Sometimes referred to as “the stethoscope of the future,” ultrasound has many advantages over other imaging techniques which make it ideal for use in primary care. With a unique combination of portability, dynamic imaging, affordability, and real-time interpretation point of care ultrasound (POCUS) is ideal for use in many practice settings. The use of POCUS as the primary imaging modality for many diseases can drastically shorten the time to definitive treatment, and as such is the preferred modality for some presentations. The purpose of this project was to investigate means to improve resident physician knowledge of POCUS and to evaluate if increased knowledge would lead to increased utilization in our outpatient clinic. We started with a pre-test survey covering basic POCUS knowledge as well as a question concerning current utilization of ultrasound imaging in the clinic. We followed that with an educational lecture about the basics of POCUS and some hands-on practice. Afterward a posttest survey was conducted. We found that there was a significant increase in both basic knowledge and the number of residents who intended to use POCUS in the clinic compared to the pre-test. These findings confirm that education on point of care ultrasound can increase both knowledge and utilization in the outpatient clinic. Further education and research could be done to see if there is an actual increase in utilization with continued education.

This descriptive retrospective cohort study utilized a large workers comp insurer database. All MRI's performed on peripheral joints during calendar year 2017 that were (a) 2 weeks after the initial clinic visit, or (b) greater than 6 weeks after injury, but (c) not more than 3 months after the date of injury were evaluated in this study. Individual diagnoses rendered on MRI reports for these cases were categorized as to whether ultrasound alone or ultrasound + xray could adequately provide the same diagnoses. Results showed that, ultrasound + xray would be able to provide all of the same diagnoses compared to MRI in 54% of cases vs 33% of cases using ultrasound alone, highlighting the utility of using ultrasound and xray together. The proportion of cases where ultrasound + xray could reasonably be substituted for MRI increases to 70% overall when less severe diagnoses, considered not likely to change management, were excluded from analysis. If point of care ultrasound was performed for all 1482 cases with subsequent MRIs pursued in only 30% of cases, a cost savings between $456,186 and $331,698 would be realized, translating to $308 to $224 per patient. Additionally, if ultrasound + xray was performed at the point of care during the first clinic visit for an injury, the definitive diagnoses could be reached on average 33.3 days earlier. In total, these results suggest a significant proportion of musculoskeletal workers comp injuries could be accurately and completely evaluated at the point of care using ultrasound and xray together. This could yield greater provider and patient confidence in the diagnosis and treatment plan as well as more expeditious accurate diagnoses leading to reductions in both direct and indirect costs.

Background: Goal-directed ultrasound protocols have been developed to facilitate efficiency, throughput, and patient care. Hands-on instruction and training workshops have been shown to positively impact ultrasound training. Objectives: We describe a novel undifferentiated chest pain goal-directed ultrasound algorithm-focused education workshop for the purpose of enhancing emergency medicine resident training in ultrasound milestones competencies. Methods: This was a cross-sectional study performed at an academic medical center. A novel goal-directed ultrasound algorithm was developed and implemented as a model for teaching and learning the sonographic approach to a patient with undifferentiated chest pain. This algorithm was incorporated into all components of the 1-day workshop: asynchronous learning, didactic lecture, case-based learning, and hands-on stations. Performance comparisons were made between postgraduate year (PGY) levels. Results: A total of 38 of the 40 (95%) residents who attended the event participated in the chest pain objective standardized clinical exam, and 26 of the 40 (65%) completed the entire questionnaire. The average number of ultrasounds performed by resident class year at the time of our study was as follows: 19 (standard deviation [SD]=19) PGY-1, 238 (SD=37) PGY-2, and 289 (SD=73) PGY-3. Performance on the knowledge-based questions improved between PGY-1 and PGY-3. The application of the novel algorithm was noted to be more prevalent among the PGY-1 class. Conclusion: The 1-day algorithm-based ultrasound educational workshop was an engaging learning technique at our institution.

