Making Waves: Ultrasound Use Increases in Medical Education
AAMC Reporter: December 2012
—By Rebecca Greenberg
Steven Clarkson, a fourth-year medical student at the University of South Carolina School of Medicine, grasps the probe from a hand-held ultrasound device and moves it over a child’s chest. Immediately, he sees an image appear on the ultrasound’s screen, which he turns to show the waiting family. To their amazement, and to the child’s excitement, they watch a heart beat in real time.
With rapid advancements in ultrasound technology, such scenarios as this are becoming more commonplace, as a handful of the nation’s medical schools make ultrasound training a standard part of the curriculum. And there is a push to encourage more schools to use ultrasound.
The Society of Ultrasound in Medical Education (SUSME) recently partnered with the American Institute of Ultrasound in Medicine to launch “2013: The Year of the Ultrasound,” a campaign to promote widespread integration of ultrasound into medical school and continuing medical education curricula.
South Carolina is one of the first schools to implement a four-year interdisciplinary ultrasound curriculum. The program started in 2006 and is based on a training model for emergency medical workers. First- and second-year students learn how to read scans during lectures and lab sessions and through Web-based learning modules. In the third and fourth years, students use hand-held ultrasound devices to examine their first patients.
Richard Hoppmann, M.D., dean at South Carolina who also helped form SUSME, considers hand-held ultrasound devices the “stethoscopes of the 21st century.”
“The technology is already here. What is lagging behind is the health care workforce who is knowledgeable and skilled in the appropriate use of these devices,” said Hoppmann, who stressed the importance of proper training.
“It is essential that academia ensure that these advances in ultrasound technology be used in the best interest and safety of the patients. Users must be trained to know when and how to use devices as well as the limitations of the technology,” said Hoppmann.
Unlike their expensive, cumbersome predecessors, today’s ultrasound devices are less expensive, smaller, and capable of producing 3-D, high-resolution digital images that can be paused and replayed. This portability allows doctors to perform bedside exams to detect acute emergencies such as internal bleeding, collapsed lungs, and intestinal obstructions. Ultrasound can be used to guide catheters with more accuracy, decreasing patient discomfort and saving time for staff. In addition, ultrasound is safer than other types of imaging because it does not emit potentially harmful radiation.
Clarkson said the experience of using ultrasound in the classroom has improved his understanding of anatomy and pathology. “It makes it exponentially easier to see real things, happening to real patients in real time. You are better able to identify something if you have seen it before.”
He added that seeing things in real time has a powerful effect on patients. Clarkson recalled one patient who, after viewing fluid buildup impairing his heart and kidneys on an ultrasound, realized he needed to improve his diet and take his medication.
“Patients have responded positively, because they can see how their lifestyle choices can have an impact on their health,” Clarkson said.
Like South Carolina, the University of California, Irvine, School of Medicine (UC Irvine), offers a four-year fully integrated ultrasound curriculum—the only one of its kind in California. What started in 2003 as a fourth-year elective in emergency ultrasound has expanded across the entire continuum.
Students at UC Irvine have shown an extracurricular interest, organizing an Ultrasound in Medical Education Interest Group with guest lecturers and hands-on sessions. Last May the group hosted UltraFest 2012, a symposium where more than 200 students from neighboring medical schools gathered to get hands-on experience with ultrasound devices. Students participated in workshops to see how ultrasound can apply to emergency medicine, urology, obstetrics and gynecology, surgery, anesthesia, and cardiology.
Kiah Bertaglio, a third-year medical student at UC Irvine, helped arrange the event. “The response was overwhelming and shows how important tomorrow’s doctors and health care workers see portable ultrasound becoming. It provided an incredible opportunity for students to learn and improve bedside ultrasound skills in multiple fields,” she said.
Clarkson reported a similar enthusiasm when students from other schools visited South Carolina and saw how students there were using the devices.
“It really made me see how cutting-edge our program is. Even if ultrasound doesn’t become a standard of care—though I’m pretty sure it will—I think there are still many distinct uses for it, and I know that I will be a better resident and physician because I had the training,” Clarkson said.
This year, Mount Sinai School of Medicine launched a program that will give first-year students access to pocketsized ultrasound devices to practice imaging on each other, so they can identify and assess the health of organs, blood vessels, bones, muscles, and tendons.
Jagat Narula, M.D., director of cardiovascular imaging at Mount Sinai, is a staunch supporter of expanding programs such as this one.
“Today’s students will latch on to technology better than past generations. I want to introduce ultrasound to students on the first day and incorporate it throughout their education, so that it will eventually become second nature to them and they will be able to use imaging in their careers,” Narula said.
Efforts to reach this goal are picking up at medical schools and teaching hospitals. The emergency medicine department at the Ohio State University Wexner Medical Center, East Virginia Medical School, and Wayne State University School of Medicine are incorporating ultrasound residency programs and fellowships. If this trend continues, Hoppmann predicts the technology could become a core competency that will enhance patient care across the board.