A Victory for Humanity

Imagine the impact on healthcare in this country and around the world if all healthcare providers were equipped with a diagnostic and patient-management tool with the extraordinary power of ultrasound. Access to care would be improved, especially in under-served areas, quality of care would be improved across virtually every area of medicine, patient safety would be improved almost overnight, and the cost of healthcare could be decreased if the tool were used wisely.

Horace Mann, the great American education reformer, said “Be ashamed to die until you have won some victory for humanity.” What a victory for humanity it would be to improve healthcare for billions of people throughout the world. As educators and practitioners of ultrasound, we are in a position to win a huge victory for humanity if we collectively embrace the “victory goal” of improved healthcare for all with ultrasound.

Hoppman Blog picture 3.7.17

I believe the place to start in the quest for this victory for humanity is with education. There are many we must educate about ultrasound—healthcare practitioners of virtually every specialty and at every level of healthcare provision and training; those who teach healthcare providers; those who make decisions concerning healthcare education, practice, financing, and regulations; biomedical researchers and the healthcare industry; and those who will ultimately be the greatest beneficiaries of every practitioner competently using ultrasound: patients and their families.

There are roles for all of us in the education of this diverse group of players. I would encourage you to give some thought to how you might help individuals in these various groups understand the power of ultrasound to transform healthcare. At the core of this transformation will need to be excellent education of all ultrasound practitioners at all levels of service they provide. This will require pooling the knowledge, skill, experience, and wisdom of all involved in ultrasound regardless of specialty, level of practice, or global location.

However, even with excellent education, I do not believe we can achieve this victory for humanity without the engagement and support of our colleagues in primary care. According to a report by the Association of American Medical Colleges in 2014, one-third of the almost 850,000 active physicians in the United States were Family Physicians, Internists, or Pediatricians. These are the 3 specialties usually classified as primary care providers but other specialties such as Emergency Medicine and Obstetrics and Gynecology also regularly provide primary care. There is also an increasing percentage of primary care being provided and supported by other healthcare providers such as nurse practitioners and physician assistants, as well as sonographers, midwives, medics, and emergency medical technicians. Thus, primary care providers as a group are the largest group of healthcare professionals in the country and probably the world.

On the frontlines of healthcare, these primary care practitioners can have an immediate and profound impact on healthcare through the use of ultrasound. It is very encouraging to note that within the various primary care sectors there are now champions of ultrasound emerging among both general membership as well as leadership as evidenced by the initiation of ultrasound interest groups and associated ultrasound societies in organizations such as the American College of Physicians, the American Academy of Family Practitioners, and the American Academy of Physician Assistants. And kudos to the AIUM, its leadership, and membership for all they have done and are doing in education and in welcoming our primary care colleagues into our ultrasound family. We need to support the ultrasound efforts of these individuals and organizations and other organizations in any way we can. Working together we can take ultrasound education and practice to a level that will ensure a great victory for all of humanity.

In conclusion, as quoted by Nelson Mandela, “Education is the most powerful weapon which you can use to change the world.”

What are your thoughts on ways to support the ultrasound efforts of primary care practitioners? How can medical education be modified to encourage the widespread use of ultrasound by future primary care practitioners? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Richard Hoppmann, MD, FACP, is Professor of Medicine, Past Dean, and Director of the Ultrasound Institute at University of South Carolina School of Medicine.

I’m Tired of Falling Asleep During Lectures

I remember the first test I failed. It was an immunology exam that I took about halfway through my first year of medical school. Seeking some solace, I asked a classmate for advice. His snarky response was, “Why don’t you try NOT sleeping through the class?”

sleeping in classHe did have a point, but I couldn’t help it. The professor was so incredibly boring. I couldn’t understand why he would spend so long talking about a study performed decades ago involving injecting mice with bacteria. How would this make me a good doctor?

I quickly found the solution to my problem: I had to stop going to class. Imagine that? The best way for me to get a medical education was NOT attending the courses–at least this particular course. It turns out I learned a lot better reading by the pool in sunny Southern California than in that big lecture hall. I soon discovered that many of my classmates were doing the same thing. Some read the textbooks at home or at a coffee shop. Some bought entirely different textbooks on the same subject. Some bought audio tapes for a particular subject. Of course some did prefer the classroom. In the end, we all passed.

Spending 4 years in college and 4 more in medical school makes you extremely sensitive to the lecturer’s delivery of the material. We spend years sitting in large groups in dark rooms quietly listening to someone on some stage talking at us. These days, most lecturers are reading off slides and within the first minute, you know what you’ve got yourself into.

Why do we subject our learners to someone standing behind a podium reading slides for an hour? Why do we think this works? Most likely it’s because very few people know there is a better way of doing things.

Our ultrasound instructor in medical school, Dr Chris Fox, likes to talk about “flipping the classroom.” Prior to our ultrasound didactics, he would give us access to an online podcast for the scanning technique of the day. We could watch it in pieces or all at once and we could watch it at any time and however many times we wanted. Best of all, we could pause, rewind and fast forward. We would then show up for a brief lecture consisting of a 5- to 10-minute review of the podcast where we could ask questions. Then we split up into groups to practice scanning.

That’s what I call efficient. And fun.

I’m now in charge of teaching my co-residents the same ultrasound skills I learned in medical school. Problem is, I don’t have a podcast series of lectures. In fact, I started with no lectures at all. Truth is, I could have devoted hours creating engaging, interesting, and effective PowerPoint slides. But, why should I reinvent the wheel when colleagues of mine from around the world have already developed these presentations? If I could use those, then I could focus on what I do best, which is teach the hands-on components.

Thank goodness for FOAM (Free Online Access Meducation). The term was coined in 2012 in the emergency medicine community and Life in the Fastlane has a whole page dedicated to its history and explanation.

Essentially, FOAM is a growing movement to provide high-quality and FREE medical education materials online for anyone to use. It’s a dream come true for any educator. Time to give a lecture? You could spend hours throwing together 60 slides for a lecture, but somebody else has already done it, and they’re REALLY good at it. Let them teach the lecture so you can use your time to practice and reinforce. Whether it’s an ultrasound technique or reviewing how to work up and treat chest pain, the principle is the same.

For me, using FOAM to teach residents is a lifesaver. Walking a learner through the machine and the exam technique comes natural to those with experience. Putting together a presentation to introduce it all to a big group requires time that I don’t always have. Plus, my proficiency in PowerPoint is limited and producing high-quality videos and images with overlaid anatomy takes considerable time, assuming you know how to do it.

Many of us know about FOAM resources already, probably just not the name. The Ultrasound Podcast is a fantastic resource with educational videos and challenges. There is also a smartphone app called One Minute Ultrasound for Apple and Android phones, which is a great on-the-go resource. The American Academy of Emergency Medicine (ACEP) runs Sonoguide.com with a whole host of resources. Another great resource is Sonomojo.org, which is a collection of FOAM resources for ultrasound. AIUM offers free resources and practice guidelines as well as teaching tools for members.

So let’s stop putting our students to sleep and start engaging them on their own terms. Give them the resources then use your time more effectively to get practical and work on procedural skills or problem solving. FOAM is there to guide the way.

How do you make your presentations engaging? Do you use any FOAM resources with teaching? If so, have you found it useful? Have questions about the future of FOAM? Comment below or let us know on Twitter: @AIUM_Ultrasound.

David Flick is a 3rd year family medicine resident at Tripler Army Medical Center. He received 4 years of ultrasound training at the University of California, Irvine School of Medicine. He currently runs the resident ultrasound curriculum and is an outspoken proponent for ultrasound training in the primary care specialties.