Mit dieser Arbeit wurde erstmalig eine qualitative und quantitative Analyse zum Status quo der studentischen US-Ausbildung im deutschsprachigen Raum durchgeführt. Eingeschlossen wurden alle medizinischen Fakultäten (n=44) Deutschlands, Österreichs und der deutschsprachigen Schweiz, die im Dezember 2015 auf den Webseiten des MFT und Thieme.de verzeichnet waren [3, 70]. Ein standardisierter Fragebogen mit insgesamt 32 Fragen beleuchtete folgende Aspekte der studentischen US-Ausbildung: 1. Allgemeine Angaben 2. Organisation 3. Ressourcen 4. Überprüfung des Lernerfolgs 5. Evaluation Der Fragebogen wurde an alle LeiterInnen der jeweiligen fakultätseigenen Skillslabs verschickt mit der Bitte nach Beantwortung bzw. Weiterleitung an die US-Verantwortlichen der Fakultät. Die Befragung begann im Dezember 2015 und endete im Mai 2016. Die finale Rücklaufquote betrug 64% (28/44). Die statistische Auswertung erfolgte mit SPSS® 20, IBM Chicago. Die Mehrzahl der medizinischen Fakultäten im deutschsprachigen Raum bieten US-Kurse an. Allerdings ist die studentische US-Ausbildung vielerorts heterogen organisiert mit eher zu kurzer praktischer Übungszeit und zu hohem Studierenden-Lehrenden-Verhältnis. Damit US als bereicherndes Lehrmittel sinnvoll in das bereits überfüllte Curriculum des Humanmedizinstudiums integriert werden kann, sind minimale Standards notwendig. Basierend auf den Ergebnissen dieser Studie und einer Literaturrecherche schlagen der Autor und die Koautoren ein mögliches Rahmenwerk und Meilensteine auf dem Weg zu einem longitudinalen US-Curriculum im Humanmedizinstudium vor.:A Abkürzungsverzeichnis 3 B Einführung 4 1 Ultraschall als Grundkompetenz zukünftiger ÄrztInnen 4 2 Ultraschall als integraler Bestandteil des Humanmedizinstudiums 7 2.1 Ultraschall als Lehrmethode in der Makroanatomie und Physiologie 7 2.2 Ultraschall als Erweiterung der körperlichen Untersuchung 7 2.3 Wesentliche Inhalte publizierter Ultraschall-Curricula 8 2.4 Peer-Teaching und Studierendeninitiativen 10 2.5 Rahmencurriculum für die studentische Ultraschallausbildung 11 3 Ableitung der Rationale für die publizierte Studie 13 C Originalpublikation 14 1 Allgemeine Angaben 14 2 Skizzierung der publizierten Studie 15 3 Formatierte Originalpublikation 16 D Zusammenfassung 28 1 Hintergrund und Durchführung 28 2 Ergebnisse und Auswertung 29 E Literaturverzeichnis 33 F Anlagen 41 1 Anschreiben 41 2 Fragebogen 42 G Darstellung des eigenen Beitrags 52 H Verzeichnis über die wissenschaftlichen Veröffentlichungen und Vorträge 53 I Lebenslauf 54 J Erklärung über die eigenständige Abfassung der Arbeit 56 K Danksagung 57

Medical-grade ultrasound devices are now pocket sized and can be easily transported to underserved parts of the world, allowing health care providers to have the tools to optimize diagnoses, inform management plans, and improve patient outcomes in remote locations. Other great advances in technology have recently occurred, such as artificial intelligence applied to mobile health devices and cloud computing, as augmented reality instructions make these devices more user friendly and readily applicable across health care encounters. However, broader awareness of the impact of these mobile health technologies is needed among health care providers, along with training on how to use them in valid and reproducible environments, for accurate diagnosis and treatment. This article provides a summary of a Mayo International Health Program journey to Bwindi, Uganda, with a portable mobile health unit. This article shows how point-of-care ultrasonography and other technologies can benefit remote clinical diagnosis and management in underserved areas around the world.