was in Long Island as a resident. As a resident, I saw the ultrasound machine lurking around the emergency department, but very few faculty seemed to know how to use it. A search of fellowships in emergency ultrasound found a single listed fellowship in Chicago, so I organized a rotation to see what ultrasound was all about.

Emergency ultrasound fellowships in the early 2000s were disconnected, isolated, and in many ways under the radar. As the ultrasound interest group president in SAEM (soon to become the Academy of Emergency Ultrasound) I heard firsthand how difficult it was for fellows to find ultrasound fellowships and how difficult it was for fellowship directors to find applicants. Partnered with Pat Hunt, we started EUSFellowships.com as a platform for fellows and programs to meet. Ultrasound became more mainstream as ACEP, SAEM, and CORD fought to have ultrasound integrated into residency training and general emergency medicine.

Eventually EUSFellowships.com evolved into the Society of Clinical Ultrasound Fellowships as a more robust organization focused on advanced training for bedside ultrasound. The first couple of emergency ultrasound fellowships started around 1997. Within 5 years there were 12 fellowships, and within 10 years there were 27. Today there are over 100 emergency ultrasound fellowships graduating more than 70 fellows each year. There are more ultrasound fellows graduating each year than in toxicology and EMS combined.

Emergency ultrasound fellows today join a large vibrant group of specialists across the United States and the world. Physicians use ultrasound to diagnose, monitor, and guide procedures everywhere from the African savannah to the neighborhoods in New York City. The initial meetings in the 1990s involved small groups getting together to discuss cutting-edge research and new applications. Now ultrasound meetings in emergency medicine involve hundreds of people discussing topics such as board certification or ultrasound program management. Research has evolved from single “we can do it too” projects to multi-center collaboratives. The change in ultrasound over the last 20 years is mind blowing.

When I interview medical students now, I ask them why they went into medicine. What do they want to achieve? One of the best answers I hear is that they want to make a difference in medicine and improve care for all patients. I feel that I have been lucky enough to witness the birth of a new subspecialty that will improve how patients are cared for in the future.

 

What was your initial experience with ultrasound education? Where did you learn your ultrasound skills? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Romolo Gaspari, MSc, MD, PhD, FACEP, is the Executive Vice Chairman of the Department of Emergency Medicine at UMASS Memorial Medical Center. He has also served as the president of a number of Emergency Ultrasound Societies including what is now the Academy of Emergency Ultrasound and the Society of Clinical Ultrasound Fellowships.

Flying Samaritans, the Seed to Pediatric Point-of-Care Ultrasound

There are some experiences in life that seem to have a tremendous impact on the person you become, and the career path you decide to take. When I started working with the Flying Samaritans in medical school, little did I know that it would change the trajectory of my career.

Kids from El Testerazo Mexico

The kids I fell in love with in El Testerazo, holding the pictures I had taken and shared with them. They came by even if they weren’t sick. Of note, they are now in their 20s with families of their own.

Since the UC Irvine School of Medicine was so close to the USA-Mexico border, the UC Irvine Flying Samaritans chapter was actually a driving chapter. Each month we drove down to El Testerazo, Mexico, to give medical care and medications to an underserved community. I immediately fell in love with the community and the children of El Testerazo, Mexico. They would all laugh at my then broken high school-level Spanish, but would appreciate my trying. There was also something about the group of undergraduates (who ran the clinic), medical students, residents, and attending physicians who volunteered their time there that brought back the humanity to medicine. The experience was challenging and rewarding at the same time—to work with limited resources, but to become a trusted member of their community was priceless. Each time I went to the “Flying Sams” clinic, I remembered why I went into medicine in the first place.

During my time with the “Flying Sams,” I worked with a then Emergency Medicine resident, Chris Fox. When he told me he was going to Chicago to do a 1-year Emergency Ultrasound fellowship, I thought he was crazy.

Old ultrasound machine

The ancient beast of an ultrasound machine that we had in the “Flying Sams” clinic.

Not only was he leaving sunny Southern California, but he was going to spend a year looking at ultrasounds? When I looked at ultrasounds, I could barely make out structures; images looked like the old tube TV’s from the 1980s. When Fox returned, he said, “Steph, the next big thing will be pediatric ultrasound.” Again, I thought he was crazy. But slowly, by seeing how ultrasound impacted the management of our patients in El Testerazo, I realized the brilliance in this craziness. Chris Fox’s enthusiasm and “sonoevangelism” was infectious. I think nearly everyone in the “Flying Sams” ended up eventually doing an ultrasound fellowship. Even though the ultrasound machine in the clinic was old, and images were of limited quality, we were still able to impact the medical care of this community that became near and dear to my heart.

And so it began…my passion for emergency ultrasound (now referred to as point-of-care ultrasound) and for Global Health. My initial goal was to become good at performing ultrasounds. As I quickly realized, I was one of the only people who had experience in pediatric point-of-care ultrasound. I felt a tremendous responsibility to become as knowledgeable and skilled as possible, if I were going to teach others this powerful tool. After 4 years of undergraduate education, 4 years of medical school, 3 years of a Pediatrics residency, and 3 years of a Pediatric Emergency Medicine fellowship, I decided to do an additional 1-year fellowship in Emergency Ultrasound. With medical school loans looming and so many years without a “real job,” I was reluctant to do this. This California girl moved from sunny Southern California, to Manhattan to embark on a 1-year Emergency Ultrasound fellowship. This was a move far outside of my comfort zone for so many reasons. And that was one of the reasons why it ended up being one of the best decisions I’ve ever made. It has been a privilege to be a part of this growing community… to take better care of the most vulnerable of patients… and to give this tool to other doctors around the world. I certainly would have never had these experiences or opportunities if it weren’t for the “Flying Sams” and Chris Fox; to both I am forever grateful.

 

 Are you involved in global medical education? If so, what led to your decision to go into the field? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Stephanie J. Doniger, MD, RDMS, FAAP, FACEP is the Editor of the first pediatric point-of-care ultrasound textbook “Pediatric Emergency and Critical Care Ultrasound,” and is currently practicing Pediatric Emergency Medicine and Point-of-Care Ultrasound in New York. She has additional training in Tropical Medicine and is in charge of Pediatric POCUS education for WINFOCUS Latinamerica.