Ultrasound in Medical Education: How Far We’ve Come

Point of care ultrasound was an obscure elective during my medical school years, a poorly-attended vacation elective to fill the free time between the match and the first day of residency. At the time, the 2 Emergency Medicine attendings directing the course volunteered an expertise, which endured widespread disregard; their craft persisted, unappreciated by the department and hospital. These faculty had a unique passion, a vision of a paradigm shift in medicine that would save more lives, make better decisions, and improve overall care.

I was initially skeptical of that vision. When they expressed excitement over our new, $50,000 Micromaxx (considered a bargain at the time), it sounded to me like the typical exorbitant medical expense with marginal benefit, peddled by savvy sales rmorrow_image1eps. Then we caught our first tamponade in cardiac arrest during a pulse check and I was hooked: POCUS didn’t belong as one of those obscure hobbies limited to the especially nerdy, but was a vital diagnostic and procedural tool, to be learned and disseminated. I went through residency clearly enamored with the technology. To my dismay, early in my internship, we lost our ultrasound director. It was then that I found mentors in podcasts and through the Free and Open Access Medical Education (FOAMed) community.

By my final year of residency, nurses and attendings were calling on me to pause my work in my assigned pod to travel to theirs to help with US-guided procedures. Having identified the need, I started teaching residents and nurses US-guided procedures. The barriers to education were high-quality simulation phantoms, machine access, and educational time. Time we could volunteer, and for machines we begged and borrowed, but for phantoms, we hit a wall. I searched for answers in the young community of FOAMed but found few workable alternatives to the hundred-to-thousand-dollar commercial phantoms. It was at this impasse that I found inspiration from Mythbusters’ use of ballistics gel. I experimented with ballistics gel to create my own phantom and found it morrow_dsf8521to be an effective and practical alternative to the commercial phantoms. I was approached by several companies aiming to turn this into a money-making opportunity, but I felt this information needed to be shared. This skill was too critical to keep it locked up behind a patent. Instead, with the whole-hearted spirit of FOAMed, I published guides and answered questions and gave cooking classes.

I’ve continued to follow the vision of bringing bedside ultrasound to widespread use, from residency to fellowship, and now into my role as Emergency Ultrasound Director and Director of Ultrasound Education at the University of South Carolina School of Medicine Greenville. The future is bright: the FOAMed community is large and growing; US technology is being integrated into earlier stages of medical education; and pocket machines are bringing US in closer reach of the busy clinician. Ultrasound is moving into the hands of clinicians at the bedside and becoming an extension of our physical exam, and there is a growing literature base to support this trend. Someday ultrasound will take its rightful place next to the stethoscope, and my job as an “ultrasound director” will seem as foreign a concept as “director of auscultation.” The complementary forces of FOAMed and formal medical education will bring us to this future of safer procedures and greater diagnostic accuracy, and I am excited to be a part of it.

How have you seen ultrasound medical education change? What are your favorite FOAMed resources? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Dustin Stephen Morrow, MD, RDMS, is Ultrasound Director at Greenville Health System Emergency Medicine, as well as Director of Ultrasound Education at University of South Carolina School of Medicine Greenville. He can be found on Twitter: @pocusmaverick.

Sonographer Stretches for an ‘A’ Game

For our first blog we introduced the reality that there is an epidemic amount of sonographer pain and injury. Almost 90% of sonographers work and live daily with that pain and injury as a result of doing our jobs. That is an epidemic and sinful statistic. As fellow sonographers, we should be incensed that more is not being done to quell the enormous pain and injury that we suffer from.

Coach Rozy and I have the solution. In our first blog with the AIUM, we detailed and gave examples of lower body stretches and exercises that sonographers should do. The folks at the AIUM relayed that our post was very popular among sonographers. Some of the feedback that we received was that many that read our blog thought it was silly that we would suggest doing lower body work for sonographers that predominately suffer from upper body issues (neck, back, shoulders, etc…).

In our 2nd blog we explained why lower body stretches and exercises are also crucial to good sonographer health and pain-free imaging. My favorite story that Coach Rozy tells is about his time in the National Football League. A prominent quarterback in the league at the time was having pain in his shoulders, and main throwing arm. He couldn’t follow through properly on his pass mechanics due to the pain in his throwing shoulder. Not good, if you are a quarterback in the NFL and you can’t pass properly.

