When medical students at the University of South Carolina make their rounds, their portable ultrasound machines are standard equipment.
Using units no bigger than a laptop computer, and sometimes as small as a cellphone, students can see gallstones or detect aneurysms more quickly and accurately than they might in a routine physical exam.
The new devices, which are starting to supplant the stethoscope as standard physician equipment, let students study things on live patients that they previously learned about only in cadavers. “There is no question ultrasound technology is going to change the way we teach medicine,” says the school’s dean, Richard A. Hoppmann. As the bulky ultrasound boxes of old are placed with smaller, cheaper, and better models, more and more medical schools are incorporating ultrasound into their curricula.
The University of South Carolina School of Medicine uses the technology across all four years of students’ training. It “complements, rather than replaces, patient histories and physical examinations, says Dr. Hoppmann.
And the portable units have a big teaching advantage: “The technology doesn’t get in the way of student-patient interaction,” he says. “The student can sit down at the bedside with the patient and they can look at the images on the ultrasound screen together.”
The ultrasound machine emits sound waves that bounce off objects, then displays the results as a picture that can identify tumors or changes in the appearance of organs or tissues.
Ross Hilliard, a fourth-year medical student at South Carolina, says using ultrasound on a living, breathing person complemented the skills he was learning in cadaver dissections during his first-year course in gross anatomy.
“When we hold the heart in our hands, we can cut and dissect it in different ways, but we can’t see what it would look like while it’s beating,” he says. “With ultrasound we can do that, in real time.”
That skill proved helpful this year when Mr. Hilliard was part of a team examining an obese patient whose low blood pressure and rapid heart rate suggested a pulmonary embolism: a blockage of the main artery of the lung.
Using the portable ultrasound device, he saw that the right wall of her heart was distended in a way that could be caused by obstructed blood flow through her lungs. He also discovered the probable cause: a blood clot in her leg. While the team ordered additional tests, he says, “we were able to make a clinical diagnosis right there and get her started on a clot-dissolving medication.”
The images also can be a wake-up call for an overweight patient. “Even if the patient doesn’t understand the anatomy or physiology, this helps him understand what we’re seeing and what we’re worried about,” says Mr. Hilliard.
Feeling More Confident
South Carolina’s medical school has 25 laptop-sized ultrasound systems, which cost $50,000 to $70,000 each. It is just beginning to use hand-held pocket devices, which are about the size of a smartphone, that sell for $3,000 to $10,000, Dr. Hoppmann says.
The machines are used in tests in which students demonstrate their skills on “standardized patients,” who are actors recruited by the medical school. In a section on family medicine, the students might screen an elderly patient for an aortic aneurysm, a potentially deadly swelling of the body’s largest artery. For obstetrics, they examine a standardized patient—who is actually pregnant—to determine the position and heart rate of her fetus. Students are also tested on their ability to quickly scan and identify a list of internal organs.
That practice, in the first few years of medical school, makes students feel more confident when they begin working alongside doctors.
“When we hit the ground in our clinical rotations, we were already comfortable using the ultrasound equipment,” says Ray Comer, a fourth-year medical student who is pursuing a residency in obstetrics and gynecology. The benefits are obvious in his field, which relies heavily on ultrasounds. But Mr. Comer found that the technology was a useful diagnostic tool in family practice and other specialties as well.
“It helps uncover things the human eye can’t see or that you can’t discover with more-traditional diagnosis techniques,” he says.
Students training in rural sites also use the portable devices to examine patients and relay the images to experts hundreds of miles away.
Stanford University School of Medicine is another early adopter of ultrasound training.
Before they start their clinical rotations, medical students at Stanford learn how to use ultrasound to perform invasive procedures more safely. They learn to use ultrasound to guide catheters through veins to administer medications or fluids. They can watch, on the screen, as the needle goes into the vein rather than relying on landmarks on the patient’s skin.
They also learn other applications, such as how to perform an ultrasound to see if trauma patients are bleeding internally. Students apply these skills during rotations in emergency medicine, while working alongside physicians.
Wayne State University’s School of Medicine has integrated ultrasound training into its first-year curriculum using 30 portable units that GE Healthcare donated in 2006. During a session this fall, the entire first-year class took turns scanning one another’s hands and carotid arteries. Scott A. Dulchavsky, a professor of surgery at Wayne State, has also demonstrated the use of pocket ultrasounds and says he’s experimenting with a version that hooks up to his cellphone.
Mr. Hilliard, who has tried hand-held units at South Carolina, finds such advances exciting.
“Having something you can walk around with in your pocket and use at the bedside is amazing,” he says. “I was blown away by the functionality of it.”