Ultrasound scanning is hard on your wrist, shoulder and elbow. Make good ergonomics a habit. Get the patient to shuffle over towards your side of the stretcher or bed. Adjust the machine console and screen height to eye level. Lower the bed if you can so that you are sitting or standing above your patient, working down and across rather than reaching up and over while you scan. To save you leaning and reaching over to your patients left side, get the patient to roll towards you partly onto their right side. Be kind to yourself.
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Why habit trumps motivation
Learning ultrasound takes a long time. Motivation is great for getting started but it wears off after time. Thankfully there is a way to keep going and achieve our goals and that is by forming a habit.
By practising ultrasound regularly and building it into your daily work routine, habit takes over after a few weeks and actually prompts you to do it.
While you scan, get into the habit of always optimizing your image: depth, focus, gain and it will soon become automatic.
Our habits are far more powerful than we realize. They often hold us back from learning but we can actually hack into this power and use them to reach our goals.
“People do not decide their futures, they decide their habits and their habits decide their futures”
F.M. Alexander
Orientate the probe marker consistently
Each ultrasound probe has a marker at one end, usually a raised line or notch. This indicates the end of the probe transducer surface corresponding to the left hand side of the image on the screen. While you scan, keep this marker pointed towards either the patients head or right side as much as possible. Why? Two reasons: firstly by doing this consistently, your brain will learn that moving the probe in one direction on the patient will result in the image moving in a consistent way on the screen. Consistency here is the key as it will help you build up the necessary hand-eye-screen coordination much more quickly. Secondly, if you ever save an image to look at later, everyone knows that the left hand side of the image corresponds to the patients head or right side.
Use the presets
Every machine comes with pre-installed manufacturer’s control settings specific to the body part you are scanning. Every ultrasound machine has many, many control settings and the number of possible combinations is mind-boggling. It used to be that operators would have to change these manually for each scan. Nowadays all that technical wisdom and experience have been distilled into selectable presets. These optimize the image for you automatically so you don’t have to. Use these. The quality of your images on the screen determines the quality of your interpretation from them. Give yourself every advantage and spend the extra 5 seconds selecting the right preset at the start.
Build an ultrasound routine
Using an ultrasound unit is a complicated process and when learning anything complicated it helps to build up a start-up routine. The actual order in which you do tasks matters less than doing them in the same order consistently, this way, you are less likely to forget a step.
Try the following:
- Turn on machine
- Enter patient demographics
- Select probe
- Choose preset
- Apply coupling gel
- Check orientation of probe (marker toward head or patients right side)
- Start scanning
- Optimize image: depth, focus, gain
Each time, every time.
Why most program bedside ultrasound teaching sucks
At the moment, many schools treat bedside or point of care ultrasound (POCUS) like an add-on, an option, a “we should probably include something on bedside ultrasound somewhere” afterthought on most curricula. Also the number of physicians actually doing it in practice is relatively small and the research base for proving its clinical benefit is limited to certain applications and clinical scenarios. The machines themselves are still quite expensive. Bedside ultrasound is still in its infancy as a tool.
At some point in the (near) future, ultrasound units will be cheap, handheld, and in the pocket of every clinician who wants one. The research base will have expanded. POCUS will become an extension to clinical examination on every patient.
How do we get from point A to point B? There are many teachers who can tell us how to take a history from a patient and many who can show us how to examine the abdomen but few who can show us how to use an ultrasound unit.
What it will take, is a generation of champions who stepped up and taught themselves, who put in the time to read, practice, get feedback and learn. Call them early adopters, advocates, trail blazers or whatever suits but these are the ones who will change the way we teach and practise medicine to future generations.
Will it be you?
Learning bedside ultrasound – Timely and quality feedback
Good quality and timely feedback supercharges learning 10x but is difficult to find.
Find a supervisor who will watch over your shoulder while you scan and give you tips on improving and optimizing your image.
Learn how to save, store or print images. Show these to an expert later and get their feedback. Carry around a USB thumb drive for this purpose but remember to respect patient privacy.
Carry around a notebook and note the names of the patients you scan then check back later after they have had their formal ultrasound or echo study and compare your findings.
Learning bedside ultrasound – Time and practice
If you are medical student, this is easy as everyone assumes you are learning all the time and you don’t have all the answers. Take every opportunity to grab the machine and practice on patients, volunteers, your friends etc. Practice at lunchtime, before work, after work. I guarantee you, the portable machine will be available most of the time. Start with the easy stuff then, when you are comfortable with that, move on. Practice, practice, practice, day in, day out. It all adds up in the end.
If you are a qualified physician, it’s a tad more difficult. Patients might expect you to give them answers. Explain that you are still learning and adopt the attitude that although it might give you positive useful information, but it also might not. In the grand scheme of things, no opportunity to learn is ever wasted.
Learning bedside ultrasound – Good learning resources
Start by finding a hands-on course or organize an elective or fellowship. No one learns to drive a car by reading a book, listening to didactic lectures or watching YouTube videos. Getting your hands on the probe early with a trainer next to you on a real human subject will orientate you to probe handling and hand-eye-screen coordination. This will give you a basic grounding.
Next find a good book or online resource with videos starting with the basics and building up. Aim to practice regularly what you are learning from reading and watching the videos on real subjects.
Getting started – 3 ingredients
To succeed we need 3 Ingredients:
Time and practice
Good learning resources
Timely and quality feedback
Any two without the third will prolong the length of time it will take to achieve mastery