IPHONE AND IPAD TECHNOLOGY AS A QUANTITATIVE METHOD FOR MEASURING AND DOCUMENTING

CLINICAL COMPETENCY IN ULTRASOUND TEACHING. John R. MacMillan Rodney, M.D

Maternal Child Health FellowDepartment of Family Medicine

Affiliate University of Texas, SouthwesternJohn Peter Smith Hospital

Fort Worth, Texas

Kelly R. Arnold, M.DAssistant Professor, Family Medicine

University of TennesseeChattanooga, TN

Robert K. Sigman, M.D.Division of Maternal Fetal Medicine

Department of Obstetrics and GynecologyUniversity of North Texas

Health Sciences CenterFort Worth, Texas

Wm. MacMillan RodneyDirector, Surgical Family Medicine Obstetrics

Medicos para la Familia FellowshipMemphis, TN

Disclosure

• Neither I nor my partners have any relevant financial interests, arrangements, or affiliations with a commercial interest.

Global Use of OB-GYN Ultrasound• Basic ultrasound competency is

necessary for the practice of obstetrics and gynecology in any setting.

• These settings range from primary care clinics to tertiary subspecialty settings.– Family Medicine Clinics– Labor and Delivery– Maternal Fetal Medicine – Rural, Remote, Underserved

Areas

Global Need to Assess and Establish Competency

• As technology has improved, ultrasound has become more portable and available.

• As a result, bedside and outpatient sonography are increasingly common.

• Yet there are no easily established methods to assess, research, and establish competency.

Application Development

• To facilitate appropriate documentation

• To verify structural identification

• To validate common measurements

• To quantify competency• To permanently store

faculty sign off on resident reports

iPhone and iPad Interfaces

Camera Function:How are the images obtained and processed?

• Using camera function built into iPhone and iPad

• Accessing native files from the camera roll

• These files can be cropped, rotated, and transmitted to this app.

Camera Function:How are the images obtained and processed?

Camera Function Examples:5 Common Biometric Markers

• Crown Rump Length• Biparietal Diameter• Head Circumference• Abdominal Circumference• Femur Length

1st Trimester Crown Rump Length

2nd Trimester Biparietal Diameter

2nd Trimester Head Circumference

2nd Trimester Abdominal Circumference

2nd Trimester Femur Length

Student 2nd/3rd Trimester Report

Final Documentation By Student

Faculty Edit Student 2nd/3rd Tri Report

Faculty Sign Off

• “The student has fulfilled documentation of competencies or deficiencies for the following areas.”

Competent Deficient

Crown Rump Length

Biparietal Diameter

Head Circumference

Abdominal Circumference

Femur Length

This program is NOT designed to:

• Replace existing ultrasound reporting programs.• Generate a billing matrix.• Replace AIUM criteria for various

levels of examinations.

This program IS designed to show:

• The resident’s educational progress in response to a curriculum.

• The resident’s limitations and deficiencies as they progress through training.

• The resident’s knowledge that she has not completed the entire program until signed off by faculty.

• The faculty’s permanent documented confidence in the student’s ability.

Future Applications

• The initial app was constructed for the most basic competency.

• It does not preclude more advanced teaching by the ultrasound program in the future.

• Cine-looping and organogenesis surveys are currently in development.

Acknowledgements• Dr. Robert K. Sigman, Maternal Fetal Medicine, Senior Presenter• Department of Family Medicine at JPS• Department of Obstetrics and Gynecology JPS• Department of Academic Affairs at JPS• Dr. Kelly Arnold, Assistant Professor, University of Tennessee, Chattanooga• Dr. Patricia S. Poole, Radiology Resident University of California, San Diego• Dr. Wm Rodney, Director Obstetrics Fellowship, Medicos para la Familia• Dr. John O. Gibson, Director Global Health Fellowship, JPS• Dr. David E. McRay, Director Maternal Child Health Fellowship, JPS• Dr. Daniel Casey, Program Director Family Medicine, JPS• Dr. Joane Baumer, Chairman Family Medicine, JPS• Dr. David Moreland, Program Director Obstetrics and Gynecology, JPS• Dr. G. Sealy Massingill, Chairman Obstetrics and Gynecology, JPS• Dr. Elwyn Grimes, Former Chair Obstetrics and Gynecology, JPS

QUESTIONS?