As a rheumatologist working in Northern Ireland, it is more or less expected that you should have developed some competency in performing ultrasound of the joints. Ultrasound training is now well embedded in the training programme for our Rheumatology SpRs, and this has perhaps been reflected in the very high ratings for trainee satisfaction in our region compared to the rest of the UK. Although most of us have embraced this new technology with enthusiasm and ‘gone back to school’ relearning anatomy and going on ultrasound courses, I can’t help feeling that the learning process would have been far easier had it been taught at medical school along with anatomy teaching. Using ultrasound not only challenges our in-depth knowledge of anatomy, but it can also help sharpen up our clinical examination skills. I often encourage students in clinic to examine a joint, declare exactly what they have found, and then I can test their findings using ultrasound and give them instant feedback.
Experience and clinical skill can help us a great deal, but even an experienced rheumatologist will get caught out from time to time!
Of course, Rheumatology isn’t the only application for ultrasound. Cardiologists were the first to embrace ultrasound and develop specific training courses. In emergency medicine, there is now a recognition that ultrasound can be invaluable for detecting a wide range of acute pathology e.g. intra-abdominal bleeding in a trauma situation. And quite apart from diagnostic use, ultrasound can help with gaining intravascular access, guiding liver biopsies and performing chest drains.
When I was trained in medical school, I was taught how to use a stethoscope in the same way as doctors had been for almost 200 years before me. I recognised that I couldn’t use this tool quite as well as a trained cardiologist, but as a screening tool it was still valuable. Now that portable and relatively affordable ultrasound is becoming available, should we not accept that in the near future most doctors will find some use for skills in ultrasound medicine? Out of hours in emergency situations when specialist ultrasonographers are not available, there are still many simple diagnoses that can be made by those with basic training. And what about screening for aortic aneurysm? At the moment this is patchy at best and many are still dying from ruptured aneurysms that could have been prevented. If we are to believe Eric Topol’s ‘Creative Destruction of Medicine’, we physicians are at risk of losing our ‘mastery’ of healthcare if we do not stay ahead of the game and adopt new technologies to make the most of our expertise. Topol describes how he, a well respected cardiologist, has set aside his stethoscope in favour of a smartphone sized ultrasound that allows him to diagnose simple valvular disorders. You can watch a YouTube video of the Vscan to see what he is referring to.
So it was with some excitement that I learnt that a medical school in South Carolina is actually incorporating ultrasound training into the medical school curriculum. Have you ever wished you could check your patient for an abdominal aortic aneurysm? Do you have twenty minutes to learn the basics about how to check for an abdominal aneurysm? Why not have a go and try the excellent basic course available online? It is currently available without charge and I think this is a great example of a clear and practical online course. Your scanning efforts probably won’t match those of a trained radiologist or vascular surgeon, but it will surely beat trying to diagnose an abdominal aneurysm using your fingers and a stethoscope! This course is provided by the ‘Society of Ultrasound in Medical Education’ who are trying to promote education in ultrasound among medical schools. There is also an enterprising group who have developed a series of online training courses in ultrasound for emergency medicine. You might argue that there is more than enough in the medical curriculum already. I would think that learning key skills should take priority over factual learning. Modern anatomy learning should surely now be based on the use of 3D imaging apps such as those from 3D 4 Medical, alongside dynamic ultrasound images and MR/CT images to supplement or replace the traditional textbook. This should help the student develop a better three dimensional and dynamic understanding of anatomy. A report on the four year experience of an ultrasound training programme for medical students in Carolina has recently been published – and the feedback from students was very encouraging. If they can achieve that in a four year programme, what is to stop our universities with five year medical courses from doing the same?