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.

 

Cadaver Lab Isn’t Just for First Years

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Credit: Rob Swatski

Of all the things people say they remember learning in medical school, the location and function of the sartorius muscle is usually not one of them. For me, I can still see the muscle lying diagonally across the dissected thigh—small but purposeful, leaving me to wonder how this tiny thing so miraculously and perfectly made it from one side of the leg to the other through evolution and use.

This memory is representative of how thought-provoking and educational cadaveric dissection was for me as a novice clinician. The sight of the
cadaver on the gurney, along with the smells, the noises, and the presence of a real human being in front of me, were my first clinical experiences of bedside learning from a patient, and it had a significant effect on me.

Despite living in the digital age where extraordinary feats in medical technology have occurred over such a short period of time, cadavers remain a fundamental part of medical education. Training and educating students with human cadavers is not just a pedagogical exercise. Cadaveric dissection emphasizes understanding of a structure’s spatial orientation and function, but perhaps more importantly, it provides a contextual environment that differs from rote memorization that often accompanies anatomical learning. Additionally, cadaveric education has gained wider importance at the post-graduate level as a training element for surgical and emergent ultrasound-guided procedures.

Dr. Demetrios Demetriades, Chief of Trauma and Surgical Intensive Care at Los Angeles County Medical Center in Los Angeles, understood the value of this type of training, and in 2006 worked with the County of Los Angeles to create a cadaveric procedural training lab for post-graduate trainees. The lab was designed to be used by residents and fellows for procedural education, practice, and anatomical dissection. There is a dedicated, full-time staff that includes a perfusionist, a technical assistant, and an administrative team through the Department of Surgery. The lab is used 2 to 3 times a day by various surgical specialties, anesthesia, and the emergency medicine residency, which includes our ultrasound division. The emergency ultrasound division uses the lab once a month to train residents and ultrasound fellows how to perform various point-of-care ultrasound-guided procedures, such as ultrasound-guided central and peripheral line placement.

Unlike other simulation modalities such as gel phantoms, human tissue phantoms, or simulators, performing ultrasound-guided procedures in the cadaver lab allows the trainee to have the tactile experience, where (s)he is touching skin, performing the procedure, and using real procedural tools on human tissue. The importance of this from a training and educational standpoint is that the trainee is in a controlled setting, has time to reflect upon the learning as it occurs, can discuss procedural technique openly with the attending, and can perform the procedure repeatedly in a safe environment.

For emergency medicine providers, the impact of using the procedural cadaver lab for ultrasound-guided procedures and anatomical learning cannot be underestimated. John James (2013) estimated that more than 400,000 deaths occurred in a 3-year span due to medical errors in the hospital setting, making it the third leading cause of death in the U.S. The conditions by which we practice our specialty are always under the auspices of being emergent. Although it has been well documented that ultrasound makes care safer and more efficient, ultrasound as a modality warrants the same practice and repetition as the procedures it provides assistance to. The cadaver lab provides this exposure to openly learn in an inaugural fashion and by one’s mistakes. It seems fitting, then, to make the cadaver lab a more central part of medical education—a place we can come back to on a regular basis as we learn and improve our skill.  Just think of the memories we’ll make.

What learning experience had the most impact on you? What other experiences should we ensure continue? Have a cadaver lab story to share? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Tarina Lee Kang, MD, is Assistant Professor of Clinical Emergency Medicine and Division Chief of Emergency Medicine Ultrasound at the Keck School of Medicine of USC.

An Idea Whose Time Has Come

By all accounts, French writer Victor Hugo wasn’t talking about ultrasound in medical education when he wrote these words. But fast forward a little more than two centuries and they seem more than fitting.

Med_Ed_Forum_Logo-blueRecent years have seen a reformation of medical school education, something many have argued is long overdue given the changes in medicine and medical practice in the last two decades. Multiple medical schools are actively changing their curricula and many are incorporating novel educational strategies to teach medical students more efficiently and to focus on less esoteric topics. In perhaps a perfect storm during this same period the accuracy of the physical examination is being questioned more than ever while over reliance on imaging and increased radiation exposure are being linked to increased costs and future mortality. Ultrasound has long been proposed by advocates as a critical tool to help address these concerns but in medical education especially, it may be an ideal tool for future physicians.

Ultrasound as taught in a point-of-care setting, or performed at the bedside, can be incorporated into almost every clinical specialty. Its uses range from procedure guidance to focused diagnostic applications allowing accurate bedside diagnosis of multiple disease states. In addition, it is proving to be an excellent adjunct in teaching basic science topics such as anatomy and physiology. Recent literature, representing just the proverbial tip of the iceberg, suggests that ultrasound is superior to the physical examination even if that exam is done by an expert. Additionally, ultrasound helps novices, known as medical students, better learn the basics needed for all medical professions. Given all of this information it is imperative to have a national conversation regarding ultrasound integration into medical school education.

It is with this backdrop that last year, the AIUM and the Society of Ultrasound in Medical Education (SUSME) convened a conference to discuss the state of ultrasound in medical education and to ultimately craft a roadmap for its integration. Forty-two medical schools, 64 attendees, and 13 faculty gathered in New York City to begin this work.

At the outset, it was clear that the level of integration varied among medical schools, with some being fully integrated, some just starting, and others still exploring. But this fact led credence to the need for this event which started with a series of discussions and presentations covering a variety of topics. Ultrasound education leaders discussed how to get started, how to overcome pitfalls and barriers, and where to find support and funding. Many corresponding resources can be found on the AIUM’s MedEd Portal.

Participants then had a hands-on scanning experience with simulation and live models that was designed to show how and where they could integrate medical ultrasound education. This was followed by roundtable discussions during which participants could share their experiences, ask questions, and focus on next steps.

One of the highlights of the event was the students’ perspective. A number of students shared how medical ultrasound education helped them develop confidence and a skill that could be used for them to teach attendings, other students and practitioners across the world.  Their enthusiasm and energy definitely created a positive and exciting atmosphere.

The participants came away with a shared understanding that it makes sense to prepare the next generation of clinicians and physicians with the skills and understanding of how and when to use medical ultrasound. However, challenges remain.

Multiple barriers exist and many Deans, associate Deans and other tasked with curricula development are not familiar with current point of care ultrasound use.  Additional barriers such as when, where and how to integrate ultrasound into a 4-year curriculum may appear to be unsurmountable, yet have been solved in multiple medical schools already. The collection and efficient distribution of this knowledge is seen as critical to the further spread of ultrasound in medical education and the unprecedented bringing together of multiple basic science and clinical educators.

This event was the first step in opening up the discussion and sharing common resources, challenges and solutions. The second Ultrasound in Medical Education Forum is scheduled to take place May 31-June 1 at the University of California, Irvine. The event is by invitation, but if you know someone who might be interested, please forward their contact information to Glynis Harvey at gharvey@aium.org.

If you are associated with a medical school, how have you integrated ultrasound? If you are a student, what do you think about teaching ultrasound in your classes? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Steven R. Goldstein, MD, is AIUM’s Immediate Past President.

* The 2014 event was underwritten by industry partners and a grant from the Endowment for Education and Research.