James Day: Hello, and welcome to the Point Of Care Ultrasound Certification Academy podcast where we focus on POCUS. Here we will discuss all things related to point of care ultrasound, the practice, the trends and its impact on healthcare. Our program will engage thought leaders who are defining global patient care with the stethoscope of the future.

James Day: James Day here today recording live from the Focus on POCUS studios. Today we have Dr. Cliff Gronseth as our guest. After graduating Dartmouth College, Dr. Gronseth worked in Africa and Asia, before attending the University of California, San Francisco Medical School. He is a triple board certified in physical medicine and rehabilitation, electro diagnostic medicine and pain medicine. Currently he is the founder and manager of Spine West, an outpatient private practice in Boulder, Colorado, focused on outpatient muscle skeletal medicine, pain management, and ultrasound. Spine West was awarded best medical facility in Boulder, Colorado in 2017 and 2018.

James Day: With a passion for ultrasound. Dr Gronseth started 7D Imaging Incorporated, an educational technology company focused on teaching ultrasound skills. He also founded the NYAGI project, which stands for ‘now you are the group’s interest’. It’s a nonprofit organization focused on teaching ultrasound skills to healthcare providers working in the field. He is a true ultrasound evangelist.

James Day: So Dr Gronseth, thank you. And how are you today sir?

Dr. Gronseth: I’m quite well thanks.

James Day: So, how are things out in Colorado and at Spine West?

Dr. Gronseth: Beautiful. I’m looking at the mountains covered with fresh snow, so that makes everybody happy out here.

James Day: So listen, so I understand you’re on a mission. Can you share your mission with us?

Dr. Gronseth: Sure. Well thanks for having me. I fell in love with ultrasound about 15 years ago when I saw my first ultrasound machine at a conference and I just thought it was the slickest technology to be able to see inside the body. As a physician, a healthcare provider, we poke, prod and we listen, but to be able to actually see things real time inside, it was fascinating to me and I realized that it was just such an advantage in the clinical space to be able to use ultrasound in the real world. The problem was the education. At the time I started ultrasound, there were very few resources available. There weren’t many courses. There were a few books from Eastern Europe and yeah, it was more of a self-learned process. It’s taken me many years to learn and I’m still learning.

Dr. Gronseth: I think if you talk to anybody in the ultrasound world, it’s a constant study, but I just realized that the ultrasound is like a crystal ball. To be able to see inside and almost anticipate problems, either real time or potential problems in the future, like aortic aneurysms, or placenta previa, where you can actually act before things go south was just incredible. And the safety profile of ultrasound with the portability just added to the perfect type of tool for using in the clinical space.

Dr. Gronseth: The biggest problem with ultrasound was the learning curve. It’s still quite steep. It’s, to me it’s analogous to learning to fly a helicopter, at night, in Italian, because it’s got a different language set, you’re looking inside the body, or if you can imagine spelunking with a slit lamp and you’re trying to figure out what the formations are with a narrow flashlight and you have to know the anatomy and ultrasound and physics and everything else with it.

Dr. Gronseth: So it’s quite complicated. But about five years ago, I sprained my ankle when I was running with my dog one morning and my dog stopped to smell something. It must have been very important because she just stopped cold turkey. I jumped sideways, my ankle twisted and popped, and being a smart physician, I knew that painful pops are not good. So I limped to my office and pulled out my ultrasound machine and was scanning my ankle. I was all twisted up trying to figure out what I was looking at and wasn’t quite sure.

Dr. Gronseth: So I pulled out some ultrasound textbooks and anatomy books, etc., and then the ultrasound machine. And I said, “This is a really silly way to learn ultrasound.” Out of a textbook, etc. And so I said, “Why don’t we take all that information and put it into an iPad that you could have right next to you as you’re learning, so that almost like a GPS that sits on your dashboard when you’re driving. I don’t know if you remember the days when you used to look at a map at home or somebody would tell you directions and you write them down, and then you’d try to find your way.

James Day: Oh yeah, man. Yeah, the old Rand McNally. Wow.

Dr. Gronseth: Yeah, exactly. And imagine driving through Boston and you’ve never been there before and you’re trying to figure it all out. So now we have the GPS on the dashboard and that’s the concept for the software. So I proceeded to combine the key resources for learning ultrasound, and I’m an orthopedic physician mostly, and so I focused on the musculoskeletal ultrasound, which was very well received. It was, people really appreciated it and it became very helpful for people. But my interest was in international health and I ended up teaming up with some OB sonographers and some expert EMET sonographers, and we made other modules besides the orthopedics.

Dr. Gronseth: So we made a women’s health module, which includes OBGYN and breast ultrasound. And then we made an emergency medicine module for learning fast exams and the pulmonary and cardiac and so we just keep building more information data sets. And with my interest in international health, I started a nonprofit to bring ultrasound to the world, just because I’m, like you said, I’m an evangelist with ultrasound. I just love it. And so I teamed up with an organization called International Foundation of Sonography Educators and Research, and they have expert teachers in their organization that teach in a lot of ultrasound schools in the United States, and I gave a lecture at one of their conferences and I said, “Anybody that wants to help me teach ultrasound in remote areas of the world, let me know.” And everybody ran to the back of the room and signed up.