Rozy immediately zoned in and started working the shoulder, with little positive result. A few days later Rozy noticed that this quarterback was walking into the locker room with a limp. He hit him up and was told that he had taken a hard hit on his hip and that it had caused him hip pain. Immediately Rozy started working on the quarterback’s hip. A few days later, the hip was better. At this time the shoulder pain also stopped, and life was good. The problem wasn’t the shoulder. The problem was the hip. The hip injury translated into the shoulder. Fix the hip, fix the shoulder. That’s why when you look at sonographer pain and injury, you must look at the body as a whole, not just the area of pain and injury.

For our 3rd blog, we want to share why it is absolutely crucial that your work as a sonographer must be done at the very highest level on each and every patient that you work on. An article entitled, “Making a Difference as a Sonographer, 100% Every Person, Every Time” details my own personal battle with my wife’s diagnosis of breast cancer. As you will read, a breast ultrasound is the only test that caught my wife’s cancer. The cancer was caught early, which made her course miraculous, given such a diagnosis. Amazing things happened in Yankton, SD, the day that my wife had her ultrasound study that caught ‘something’. Enough ‘something’ that a biopsy was done, the cancer was found early, and the course for my wife was incredible.  As sonographers it is CRUCIAL that we be on our ‘A’ game for every person that we work on.

The following are a few simple, quick, easy stretches that can be easily done at work or home. Working the body as a whole is important.

Lying thoracic spine rotation

Start by lying on the ground on your side (either side). With your arms extended straight out at chest level pull your knees pulled up to your chest. The hips and knees should both be at 90 degrees. Work to have your ankles at 90°. You can use a mat, and for added comfort and support use a pillow.

To begin, keep the knees together (place a rolled-up towel or small ball between the knees if you need more support), move your top arm over your body and toward the floor on the opposite side. The objective is to get the arm and s
houlder blade touching the ground, not just the hand.

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All images courtesy of Doug Wuebben.

The goal is to do 2 sets of 8 reps on each side. Tip: You want the movement to come through the thoracic spine — not just the shoulder area.

Kneeling thoracic spine rotation

After completing the lying thoracic spine rotation, progress to the kneeling thoracic spine rotation exercise. This is a more progressive move and requires enhanced control over your posture, movement, and stability.

Begin in a 6-point (some say 4-point) position, on your hands and knees. Take one hand and put it on the base of the skull behind your head. It’s important to keep weight evenly distributed between the legs and your other arm.  Keep the bent arm locked in position. The elbow stays pointed toward the ground. Rotate your torso with motion going through the spine, ending so that the bent elbow is pointed up.  The movement should come through the back/spine — and not just the shoulder! Take the movement through as large a range of motion as possible.  The benefit comes from movement from the thoracic spine. Don’t use your shoulders or hips.

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Do 2 sets of 8 reps on each side.

Psoas lunge

Most people consider proper lunge technique to include pushing the hips forward to stretch what they feel are the hip flexors and the psoas. The iliacus crossing the hip is what is stretched in the traditional lunge, but the psoas also crosses the hip and all lumbar joints.

The best way to stretch the psoas occurs when it is isolated with a lunge that includes lateral bending of the spine and twisting and extension motions. This is a great warm-up stretch before running or doing a lower body routine. Stretch and hold for 20 to 30 seconds. Repeat several times, both directions.

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Farmer’s walk

Another simple yet effective routine is what we call the farmer’s walk exercise. Pick one or two dumbbells and hold them by your sides. Then walk around your training area. Start by walking 25 yards or you can also time yourself, say for 30 seconds, to begin with.

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If you are a beginner, perform the farmer’s walk by carrying any object that has some weight to it. Increase the weight as you progress. The farmer’s walk is a simple yet effective leg-strengthening exercise that works your calves, quadriceps, and hamstrings. The core muscles that help support your spine also benefit. It also creates intra-abdominal pressure to prevent your spine from collapsing.

To vary this routine, hold the weights overhead, use only one weight, or hold one weight overhead and one at your side.

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

 Doug Wuebben BA, AS, RDCS (Adult and Peds), 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. He has also been published on the topics of telemedicine and achieving lab accreditation.

Mark Roozen, M.Ed, CSCS,*D, NSCA-CPT, FNSCA, is a certified strength and conditioning specialist, a certified personal trainer, and a fellow of the National Strength and Conditioning Association (NSCA).

