A woman in her 50s enters the critical care unit with complaints of chest pain. There are no specifics or a history of medical problems. Her EKG is normal, and blood tests show a mild troponin elevation. According to the patient, who is now admitted, she has no cardiac history and had an echocardiogram that determined no complications. Curiosity heightens in the attending physician.
The next move conducted is a bedside focused ultrasound that reveals a regional wall motion abnormality on peripheral long axis view. A cardiologist reviews images, confirming that the patient is suffering from a cardiac etiology, resulting in an angiogram and stent placement.
“Had I not look at her heart through the focused ultrasound exam, we could have waited for maybe hours to have another troponin elevation or have the cardiologist see her the next day. By that time, multiple myocardial cells could have died,” describes Dr. Karthik Vadamalai, the attending physician.
Moments similar to this case have been a frequent occurrence in Dr. Vadamalai’s career. Currently a full-time faculty member at the University of Missouri, Springfield campus at Mercy Hospital, he has experienced the impacts of point-of-care ultrasound (POCUS) one too many times not to believe in its transformative power on medicine. His torch for POCUS is one that he is earnestly working towards passing on.
Dr. Vadamalai began studying the modality in his second year of residency at Rochester General Hospital in New York and deepened his POCUS roots during his critical care fellowship at the University of Pittsburgh Medical Center. His belief in and love for POCUS led him to develop a POCUS curriculum for internal medicine residents at the University of Pittsburgh with assistance from his mentors and colleagues on staff.
He is continuing to create a footprint on POCUS education within his current position. Dr. Vadamalia is developing a sustainable point-of-care ultrasound curriculum for the third and fourth-year medical students at the University of Missouri. During his visit to the Focus on POCUSTM podcast, Dr. Vadamalia shares five areas medical schools should consider when implementing a POCUS program.
- Removing Barriers: At present, absent is a notable criterion or agreed-upon approach to conducting POCUS. POCUS standards remain undefined and are needed to provide context that informs and guides any developed curriculum. Medical schools should support and champion for standards in POCUS to ensure that elements taught are viewed as POCUS expertise to the medical community. “This [lack of standards] is where we have the most trouble—trying to define what you should teach an internal medicine resident,” states Dr. Vadamalai.
- Consider the Approach: Dr. Vadamalai notes, “The way we designed our curriculum at the University of Pittsburgh is through a multidisciplinary approach and training-the-trainer model.” Employing a multidisciplinary method means looking across medical disciplines and incorporating in the curriculum how POCUS is applied and utilized within each specialty.
- Involve a Variety of Specialties: The curriculum should be developed with diverse experts from differing medical specialties. The review team should also include healthcare professionals from different backgrounds and focus areas. Building in this manner lessens the risks of overlooking vital components that should encompass a POCUS curriculum. The teaching staff should also reflect the same diversity utilized to create the program.
- Have the Right Resources: The best POCUS training and education involve hands-on experience. Allowing students to encounter real-life scenarios enriches the program and provides them invaluable knowledge. To do so means resources are at the ready. Having superb ultrasound machines and access to expert faculties ensures the longevity of the program.
- Determine Evaluation Method: “How do you define competency? How do you know that students have learned what they were taught,” asks Dr. Vadamalai? Meaningful evaluation of a POCUS education program is a must. Conducting assessments generate room for continual improvement and growth of the curriculum. Develop evaluation methods that are measurable and provide insights into how well students can apply what they learn.
The undercurrent of any program is sustainability and stability. Creating a culture of POCUS expertise requires the willful sharing of knowledge and intentional practice. Erecting POCUS curricula that emphasize these points will be critical in seeing the device’s use not only continue to increase, but the skillfulness of doing so propel the medical community to flight.
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