Top or Flop

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To the Editor: Fox and colleagues1 define criteria, opportunities, and limitations of clinical ultrasound (US) teaching, training, practice, and research, describing how they integrated diagnostic US into the four-year curriculum at their medical school. As we are involved in a similar experience in Italy, also using e-learning and information and communication technology tools and strategies, we would like to add our own observations and recommendations to the conversation. The repercussions of Fox and colleagues’ effort to promote early, comprehensive, sustainable, and accessible US training go beyond the simple medical education intervention. Typically, teaching models are focused on essential medicine, dictated by needs and financial and time constraints, not to mention the quality of the trainers and trainees. This means that rather than all young practitioners getting to the “top” performance level, trainees (and their patients) could have to make do with minimally acceptable skills—a “flop,” as it were. When dealing with US imaging, however, excellence is mandatory, and no shortcut should be permitted, lest we risk the health of our patients.2 Thus, we fervently endorse the pathway recommended by Fox and colleagues, which, through shared experience, also contributes to filling the gap between abstract anatomical knowledge and actual physical examination information. Indeed, the teaching materials and proprietary videos available on the Internet represent a valuable adjunct to tailored on-site learning and training, providing both basic and advanced knowledge on demand. However, in our experience, the best tool for enhancing and updating students’ and trainees’ knowledge and skills in medical ultrasonography remotely is via open-source platforms, which enable us to offer direct interactive video tutorship fairly easily and with very limited costs. We have also found that apps for smart messaging or video chatting, which are available for smartphones, laptops, and tablets worldwide and virtually free of charge, are perfectly suited to providing continuous remote support. Such apps enable not only one-to-one counseling but also conference calls and closed-group sharing of images, medical records, etc. The current image quality and usability of these apps is fit, in our experience, for providing top-quality continuous support, ensuring that students and trainees do not “flop.” By developing US expertise among today’s trainees, we aim to overcome, as much as possible, the current shortage of experienced and committed teachers and instructors, which limits our ability to guide the hands, the eyes, and the minds of our students. Guglielmo M. Trovato, MD Director, Postgraduate School and Master’s Degree in eLearning and Information and Communication Technology in Medicine and Health Sciences, Department of Clinical and Experimental Medicine, State University Hospital of Catania, Catania, Italy; [email protected] Daniela Catalano, MD Director, Postgraduate School and Master Degree in Clinical Echography, Department of Clinical and Experimental Medicine, State University Hospital of Catania, Catania, Italy. Marco Sperandeo, MD Chief, Diagnostic and Intervention Ultrasound Unit, and director, Postgraduate Medical Schools of Pulmonary and Muscle-Skeletal Ultrasound, Casa Sollievo della Sofferenza IRCCS Hospital, San Giovanni Rotondo, Italy.

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