Wuebben and Roozen are co-founders of Live Pain Free — The Right Moves. They can be contacted at livepainfree4u@gmail.com.

 

Why SonoStuff.com?

Three reasons:

As a co-director of technology enabled active learning (TEAL) at the UC Davis school of medicine I incorporate important technologies into the medical curriculum, which has primarily been point of care ultrasound (POCUS). Ultrasound is an incredible medical education tool and curriculum integration tool. It can be used to teach, reinforce, and expand lessons in anatomy, physiology, pathology, physical exam, and the list goes on.

I knew there was a better way to teach medical students thaschick_photo_1n standing in front of the classroom and giving a lecture. Student’s need to learn hands-on, spatial reasoning, and critical thinking skills to become excellent physicians. Teaching clinically relevant topics with ultrasound in small groups with individualized instruction
is the best strategy. I needed to flip the classroom.

I started by creating online lectures for an introduction to ultrasound lecture, thoracic anatomy, and abdominal anatomy:

Introduction to Ultrasound, POCUS

FAST Focused Assessment of Sonography in Trauma Part 1

FAST Focused Assessment of Sonography in Trauma Part 2

Aorta Exam AAA POCUS

Introduction in Cardiac Ultrasound POCUS

Topics quickly grew in scope and depth. I initially housed my lectures on YouTube and emailed them out to students before the ultrasound laboratory sessions. However, I wanted a platform that allowed for improved organization and showcasing. I needed a single oschick_photo_2nline resource they could go to to find those materials I was making specific to their medical curriculum.

https://www.youtube.com/channel/UCOhSjAZJnKpo8pP7ypvKDsw

Around the same time, during a weekly ultrasound quality assurance session in my emergency department I realized we were reviewing hundreds of scans each month and the reviewers were the only ones benefiting educationally from the process. Many cases were unique and important for education and patient care.

We began providing more feedback to our emergency sonographers and I decided I could use the same software I was using to develop material for the school of schick_photo_3medicine to highlight the most significant contributions to POCUS in our department every week. I quickly realized I needed a resource to house all these videos, one that anyone in my department could refer to when needed. The most efficient and creative method was to start a blog. I was discussing the project and possible names for the blog with colleagues and Dr. Sarah Medeiros said, “sounds like it’s a bunch of ultrasound stuff”. https://sonostuff.com was born.

I owe a great deal to free and open access to medical education or FOAMed. I was hungry for more POCUS education in residency and the ultrasoundpodcast.com came to the rescue. I became a local expert as a resident and even traveled to Tanzania to teach POCUS.

schick_photo_4I primarily began www.SonoStuff.com to organize and share with my department of emergency medicine and school of medicine, but it grew into a contribution to the growing body of amazing education resources that is FOAMed. I now use it as a resource in my global development work along with the many other FOAMed resources.

The work we all do in FOAMed, including AIUM’s the Scan, are an incredible and necessary resource. I have read the textbooks and attended the lectures, but I would not be where I am without FOAMed. I know all or most of those contributing to FOAMed do it out of love for education and patient care, without reimbursement or time off. Thank you to the many high-quality contributors and I am proud to play a small part in the FOAMed movement.schick_photo_5

Michael Schick, DO, MA, is Assistant Professor of Emergency Medicine at UC Davis Medical Center and Co-Director of Technology Enabled Active Learning, UC Davis School of Medicine. He is creator of www.sonostuff.com and can be reached on Twitter: ultrasoundstuff.

Interdisciplinary Education and Training in MSK Ultrasound

In my primary specialty of occupational medicine there is a need for practical education in musculoskeletal ultrasound for both diagnostic evaluation and therapeutic interventional guidance. Incorporation of this into education has begun recently and is continuing in the specialty. A wide variety of specialties are represented in occupational medicine, including many specialists who move into the field after a mid-career transition.

Interestingly, over the last few years clinicians have approached me and asked me to help them learn musculoskeletal ultrasound from many different disciplines outside of occupational medicine. These have included emergency medicine, orthopedics, rheumatology, sports medicine, family medicine, radiology, palliative care, and physical medicine and rehabilitation. When inquiring into why these clinicians are seeking training in this modality it seems that the consistent answer is thdr-sayeedat medical students are graduating and insisting on using ultrasound in their residency training. It would seem that many of our medical students are learning ultrasound at a rate that will outpace attending physician knowledge, exposure, and experience. Indeed, when teaching ultrasound to many of the medical students at West Virginia University as part of their medical education, I was astounded to see how proficient they were at using the machine, the transducer, and correctly identifying both normal and pathologic anatomy. It’s my understanding that many universities have included medical ultrasound into the academic curricula as a bridge to their respective gross anatomy courses and in their general clinical medical education.

