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POCUS: Practice Makes Perfect

The Focus on POCUS podcast where all things related to point-of-care ultrasound (POCUS) is discussed featured an incredible guest who has made it his life’s mission to train and educate other medical professionals on the use of POCUS.

Dr. Victor Rao is a radiologist by training and a pioneer of POCUS learning content for medical students, physicians assistants and residents, and continuing medical education content for physicians at the University of South Carolina School of Medicine in Columbia. He has trained physicians worldwide to include Tanzania and the University of Santo Tomas in Manila, Philippines where help establish POCUS programs.

Dr. Rao also shares his knowledge on the subject via contributing chapters on POCUS in several textbooks. On this podcast episode, he shares one great word of advice, “Don’t get intimidated.” He believes that POCUS is a teachable and learnable skill. Anything new will appear complicated at first, however, its just an appearance.

An appearance of something doesn’t actually make what one sees true. The inability to master POCUS is an example of this. It’s a false notion, and Dr. Rao provides a few tips to help navigate the steps needed to become a POCUS expert.

First, Dr. Rao stresses that having an in-depth intelligence of basic physics and biology is the foundation for understanding the images that POCUS provides. Once completely understood, developing hand-eye coordination skills becomes the next step. Advance tools like simulators can support in this effort. “I’ve had great success teaching people who are having a hard time learning ultrasound, but the simulation made a big difference,” Dr. Rao shares.

Scan with a targeted goal and with purpose. Identify prime interest and know what portion of the body is of most importance to view in detail. Dr. Rao recommends, “Decide what you want to do and learn it really well and practice.” This approach entails scanning both normals and abnormals.

Dr. Rao provides in length how to make this work:

  1. Send the patient for an ultrasound exam or CAT scan, do the scan yourself and note the findings in a log book (not on the patient’s chart). When the results from the ultrasound exam or CAT scan comes back, compare it to the one you performed with POCUS. Did the findings match up or not?
  2. If you already have a patient with an ultrasound report, scan the patient yourself as well. Determine if the ultrasound finding match up.
  3. If you already know the diagnosis, for instance, you are aware that the patient has pericardial effusion. Scan the patient’s heart and see if you can find that effusion. The patient has a pleural effusion, can you find it yourself? The patient has gallstones. Can you find those gallstones? “Be aware of what normal images look like and what is not normal will start to be obvious,” Dr. Rao encourages.

These are confident building methods proposed by Dr. Rao. Techniques that he says just after one hour of training first-year medical students were able to identify what was not right.

He also points out to keep in mind that POCUS is an extension of the physical exam. It should be included in taking the patient’s history, running lab tests when required, and used to confirm or obtain more insights into a patient’s condition. Indeed, POCUS is a physician’s wish come true, according to Dr. Rao.

“Essentially, you’re using a 21st-century tool, an advanced tool that gives us the ability to see inside the patient’s body. Every physician wanted the ability to examine with a tool that allows you to see what is going on inside the body.”

Now, that capability is available, and there is a community creating a movement centered on this wish come true — a 21st-century modality defining a 21st-century mission:

To see POCUS utilized and continued to bring the utmost care to patients through enhanced diagnosis.

Become a part of that movement today and join Dr. Rao in spreading the skills and education needed to transform patient care.

Listen to the full podcast episode with Dr. Rao on Focus on POCUS.

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