Dr. Gronseth: So I ended up starting a nonprofit organization that’s focused on training healthcare workers that work in the remote areas of the world. Not as much focused on the central city based hospital staff, but the more the people that are in the rural areas that have little resources and we teach them in a very rapid way, in person with hands on training combined with the software that I created, and that’s proven to be very effective and we’re saving lives as we speak.

James Day: Is that what NYAGI is? Which means the acronym for ‘now you are the group’s interest’, is that what you’re teaching overseas is based in?

Dr. Gronseth: Yes, exactly, Yeah. So the nonprofit organization is called the NYAGI project and the NYAGI, it’s an acronym for ‘now you are the group’s interest’, and NYAGI represents that woman, man, or child that’s in a remote village that has little access to healthcare, certainly diagnostic imaging, that can perhaps get the traveling healthcare providers coming out to them, screen for potential problems. Currently we’re focused on women’s health. We screen, we do basic prenatal screening looking for placenta previa, or ectopics in the remote villages. So that healthcare providers can warn the mothers that may feel fine during the pregnancy, but if they’ve got placenta previa, they will likely die if they deliver in their village.

Dr. Gronseth: And we’ve been to Nepal a couple of times, and the roads there are difficult to say the least. It can take two weeks to get to any type of healthcare facility. But if they know that they’ve got placenta previa, it gives them a fighting chance to be close to a facility where they can save the mother and the baby’s lives. So right now we’re saving about 10 mothers a month just based on the ultrasound referrals out of Nepal.

James Day: Wow. So you’ve seen a lot of results with that. That’s very inspiring.

Dr. Gronseth: Yeah, it’s fantastic. And the people that participated in the NYAGI project, we have scenography teachers, and we’ve been over to Nepal twice, and the first time we, in five days we taught the 30 nurses basic prenatal ultrasound skills. And we gave them a self confidence score or test on different things that they would have to learn, and by day three, they were 8 out of 10 confident with being able to identify the location of the head, the placenta, the heart, etc. So, we did a great job with the ultrasound. The interesting thing is when we, on their first trip, we got an A plus for teaching ultrasound. We got a C minus for teaching them how to use the iPads that we brought over there.

Dr. Gronseth: Of course, part of the whole project is having the software that’s loaded onto the iPads that are donated from individuals, companies, etc. and these are old iPad 2s etc. that people just almost discard here in the States. But we can use those and we have the software that sits on the iPad on airplane mode so they don’t need internet connection to use the software, and that allows the students to continue learning. So that combination of hands on teaching with the iPads that we leave there allow them to continue to learn, because they, as you know, learning ultrasound is difficult, and it’s mainly because we’re prone to forgetting. If you go to a lecture, or course, or conference you forget 95% of what learn unless you actually use it right away and intensely, use it or lose it kind of thing. And even by six months it’s a 0% retention from things like that, but the software allows them to continue to practice and learn and to just refresh things. And so it really speeds up the learning process and it’s been very successful.

James Day: That’s really inspiring. So tell me about any surprises that you’ve experienced in this field.

Dr. Gronseth: What was interesting is how interested people were in contributing or sharing either their effort or interest or iPads for the NYAGI project. We oftentimes forget how lucky we are here in the developed world and in the less fortunate areas of the world where they have very little, people really want to give back. And the teachers that have worked with us and people that are just volunteering their time and interest in trying to find old iPads from their companies or their schools, neighbors, churches has been amazing.

Dr. Gronseth: Our goal is to get 3000 iPads for Nepal, that’s what we need to get there, and then we got calls from people that heard about the NYAGI project and so we’ve been invited to Haiti, which we’ll probably go to in January, and Ethiopia, Uganda, Peru, Guatemala. We just, we can’t keep up. So yeah, and the beautiful thing is we have found some wireless probes that will transmit the signal, the ultrasound signal to the iPads. So these little cell phone sized ultrasound probes combined with the iPads that we have donated from people is in essence a portable ultrasound machine. And the real fun part is that we can geo-track these iPads around the world with ‘find my iPhone’, ‘find my iPad’ that’s built into this software.

James Day: Sorry to break your stride, but the software app that you developed, I’m intrigued. You’re a brilliant guy. It sounds like it’s a quick and fast packaged POCUS training in a box for OBGYN? Did you write that software? That’s pretty impressive.

Dr. Gronseth: Well yeah, I didn’t write the software myself. I hired a company that did the coding for me.

James Day: Okay.

Dr. Gronseth: But, but the concept was there and yes, we have emergency medicine modules now and I team up with people that are just experts in the field and we just put in a lot of different types of content. We have very short videos with overlays that explain the anatomy. We have techniques, various types of information that is not just basic content, not just basic ultrasound, but much more depth of information as well. So the user of the software can immediately draw or go to the level that they’re looking for, where they’re at. Like if you’re a video gamer, you don’t want to start at level one if you’ve been playing a game for years. You want to just jump right to level 20 and go from there. Otherwise they get frustrated. Vice versa. If you have a beginner that starts to level 20 they get very frustrated and they’ll quit.