Ultrasound is a modality utilized by many medical specialties for various indications. Several specialties outside of radiology, including the ones above, utilize ultrasound. Increasingly, residency programs are integrating ultrasound into their ACGME-accredited curriculum and, importantly, medical students are also learning the benefits of using the modality. It seems clear that despite the number of pitfalls, hurdles, and difficulties using ultrasound, the modality has proven to be an asset in clinical settings and has become a permanent fixture in hospital and clinical settings. The benefits of utilizing ultrasound have been well documented across many academic medical journals. I believe that medicine, as a whole, has done well to embrace the modality, however, there seems to be another vital step to take in the education arena to more fully integrate the modality into our patient’s care.

Currently, most education models for teaching ultrasound, whether it is for residents or medical students, involves grouping like kind together. Emergency residents learn it in the emergency medicine didactics. Physical medicine and rehabilitation (PM&R) residents learn it from demonstrations in their own didactics, and so on. Perhaps approaching the curriculum from a more inclusive perspective, however, would be more beneficial for residents and fellows. I, personally, had experience teaching an integrated musculoskeletal course at West Virginia University. The idea, admittedly, was born out of necessity. Physicians experienced in ultrasound from sports medicine, emergency medicine and occupational medicine created and executed a curriculum to teach musculoskeletal ultrasound and invited residents from other specialties. The interest we were able to garner quite frankly surprised me. Although the curriculum was targeted to occupational medicine residents the interest in using musculoskeletal ultrasound was widespread. Residents from specialties like emergency medicine, radiology, family medicine, internal medicine, and orthopedics attended our sessions.

While the course was a success, introducing an integrated curriculum across medical specialties posed a new set of challenges. My specialty was able to use dedicated didactic time for the education but many other specialties have disparate educational time. Many residents could not make all of the sessions and many more could not make any sessions because of fixed residency schedules. This makes coordination very difficult. As I have pondered this over the last few months I believe that educational leaders should begin to form structured educational collaborative time for activities like education in musculoskeletal ultrasound. Each discipline will be able to contribute to teaching to ensure high quality evidence-based curriculum for residents learning ultrasound. Each discipline has their individual strengths and collaboration ensures coordination and even learning amongst instructors. Integrating medicine has been a goal of thought leaders in medicine at the very highest levels and can be replicated for the instruction and training of our resident physicians.

Another option is to allow residents to attend the American Institute of Ultrasound in Medicine’s annual conference where interdisciplinary education in ultrasound occurs. This conference even has a day for collegial competition among medical students and schools. In fact, the courses are created to encourage engagement in the education and training of clinicians at all levels of training. The overall goal is to advance the education and training in this modality and hope that education leaders begin to encourage collaboration in a much larger scale thus achieving integrated medical care that provides a building block to lead to high quality evidence-based medical care for our patients, families, and communities.

What other areas of ultrasound education have room to grow? How would you recommend making changes? Do you have any stories from your own education to share? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Yusef Sayeed, MD, MPH, MEng, CPH, is a Fellow at Deuk Spine Institute, Melbourne, FL.

The Spirit of Collaboration – A Tribute to Carmine M. Valente, PhD, CAE

Are you aware of the depth and breadth of engagement activities at the AIUM? Most likely, our flagship enterprises, such as the JUM and the convention, as well as the 18 (and growing!) communities immediately come to mind. And for almost 20 years, AIUM CEO Carmine M. Valente, PhD, CAE, has been at the heart of it all. As we close out 2016, we say goodbye to a leader, a catalyst, and a friend. While Carmine has set his focus on new adventures in retirement, it’s interesting to note how much the AIUM has grown during his tenure.

Back in 1997, the AIUM had 8 communities, known in those days as sections. There were 2 types of practice accreditation – OB/GYN and abdominal/gecarmneral. There are now 12. The EER, in its infancy, had $47,000 in its coffers. Over time, 8 practice guidelines have grown to 31 practice parameters; training guidelines have expanded from 1 to 12; and the number of societies that have worked with us to develop these tools has expanded exponentially.

