New Teaching Techniques in Multimedia

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Dr. Eric Blackwell: "Hi, I'm Eric Blackwell, and I'm Co-Chairman of the History of Ultrasound project for OBGYN.net and the Society of Diagnostic Medical Sonographers along with Joan Baker and with tremendous technical help and support from Terry DuBose. We're delighted to have visiting with us today Dr. Gregg DeVore who is currently at the Fetal Diagnostic Center of Pasadena in California. Dr. DeVore, of course, is well known to most of you out there I'm sure if you're in ultrasound. He's a true pioneer in fetal echo and in the teaching methods, which make this understandable to the rest of us. I'd first like to ask how you first got into ultrasound and how did you become one of the first in line?"

Dr. Greggory DeVore: "When I was at Yale University as an intern in internal medicine in 1975, I decided to switch into obstetrics and gynecology. I moved over to the Department of Obstetrics and Gynecology, and John Hobbins was a new faculty member. John had ultrasound that he was using and he thought that this was a useful tool so after my first year of residency I realized that ultrasound may have a future so I stayed and did a fellowship at Yale in Maternal-Fetal Medicine with a heavy emphasis in Ultrasound."

Dr. Eric Blackwell: "What sort of equipment were you using in those early days with Dr. Hobbins?"

Dr. Greggory DeVore: "We initially had what are called 'static scanners' where you had an articulated arm and you would move it across the abdomen and obtain a still image. Then when real-time first came out, they had green screens and they had little images that would flicker on the screen that you would think could be a fetal head or a fetal leg. So we had the very first real-time units in the United States at Yale and from that evolved the current experiences."

Dr. Eric Blackwell: "As far as the fetal heart, as opposed to anything else specific, that seems to be a niche that you are very, very good at."

Dr. Greggory DeVore: "What happened was when I was at Yale I was preparing for my fellowship, and ATL came out with a machine that for the very first time allowed the clinician with real-time imaging to place an M-mode cursor through the heart and know where you were going so you record the M-mode from the real-time image. It was a breakthrough in echocardiography and so I applied for a research grant from a foundation and received over $75,000. We bought one of these machines, which were the hottest item at the time and the question was - could we apply this to the fetus? Because of the size of the heart, which is the size of, perhaps, a thumbnail in the second trimester, we had to ask could we see in a miniature heart the detail that we would see in a newborn or adult heart? So those were the first questions that we addressed."

Dr. Eric Blackwell: "The topic that I think we really ought to move to is you've certainly been a pioneer in the use of multimedia and computer assisted teaching aides and have done it right, at least in my book, in terms of making things that bring clarity instead of confusion to the field. How did you first come to do that?"

Dr. Greggory DeVore: "It's interesting, when I was thinking about writing a textbook on fetal echocardiography unlike other images in ultrasound like a liver or a kidney that can be a still image, because the heart is moving the question was how do I teach the features of a moving heart to identify pathology or other abnormalities that the clinician needs to know about. So I realized that multimedia with the ability to show the beating heart was a priority, and I went out and contacted professionals who'd created multimedia programs in the educational arena and asked them which programs they used. The first program I used was a program called 'Quest' and it sold for over $4,000. I wrote the check, and my wife killed me when she saw the stub. I created my first multimedia program using Quest and from that point I then evolved to using software that was even better so it was just a matter of a need. I taught myself, I didn't have any formal schooling, and I didn't go to any classes. I got the manual, used the program and tried to figure it out, and with time I was pretty successful doing that."

Dr. Eric Blackwell: "I understand that your first sales efforts were you at a table with a few hundred that you'd burned or had burned. It was quite popular."

Dr. Greggory DeVore: "Yes, we were at an international meeting in Rotterdam, I sat at a table next to a publisher, and I had my laptop computer. I had brought with me about 300 or 400 CD's in my briefcase, I started showing it, and pretty soon I had 1, 2, 20, 30, 40 people around the table. For three days they bought every CD; it was so embarrassing in the sense that we walked out and I had money coming out of my pockets, I didn't know what to do with it all. We sold it to them for something like $35 or $39 and it was an instant success."

Dr. Eric Blackwell: "Now how many generations of product have you gone through from your first $39 CD?"

Dr. Greggory DeVore: "A year after that I developed a 2-CD ROM series, and it evolved from maybe having 30 video clips on the CD to over 500 so now we have a full featured 2-CD ROM set on fetal echocardiography. I have a new program coming out this summer to address the use of ultrasound in identified Down syndrome for genetic ultrasound, and we'll have many cases of Down syndrome with a lot of features with that one as well."

Dr. Eric Blackwell: "On aside to our viewers, just before this meeting of the 45th Annual Convention of AIUM which is in Orlando, there was a pre-meeting conference. Dr. DeVore along with several other people including Phillippe Jeanty, a gentleman from Brazil, and a woman from Mexico - all very knowledgeable in multimedia and teaching - presented a wonderful program. So if those names show up and it's something you're interested in, I would encourage you to catch them the next time they're able to offer this. Also, Dr. DeVore has a website at www.fetalecho.com  so that would be another place you could go for more information about what he's up to in this realm. One final thing, I always like to ask people - where do you see things going from here both in terms of educational approaches and media and in the field itself?"

Dr. Greggory DeVore: "I think if we compare ultrasound today with what it was years ago when I first started, the technology is superior. There are more dials, knobs, and buttons to learn about, and I think that education using multimedia will help shorten the learning curve because many people who buy this very expensive equipment often don't know how to use it to its fullest capacity. So I think the multimedia will allow companies and other physicians to teach their colleagues how to better use the equipment because it's like anything else, if you know how the car functions, you can drive it better. If you fly a plane and you know all the instruments, you ultimately won't crash as often. Same thing with ultrasound, the better you use the tool, the better the diagnostician you're going to be."

Dr. Eric Blackwell: "Thank you very much, Dr. DeVore. We're delighted that you've been with us, and we look forward to hearing what you're up to a year or two down the line."

Dr. Greggory DeVore: "Thank you."