Advancements in medicine can often occur by discovering new, innovative ways to use existing technology. Michael Hellmann, MD, assistant professor in the Department of Internal Medicine at the University of Cincinnati (UC) College of Medicine, has created a bedside ultrasound course for residents in Internal Medicine. The knowledge gained from the program is already showing promise in the field, including as far away as Africa.
Hellman says the idea first came to him during discussions with other College of Medicine residents.
"When I was doing my fellowship at the College of Medicine, one of my goals was to take ahold of this idea and become the person to coordinate teaching and coordinate ultrasound education,” he says. "Last year was the first year we did it, and applicants, residents and fellows are all chomping at the bit to get this education.”
Prior to Hellman developing this two-week elective course, there was no formal education on using ultrasound in the Department of Internal Medicine. Hellmann says in his field of critical care, ultrasound is used on almost every patient every day.
"Whether it be placing IVs or seeing how the patient’s heart is working or looking at their lungs, it’s really helpful on almost any organ,” Hellmann says. "It’s become common practice in the past 10 years or so, and it has so many easy bedside applications that it can be used to answer a lot of questions.”
Some of those questions are being answered in rural Africa through the use of bedside ultrasound through the training learned by Merranda Holmes, MD, a 2018 College of Medicine graduate. Holmes says she was eager to take the two-week elective course just prior to her third trip volunteering at Mbingo Baptist Hospital in Cameroon, West Africa.
"The course was great,” Holmes says. "We got to practice echocardiograms on patients throughout the ICUs, some who were awake and some who weren’t. We got to learn from a lot of critical care attending physicians how to do those echocardiograms and how to interpret them as well as doing ultrasound of kidneys, bladder, lungs—a little bit of everything.”
Holmes used what she learned in the course in her most recent month-long mission trip to Mbingo Baptist Hospital i, serving as a hospitalist on both pediatrics and internal medicine wards.
"I’ve always been interested in global health and that was why I chose a combined med-peds residency at the College of Medicine so I would be able to do a little bit of everything,” Holmes says. "Mbingo has an internal medicine residency training program, so I get to teach Cameroonian residents as I work alongside them. This is another reason I wanted take Dr. Hellmann’s ultrasound course—to learn, and then to teach others.”
Holmes says Mbingo Baptist Hospital has approximately 25 beds in the children’s ward and about 70 beds in the male and female medicine wards combined. Some patients travel as far as a nine-hour taxi ride to get much-needed quality care. It’s a trip with which she is familiar, since the the hospital is located 235 miles northeast of Douala, a city of just under 2.5 million, the largest in Cameroon, which has the closest airport. The hospital, located in the middle of a picturesque mountain range, was formerly a leprosy hospital.
The value of the bedside ultrasound training course was a potential life-saver during her most recent visit to Mbingo.
"I had a three-year-old patient who was being managed for kidney failure, however his liver was enlarged, and he was swollen all over his body and I was thinking he likely had heart failure,” she says. "With the only pediatric ultrasound tech out sick that day, I was able to perform a bedside echocardiogram, determine he was indeed in heart failure and was able to start treatment immediately. Had Dr. Hellmann not taught me to do some basic ultrasound, I fear we would not have been able to confirm this diagnosis for a few days, so this was potentially life-saving for this child.”
This was the case in several other scenarios with both adults and children during Holmes visit to the hospital. Holmes also taught some of the Cameroonian residents how to perform basic echocardiograms and to use ultrasound to identify fluid around the lung in order to drain it. She hopes to do more teaching in ultrasound on her next trip to Cameroon, and with her residents in the United States, as she starts a med-peds hospitalist position at Vanderbilt University Medical Center in the fall.
Hellman says there are countless ways to use ultrasound, from measuring blood flow in the head, to see if blood vessels are constricting down after strokes to placing difficult IVs in people.
"The course that I developed is a two week elective and we had seven residents go through it this past year,” Hellmann says. "Moving forward, I’m looking at doing it either one or two more times a year. I want to train six residents and two fellows to incorporate some of the new fellows who come in to give them some of this training.”