This growth is a result of a theme Carmine has instilled throughout his tenure—collaboration. Carmine is often heard declaring “It makes no sense for the AIUM to develop [fill in the blank] without looking outward. The more stakeholders at the table, the stronger the result.” The imaging community recognized this as early as 2007, when RT Image recognized Carmine as one of radiology’s 25 most influential movers and shakers. “Dr. Valente has been a key element in facilitating and coordinating these and other important activities that continue to grow both the AIUM and interest in the ultrasound arena.”

Over time, Carmine has partnered with 10 of AIUM’s 31 presidents, enabling them to achieve their goals and further the AIUM mission. In the last 12 years, the AIUM has hosted 9 forums on a variety of topics with dozens of participant organizations at each; and all within the framework of collaboration: Compact Ultrasound (2004); Training/Exam Guidelines and Scope of Practice (2006/2008); Patient Safety and Quality: The Role of Ultrasound (2007); Point-of-Care Use of Ultrasound (2010); Ultrasound First & Beyond Ultrasound First: Quality Imaging (2012 & 2016); and Ultrasound in Medical Education (2014 & 2015).

In October 2016, the AIUM’s Board of Governors established the Carmine M. Valente, PhD, CAE Distinguished Service Award to memorialize and recognize significant contributions to the AIUM and the ultrasound community as a whole by furthering the multidisciplinary nature and collaborative efforts of the organization. Its first presentation will occur at the 2017 AIUM Annual Convention in Orlando, Florida.

For those who visit the AIUM Headquarters, you will see that the AIUM’s primary conference area has been dedicated as an enduring reminder of Carmine’s Spirit of Collaboration. This space will serve as a center for informing, educating, inspiring, and entertaining, and instill a growing sense of belief and pride in our ability to advance the safe and effective use of ultrasound in medicine.

Today, it is endemic of the AIUM’s culture to ask “Who else should be at the table?” whenever a project is discussed. And for that, we thank you, Carmine.

The spirit of collaboration is, in Carmine’s immortalized words, “to be continued…”

Do you have a memory, thought, or story to share about Carmine? Comment below and on Twitter: @AIUM_Ultrasound.

Glynis V. Harvey, CAE, is the AIUM’s Chief Executive Officer Designate & Deputy Chief Executive Officer.

Puzzle Solver

During the 2016 AIUM Annual Convention, Michael Kolios, PhD, was awarded the Joseph H. Holmes Basic Science Pioneer Award. We asked him a few questions about the award,November 11, 2015 what interests him, and the future of medical ultrasound research. This is what he had to say.

