This article was written by Alexa Mieses, a first-year medical student, and first published in The Rossi: Medical Student Quarterly Report.
Icahn School of Medicine at Mount Sinai is known for innovation within the realms of patient care, research, and medical education. Training future physicians requires a commitment to progress, and the newest addition to the medical school’s curriculum is no exception: In the spring of 2013, handheld ultrasound will be introduced to enhance students’ and trainees’ clinical skills and generation of a differential diagnosis by reinforcing anatomic and physiologic principles.
Unlike traditional ultrasound, bedside ultrasound is performed at the point of care, not in an imaging suite. Handheld ultrasound – an even more recent technology – is small enough to fit in the palm of a hand, with a screen roughly the size of a smart phone. Compared to traditional ultrasound, these devices are more portable and less expensive, although the quality of image may be compromised.
Dr. Bret Nelson, an Emergency Medicine physician and Director of the Emergency Ultrasound Division at Mount Sinai, compares the use of various ultrasound machines to the use of various computer devices. “Your smart phone can be a passable computer in many circumstances,” he says, “but more elaborate work requires a laptop, and when you need high-end processing power you use a workstation. Similarly, handheld ultrasound devices can image structures quite well and can hugely benefit medical decision-making in real time. For added options in high-end imaging, more robust documentation, image archiving and other options, generally cart-based machines have more features. And top-of-the-line imaging systems generally used in imaging suites (and not at the bedside) will have the most comprehensive imaging tools.”
Icahn School of Medicine is one of few medical schools across the country to include handheld ultrasound devices in its training curriculum. Previously, ultrasound has been used in the Gross Anatomy course directed by Dr. Jeffrey Laitman, for example to explore the chambers and blood vessels of the heart. Medical students appreciated the experience, but many wished they had more time to learn how to use the technology. “I thought it was interesting,” one student said, “but I spent most of my time trying to orient myself.”
Handheld ultrasound is now also used in the Art and Science of Medicine I course, in order to provide additional information about the physical examination of the heart. The course is directed by Dr. Joanne Hojsak, M.D. a pediatric critical care specialist and Director of the Pediatric Intensive Care Unit at Mount Sinai. She says: “When first approached about incorporating ultrasound into the ASM I physical examination component, I was skeptical. How do you introduce technology when many students have yet to understand how to wear a stethoscope? However, with some thought I realized that ultrasound examination of the very areas the students will palpate and auscultate reinforces what they feel and hear, often for the very first time.”
Because medical students will again encounter both traditional and handheld ultrasound during clinical rotations, Dr. Nelson – the director of the ultrasound course-complement – says that students will be “more prepared to use this rapidly-growing technology… The ability to visualize anatomy greatly enhances our understanding of normal and pathologic states as we encounter them…Central line placement, peripheral IV access, lumbar puncture, bladder catheterization, joint aspiration, nerve blocks, and a host of other procedures can be enhanced by visualizing target anatomy and needle placement.”
General Electric provided the VScan model ultrasound devices to Mount Sinai. The $1,000,000 gift is entirely due to the work of Dr. Jagut Narula, cardiologist and Director of Cardiovascular Imaging. Ultimately, Dr. Narula would like medical students to receive their handheld ultrasound devices at the White Coat Ceremony at the beginning of medical school. Each device currently costs approximately $8,000. However, many companies will release individual versions of the device in 2013, and the price is expected to drop substantially. As a result, these ultrasound devices will become more accessible, with the potential to be useful in public community clinics as well as large medical institutions.
Dr. Narula also credits Dr. Bret Nelson, Dr. Reena Karani, Dr. David Muller, and Dean Dennis Charney with their willingness to accept what she calls her “radical idea” – an idea for which, speaking for my entire class as a current first year medical student, we are incredibly grateful.