Amy Morris, MD and R. Eugene Zierler, MD, RPVI
UW School of Medicine
Dr. Amy Morris is an Assistant Professor in the Department of Pulmonary and Critical Care Medicine at the University of Washington. As a clinician educator, Dr. Morris is interested in the use of point of care ultrasound for diagnosis, procedural guidance, and medical decision-making in the ICU. She is a core faculty member of the Institute for Simulation and Interdisciplinary Studies (ISIS) at the University of Washington, where she develops educational curricula for and provides training in point of care ultrasound, as well as procedures relevant to pulmonary and critical care medicine.
Dr. Zierler is a Professor in the Department of Surgery, Division of Vascular Surgery, at the University of Washington School of Medicine. He is also Medical Director of the D. E. Strandness, Jr. Vascular Laboratory at the University of Washington Medical Center and Harborview Medical Center in Seattle. Dr. Zierler is the author or co-author of over 100 journal articles and 47 book chapters, and he is the editor of four text books. Dr. Zierler’s research interests have focused on the development and clinical applications of noninvasive diagnostic techniques for vascular disease. Over the last 25 years, he has been involved in a series of projects based on the use of ultrasonic duplex scanning for screening and follow-up of various vascular problems, including carotid artery disease, lower extremity arterial disease, surveillance of vein bypass grafts, deep vein thrombosis, and renal artery disease.
Point of Care Ultrasound Modules: Together, Dr. Morris and Dr. Zierler recently created a comprehensive series of didactic lectures and videos designed to provide an in depth introduction to point of care ultrasound. Beginning with the basics of ultrasound, the series also includes a lesson on limited point of care echocardiology. After completing the first two modules, the participant is then guided to conclude the series with a lesson in screening compression ultrasound for lower extremity deep vein thrombosis. This new series of online modules can be taken online here.
From your perspective, why is the training on point of care ultrasound so important?
Dr. Morris: “Ultrasound is an old medical technology that has only recently become widely accessible outside of specialty imaging areas as the size and price of equipment has become smaller. As a result, there is growing interest among providers at all levels, in many disciplines, to learn how to use this modality for diagnostic and procedural guidance. Unfortunately, opportunities for formal training for most providers are few, and many are using ultrasound at the bedside without much training or experience.”
Dr. Zierler: “While access to equipment for performing point of care ultrasound examinations is improving, this also increases the likelihood that healthcare providers might use this technology without adequate training. This is not only bad for patient care, but it also could lead to the false conclusion that point of care ultrasound is not effective. This situation has created a demand for education in all areas of point of care ultrasound, as well as an opportunity for ultrasound professionals to create programs to meet these needs. Maintaining quality in point of care ultrasound also requires some oversight by the professional ultrasound community which could include training programs and a certification process.”
How will your training be beneficial for patients, hospitals, etc.?
Dr. Morris: “It has become standard of care to perform some procedures at the bedside with ultrasound guidance, and the medical community at large is beginning to recognize the potential for this modality to improve patient safety and medical decision-making. A basic ultrasound curriculum can introduce potential users to key concepts and techniques, so we can be assured that any provider picking up a transducer will have a basic understanding of how the technology works, how to use it for appropriate indications, and what the limitations are. That is, when an exam should be deferred to radiology, cardiology or the vascular lab. Ultimately, patients will benefit when providers use ultrasound at the right time, for the right reasons, and know their limits.”
Dr. Zierler: “The short training module on screening compression ultrasound for DVT will give providers the knowledge and skills they need to start performing this examination and developing their own expertise with it. While this examination does not replace a complete diagnostic lower extremity venous duplex, it does provide clinically useful information that can facilitate the immediate management of patients with suspected DVT.”
What do you see as a long term goal for ultrasound training?
Dr. Morris: “I would like to see an essential core curriculum available to all clinical providers who use ultrasound at the point of care. We will be able to assess their cognitive skills as we do in these modules, and eventually their practical skills as well through the development of hands-on training and assessment tools. I expect that physicians, nurses and advanced care providers at the University of Washington will be at the forefront of this new application of an old science- ultrasound at the point of care.”
Dr. Zierler: “The ultimate goal of training in point of care ultrasound is to ensure that all healthcare providers acquire the knowledge and skills they need to manage their patients efficiently and effectively. The scope of point of care ultrasound is extremely broad and can be applied in virtually all medical specialties. The challenge for the professional ultrasound community is to keep up with current developments in clinical applications and provide appropriate opportunities for education and maintenance of skills.”