Pursuant to my earlier post, here are two more small (no, very small) but current reports on snapshots of bedside physician competence with compact-console* (heretofore known as "hand-carried") ultrasound systems.
1) Hospitalist Performance of Cardiac Hand-Carried Ultrasound After Focused Training. The report documents the inability of Hospitalists to replicate the level of competence of skilled echocardiographers after "focused" training and practice on 35 subjects. American Journal of Medicine, November 2007. Link: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDC-4R168D6-19&_user=10&_coverDate=11%2F30%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f092e4a98d9f1a135db41cf4dc9d9809
2) Assessment of knowledge retention and the value of proctored ultrasound exams after the introduction of an emergency ultrasound curriculum. In this one, Residents were trained and later tested for retention of cognitive skills six months after training in echocardiography. Results showed a small but significant improvement over controls. The depth of training and specific method of post-training skills measurement isn't specified. November, 2007. Link: http://www.biomedcentral.com/1472-6920/7/40
And the point today is:
It looks again like intelligent, motivated humans can learn... and remember. And that competence is a lot more than "memorizing the motions".
The bedside-care physician's use of this technology--for the patient's targeted, time-specific benefit--is here to stay. Our collective use of it, and therefore our own organizational/institutional structures, will mutate and evolve to accommodate and benefit from it. Always has.
Our goal is to alleviate suffering; the business remuneration (in every form) will follow.
Always has.
*The distinction of ultrasound technology--or its diagnostic capability--has already been characterized by our community based on the size and weight of the box... a curious and naive mindset that seems to herald back to the adolescent experience. The terms "hand-carried", "miniature", and "ultrasound stethoscope" are misnomers that profile the product in what could be construed as a preeminent strike for academic, business, or political posturing. Science--and medical science at that--deserves more respect than this. Size doesn't matter; product and operator performance do. For this reason, we've now introduced the term "compact-console" to describe this new class of products, without regard to their software capability. And the alliterative effect should be catchy enough for even the most conservative among us.
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