  1. What does being named the Joseph H. Holmes Basic Science Pioneer Award winner mean to you?
    It means a lot to me to be recognized by my peers in this manner. It motivates me to work even harder to contribute more to the community.  I have been associated with the AIUM for a long time and have thoroughly enjoyed interacting with all the members over the years. When I peruse the list of the previous Joseph H. Holmes Basic Science Pioneer Awardees and look at their accomplishments, I feel quite humbled by being the recipient of this award, and hope one day to match their contributions to the field.
  1. What gets you excited the most when it comes to research?
    I get excited when I generate/discuss new ideas, participate in the battle of new and old ideas, and the immensely complex detective work that is required to prove or disprove these new ideas. I thoroughly enjoy the interactions with all my colleagues and trainees that join me in this indefatigable and never-ending detective work, as solving one puzzle almost always creates many new ones. This is what I’ve encountered in the last 2 decades while probing basic questions on the propagation of ultrasound waves in tissue, and how different tissue structures scatter the sound. Finally, I get very excited when I try to think about how to use the basic science knowledge generated from this research to inform clinical practice, and envisioning the day this will potentially make a difference in the lives of people.
  1. How can we encourage more ultrasound research?
    We need to provide the resources to people in order to do the research in ultrasound. Most funding agencies are stretched to the limit and success rates are sometimes in the single digits. This makes it very challenging to do research in general, including ultrasound research. Therefore, pooling resources and providing environments where ultrasonic research can excel will partially help—creating/promoting/maintaining centers for ultrasound research. This can also be promoted through networking and professional societies, such as the AIUM.Another thing to do to encourage more ultrasound research is by demonstrating the clinical impact of ultrasound and how it could be used to save the lives of patients. Only through the close collaboration of basic scientists/engineers with clinicians/clinician-scientists/sonographers can this be achieved. Developments in therapeutic ultrasound for example are very exciting, and have recently attracted the attention of both public and private funding agencies with many success stories. Moreover, providing seed money through opportunities such as the ERR (Endowment for Education and Research) is a step in the right direction—to give people the opportunity to pursue their ideas in the field of ultrasound research.
  1. What new or upcoming research has you most intrigued?
    While I spent a lot of time trying to understand ultrasound scattering, and how changes in tissue morphology influence this scattering, I’m currently dedicating most of my time to the new field called photoacoustic imaging. It is known that conventional clinical ultrasound has relatively poor soft tissue contrast, but in photoacoustic imaging light is used to generate ultrasound. These ultrasound waves, created when light is absorbed by tissue, provides exciting results that allow not only probing tissue anatomy, but also function in ways that not many other modalities can. After the light is absorbed and the waves initiated, everything we know about ultrasound applies—and in fact we can use the same ultrasound instrumentation to create images. I expect this imaging modality to have clinical impact in the near future.
  1. You are well accomplished within the medical ultrasound research community, but when you were young what did you want to be when you grew up?
    When I was young I wanted to be firstly an astronaut, then a philosopher, pondering basic questions and fundamental problems in nature. I ended up studying physics and its applications in medicine. It has been a highly rewarding choice!
  1. If you were presenting this award at the 2017 AIUM Annual Convention, who would you like to see receive it and why?
    I’d like to see someone that has contributed to ultrasound, with work spanning from the basic science/engineering to clinical application! It would also be encouraging to see the next recipient being a woman or minority, reflecting the true diversity from which new ideas come, and representing a constituency for which society has relatively recently given the opportunity to contribute to science in a meaningful and sustained manner.

Who would you like to see win an AIUM award? What ideas do you have to increase the interest in and funding for research? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Michael Kolios, PhD, is Professor in the Department of Physics, and Associate Dean of Science, Research and Graduate Studies at Ryerson University.

Why I Love Credentials

My name is Mike. I am many things, including a veteran, a business man, a coach, and a sonographer. And while the “things” I am change over time, one thing has remained the same: I am a student! This is thompsonmost evidenced by the 8 professional credentials I currently hold.

I have found that after being in the field of ultrasound for more than 2 decades, credentialing and continuing education can distinguish the enthusiastic sonographer from the merely competent one. With the introduction of more focused credentials such as musculoskeletal, breast, pediatric, phlebology, and advanced cardiac subspecialties, sonographers can now stand out from the crowd in terms of awareness and competency while at the same time being on the cutting-edge of the latest techniques and literature.

Acquiring a new credential, or even just studying for the registry examination, requires you to learn valuable new knowledge that may impact the way you treat and diagnose patients. For example, while I was preparing for the RPhS registry, multiple sources recommended a pneumatic compression device to augment venous flow while a patient is standing as an alternative to the patient performing the Valsalva maneuver in order to induce and record venous reflux. For me, this method has helped me better evaluate for this condition with less strain on the patient while eliminating communication barriers that may exist. If I hadn’t been preparing for that exam, I probably would never have learned this technique.

While some credentials are necessary for certain jobs, multiple credentials prove to existing and future employers that you take your profession seriously and you don’t settle for the minimum standard. I am not saying you need to get multiple credentials. If your professional interest does not reach beyond one credential, that is fine, but few ultrasound labs today only perform only one specialty. Echocardiography labs and vascular labs are growing together as cardiovascular labs, and many departments are requiring a more comprehensive knowledge in ultrasound. Credentialing yourself to the highest degree may get you the new job you pursue or secure the one you have. While increased pay is always a motive, sometimes the satisfaction of being able to set yourself apart from others in the field can be just as rewarding.

Some sonographers have the position that if the credential doesn’t come with a pay raise, it’s not worth it. With reimbursement cuts and higher credentialing standards being proposed by private and government payors, my opinion is that keeping your job is a pay raise.

Why do you hold the credentials you have? What are your go-to resources? What book would you like to see written? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Mike Thompson, MPH, RDMS, RDCS, RVT, RPhS, RVS, RCS, RCCS, is Owner of Diagnostic Resources in Perry, Georgia.