The Role of the Primary Care Physician in Ultrasound and Teaching Resources Available

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Dr. Allen Worrall: "I'm Allen Worrall from Fairbanks, Alaska and we're here at the 45th Annual meeting of the AIUM in Walt Disney World. We're actually at the Dolphin Hotel and with me is Dr. Mark Deutchman, he's in the Department of Family Practice at the University of Colorado Health Sciences Center in Denver. We're going to talk today about the role of the primary practice doctor in ultrasound and also the teaching resources that are available, particularly to the primary care physician in ultrasound. So, Mark, go ahead and tell us why you're here at this meeting."

Dr. Mark Deutchman: "I've been a AIUM member since around 1980. I was in private practice in a rural area in Washington state and discovered that I needed to send patients sixty miles away for ultrasound so I better learn how to do it. Obstetrics was a big part of my practice as it still is, and I found that I couldn't practice modern maternity care without ultrasound so I got one of the first real-time scanners and learned real-time ultrasound. It's been a very useful part of my practice ever since."

Dr. Allen Worrall: "You do all types of ultrasound and not just obstetrics?"

Dr. Mark Deutchman: "I do obstetric, gynecologic, and general abdominal ultrasound and I've used it in the office, in the hospital, and in the emergency department for many years."

Dr. Allen Worrall: "And you teach family practice residents?"

Dr. Mark Deutchman: "Right, I left private practice ten years ago and I've been teaching since then. I teach residents and I also teach a fellowship designed to train family physicians in the skills they need to practice in a rural practice. We teach them surgical skills, endoscopy, and ultrasound is one of the skills that we also teach."

Dr. Allen Worrall: "Now one of the problems or one of the areas of contention in sonography is the untrained, unskilled, or uncredentialed person doing ultrasound. How are your family practice residents going to convince the rest of the sonography world that they're qualified? I might say that the same thing is true of obstetric residents, emergency room residents, or any others."

Dr. Mark Deutchman: "I think that's a good question, it's one that we're very concerned about. There are quite a range of sonographic skills and I think that a person needs to pick the application that they're going to do, look at how frequently they're going to use that application, and look at what training they need. We find that we can train essentially all of our residents to do a basic core of skills that I call labor and delivery skills - fetal life, fetal number, fetal presentation, and doing amniotic fluid indexes. Frankly, I think any physician that delivers babies should be able to use an ultrasound scanner to do those kind of skills."

Dr. Allen Worrall: "Even the labor room nurses do that too."

Dr. Mark Deutchman: "We find that there's really not much trouble training all of our residents to do those skills. However, if a resident or a fellow or a faculty member wants to go ahead and learn how to do fetal biometry and fetal anatomic surveys, that's a completely different skill set and takes much more training and much more supervised education and practice. It's really a life long skill because you keep adding as you go. We also practice under the model where the physician does his or her own scanning rather then hiring a sonographer and then signing her over for validating the reports. We find that the clinical knowledge that the physician has of the patient and of the biologic process enables that physician to do a better job, and I encourage physicians to do their own scanning rather then hiring someone else to do it."

Dr. Allen Worrall: "That's the way I practice sonography, and I just can't imagine doing it any other way. I don't want to imply that sonographers can't reach huge and very high levels of skill, they certainly can, but I find that as a gynecologist and obstetrician doing my own scans is just the perfect way to do it. Fortunately, I enjoy it and it's a lot of fun. We need to talk about the resources that are available, and I know that you have an interest in producing educational materials. Do you want to talk about that?"

Dr. Mark Deutchman: "About seven years ago I got interested in the multimedia platform as a way to help people learn ultrasound skills in an interactive fashion because the CD-ROM platform enables you to do things like fetal measurements and identify structures in an interactive way rather than sitting in a lecture or at a videotape. I've now written either myself or with co-authors four multimedia CD-ROM's. The first one is on obstetric ultrasonography, the second one was general abdominal, basically upper abdominal. The third one is on fetal anomaly recognition and that, by the way, won a prize in the scientific exhibits at the AIUM two years ago. This year I have a scientific exhibit on a CD-ROM on emergency and trauma ultrasound co-authored with a friend in Denver. The fetal anomalies one was co-authored with a colleague in Belgium. I found that these tools really help people learn some of the cognitive-type skills as well as some of the procedural skills of manipulating images and operating electronic calipers. It accelerates their learning curve so when they actually learn on patients after that they're farther along then if they just started from scratch."

Dr. Allen Worrall: "Did you do a lot of the actual production? In other words, did you have to learn the software that allows you to produce these educational material?"

Dr. Mark Deutchman: "I've done a lot of image editing and processing, and the current CD that is being exhibited in the scientific exhibits is done with HealthStream. There are physicians that are learning how to produce these things on their own so as the technology evolves there are more options as time goes on. Another advantage of the CD-ROM format is it enables a person to encounter many more abnormals than they ever possibly could scanning on their own. So in a few hours you can pack into your brain some recognition of abnormalities that would take you years to see if you were scanning patients."

Dr. Allen Worrall: "That's a very important point. I have a very small practice and I'm simply overwhelmed when I hear someone like Beryl Benacerraf say they do on average eighty prenatal scans a day in her laboratory. It takes me two or three months to do eighty prenatal scans so there's just no question that if you have a low volume prenatal practice you're going to be greatly disadvantaged by not seeing anomalies because most babies are normal, thank goodness. Thank you very much."

Dr. Mark Deutchman: "Thank you."

Dr. Allen Worrall: "Again, this has been Dr. Mark Deutchman from Denver, Colorado talking about the family practice and primary care teaching of ultrasound."