Dr. Gronseth: So, the software allows quick access to information, unlike say an online YouTube video or things where it’s passive and you have to watch the whole video, etc. I mean those are helpful as are hand on training, but ultrasound is learned by practice. It’s like learning to ride a bicycle. You have to be on the bicycle and feel it, and see it, and do it to really appreciate it. You can’t learn from a lecture or a PowerPoint or a video, you have to really just jump in there and get the probe in your hand and start scanning.

James Day: Very true.

Dr. Gronseth: And what this software does is, it’s like an expert in a box in the iPad, and so the information is in there and if you quickly need to know how to measure the head circumference or the abdominal circumference and what the key landmarks are, it’s all in the software. So they can quickly just refresh things and go to the information that they need very rapidly. And the people that use the software also use it for patient education, which has been very helpful. That way the patient can understand what might be happening, what the anatomy is, or what normal should look like, and they might have an abnormal problem, a dilated aorta, or fluid in the lungs or something like that. So, it has a twofold purpose.

James Day: Sure. Actually, Cliff, I’m just impressed that you started out with what I think is one of the most dynamic and harder modules to learn of POCUS is a musculoskeletal. Most people start out with FAST, that’s sort of the gateway exam, but you’ve started with the hardest.

Dr. Gronseth: Well I didn’t know any different. I’m a musculoskeletal guy and yeah, little did I know that I could have started with something easier. Yeah, it’s been a journey. There was just a study done with our software at a medical school, the results are going to hopefully come out soon, but they basically let the medical students use iPads with the software loaded onto it as a self teaching tool. And they said, “Here’s the iPad, here’s ultrasound machines.” And they learned the FAST exam in a couple of hours. They all felt confident doing the FAST thing just using the software. So the ability to self teach and know what to look at, and know what to look for, which is in the software, just allowed the students to just pick it up and go, which was very exciting. Because that way … My goal is to bring ultrasound to the world. I just would love ultrasound to be the first diagnostic tool in any clinical space, just because it’s so safe and immediate.

James Day: Yes. And what I wanted to ask you is what inspired you to pursue this?

Dr. Gronseth: Well, it’s really just the under utilization of this amazing technology. I think that if the learning curve was lowered, the ultrasound machines used to be big and expensive, but the price and the size have really diminished dramatically. Now they’re coming out with these handheld little probes that attach to your phone or tablet, computers, etc., kind of like the ones we used in Nepal, and the price point on those is very reasonable. So that price barrier is no longer an issue, and it’s really the main barrier is the education piece, and I think that with the software that we created, I think we’re onto something where we can really accelerate, that we can flatten out that learning curve and really get people riding the bicycle, so to speak, quickly.

Dr. Gronseth: And once you start riding the bicycle, then you learn to balance and then you learn to jump on the curb and then all of a sudden you’re in the bike terrain park doing flips and then all of a sudden your in the X Games. It’s small steps. It’s like when you’re a baby, you learn step by step. You learn to roll, then crawl, then walk and run, and you can’t just expect to be running right away. So I think the concept of using small bites and just gaining your confidence as you need it, based on what you need is the beauty of the software. So it just allows people to learn at their own pace, learn what they need quickly, get confident, and then just use it more and more.

James Day: Yes. You sound like a brilliant guy, a passionate guy, and if I make another snowboard trip out west and I unfortunately, God forbid, if I wind up, I hope I land in Spine West. Sounds like you’re a good provider. I just want to put something out there, maybe you could tell us how we could, the listeners and the audience could engage with this?

Dr. Gronseth: If people are interested in NYAGI project, or even in the software, certainly just have contact me. The software company’s 7D Imaging and the nonprofit is called NYAGI.org. If people are interested, if they have children or if they belong to organizations like churches or businesses that maybe have old iPads accessible, that they’d like to donate so that we can use those iPads to literally save mothers and babies lives, we’re definitely looking for those types of things. Yeah, and there’s always, always looking for people that want to volunteer their teaching skills, or especially money to help pay for probes and things to bring ultrasound again to the remote areas of the world, people that have much less than we do here.

Dr. Gronseth: So, between the iPad donations and the financials and teaching, that’s really the core of it. And if they’re interested in the software, which is being used now in medical schools and residency programs, I’d be more than happy to talk to them about it as well.

James Day: All Right, Dr Gronseth, listen, thank you for taking the time to be here on today’s show. And for the audience, I really appreciate you guys for listening, and don’t forget for even more POCUS talk, follow us on Twitter @POCUSAcademy and on Facebook @PocusCertAcademy. Cliff, it was truly an honor to have you on our podcast today.

Dr. Gronseth: Well, thank you very much for having me.

James Day: Thank you. Bye.

Dr. Gronseth: Bye-bye.

James Day: We hope you enjoyed today’s podcast, Focus on POCUS. Be sure to tune in with us next week for more interviews with thought leaders that are on the forefront of global point of care ultrasound.

James Day: The thoughts and opinions expressed in this podcast are the views and opinions of the guests and not those of Inteleos. This podcast is for information purposes only.