Innovating Ultrasound Training

Laleh Gharahbaghian, MD, medical director of adult emergency medicine [and director emeritus of the emergency ultrasound program and fellowship], led the five-year development of the online, case-based training game,, for point-of-care ultrasound education.

Dr. Gharahbaghian recently discussed the process, challenges and happy surprises in developing an innovative solution for medical education.

What is the objective of the game?

The game is intended to take the fear away from learning bedside ultrasound. Users can play for free [the CME option costs $25], become familiar with viewing ultrasound images, and test themselves on their interpretation. The game isn’t inclusive of every single point-of-care ultrasound application, but it provides cases that can lay a strong foundation.

The goal is to help users - healthcare providers, medical students, residents, physicians - learn about bedside goal-directed, point-of-care ultrasound indications, the how to's, and then what to do with the data provided by the ultrasound images.  

It’s a fun way to learn from scratch or to hone existing skills. Real and typical case stories help illustrate how point-of-care ultrasound can expedite a diagnosis, start a needed intervention early, increase confidence in clinical decision making, and even save a life!

How does it work?

The game presents commonly seen cases to teach indications, techniques, and interpretation of various bedside ultrasound applications. Users can choose which specialty to focus on: emergency medicine, surgery, internal medicine, critical care and family medicine. They select a choose an avatar and persona before being introduced to a case, beginning with the patient history and physical exam findings. From there, the game walks through various patient care decision points.

The game teaches how to identify various medical conditions on ultrasound, but goes further, touching on what type of probe to use, appropriate patient positioning and orientation, primary characteristics to focus on, and even patient management. Points are accrued or subtracted as the “player” progresses.

What prompted you to create it? 

I realized that the platform for medical education in point-of-care ultrasound is very broad and there were additional ways for learners to learn, including game-based formats.

I was also inspired by a Stanford colleague friend of mine, Dr. Lisa Shieh, who created Septris [an educational tool to teach sepsis identification presented by Stanford Department of Medicine]. I was a fan of her game and innovative spirit and when she attended an ultrasound course I was teaching, I asked how she got started. I applied for a grant soon after and began the process of creating what hadn’t been done before – gamifying ultrasound education.

What challenges did you encounter?

I had the vision and ideas in my head, but it was tough to put it down in a format that our user interface and user experience folks could interpret. Thankfully, I had a great team in Two Trees Studios, and financial support from a Stanford Pfizer grant.

My Stanford emergency ultrasound faculty colleagues served as amazing case authors, and Stanford faculty from multiple specialties were game beta testers and reviewers...and, we all made it happen.

Why is this game important now?

Ultrasound technology has evolved from huge monster machines that were lacking portability to hand-held devices that can insert into your smart-phone and be carried in your pocket. It is also much cheaper than ever before.

When the emergency medicine world became early adopters, they found many applications for point-of-care ultrasound - from evaluating for life-threatening diagnoses like cardiac tamponade, abdominal aortic aneurysms, intra-abdominal bleeding, and ruptured ectopic pregnancies to urgent conditions like retinal detachment, gallbladder disease, heart failure, and pneumonia.

The global impact in resource-limited areas is high for things like pregnancy assessments, trauma and musculoskeletal injuries, and wilderness medicine assessments for high altitude illness.

Using ultrasound to guide procedures can significantly reduced complication rates and decrease the number of attempts to successfully complete procedures. In some cases where a physician might otherwise attempt a bedside procedure, ultrasound imaging has revealed poor access, indicating the physician should instead call for more advanced radiologic imaging guidance.

Simply put, ultrasound makes good doctors great – at diagnosis, intervention, and decision making. 

What is the biggest hurdle for caregivers to overcome in ultrasound training? 

Providers need access to available equipment after training to allow them to practice what they learned. Also, as more studies are completed on specific ultrasound applications, best practices change so providers need to stay current and informed.

It can be a challenge for hospitals to purchase equipment, and for physicians to learn to use it with quality assurance. But all it takes is acquiring one machine for a given floor and hiring one knowledgeable person to direct those efforts and the payback in patient care optimization, metrics, resource utilization, and patient satisfaction makes it all worthwhile.

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