M0: Introduction and Basic Principles
”Ultrasound: making horrible doctors decent and good doctors great.”
— Ultrasound Podcast. *
”There has never been a greater opportunity for ultrasound, and our challenge now is to pursue a research agenda that evaluates how to incorporate point-of-care ultrasound into patient care safely, efficiently, and effectively.”
— Vicky Noble. 2009.
Index: Introduction | Principle 1 – Legacy & Transparency| Principle 2 – The Limits of Bedside Ultrasound | Principle 3 — Evidence Based Learning & Practice | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V W | X | Y | Z
Welcome to POCUSbasics.com. This is the introduction to the course and course material that accompanies a five day long hands-on Point of Care Ultrasound (POCUS) course for physicians held by physicians at a major emergency hospital in Stockholm, Sweden. The course is based on the model of ”flipping the classroom” — by making the course material available online and having the students learn it on their own before the course takes room; we can optimize their time on-site with instructors for questions, discussions, and (most importantly) for supervised hands-on training — instead of giving a mostly lecture-based course.
This is, to our knowledge, the first time a course of this scale (30 students) takes room over so many days (similar courses are usually 2-3 days long) in Sweden. The scale and duration of the course results in its own challenges when it comes to maintaining quality, a decent instructor-to-student ratio, securing appropriate locations/machines, and staying within the designated financial budget.
Principle 1 — Legacy & Transparency ^
We decided to create the course material in english and make it completely available online for two main reasons. Firstly, there is a rich legacy of online POCUS material made available by physicians in the medical community (in the tradition of FOAMed: Free Open Access Medical Education) that we have learned from, practiced, and taught over the years in our own clinic. Also, a lot of the material available elsewhere online is frequently borrowed from and referred to in this course. Creating everything from scratch for this course would just not be feasible at this time within our current budget and timeframe. Our hope is to, over time, be able to add original content, such as original videos, to the course material.
Secondly, making the course material available online in English, and not in Swedish, also means anyone speaking English can (theoretically) give feedback, use the material, and adjust it to their own course as they see fit (letting us join and contribute to the FOAMed tradition). English as the main language for the course material gives the course global transparency. As English is the dominant scientific and medical language of the world, and as Swedes in general (and medical professionals in specific) have excellent language skills in English, it seemed to us as the obvious choice since we wanted to make what we teach open for scrutiny to the (global) medical community.
Principle 2 — The Limits of Bedside Ultrasound ^
Bedside ultrasound is just another tool in the clinician’s toolbox, similar to other adjuncts such as labs, x-ray/CT, and the stethoscope. It has its own limits and requires, like other adjuncts, a learned skill set for adequate interpretation. It is, however, perhaps unlike the other adjuncts mentioned, more user dependent and requires a higher level of proficiency from the practitioner for correct assessments. Understanding this basic premise and the limits of one’s own ability is one of the most important lessons to keep in mind for the beginning practitioner who is just starting to learn bedside ultrasound.
We are in the firm believe that bedside ultrasound is a great tool for every clinician and that it should be practiced widely by anyone who has access to proper equipment. However, we make a distinction between practicing bedside ultrasound and the ability to make clinical judgements based on the images retrieved. There is to this date no specific certificate or consensus in Sweden on what bedside ultrasound constitutes or what is required before clinicians are able to make judgments and write their assessment in journal records. As long as the clinician is honest with the patient and the clinic when it comes to their ability or lack thereof, we believe in-clinic practice with ultrasound should be encouraged as it is the only way for each clinician to improve proficiency.
Ideally any clinical practice done with bedside ultrasound should be supervised and reviewed by more skilled practitioners, and each clinic should have their own terms and regulations when it comes to when and what clinicians can assess and journal. However, since that is, for the time being, far from the case in most clinics/hospitals outside the main cities in Sweden, we believe in the case-to-case use of bedside ultrasound, where each clinician is trusted to apply good judgement and where it is done in continuous dialogue and development with the home clinic/hospital.
Principle 3 — Evidence Based Learning & Practice ^