iPods in Bedside Medical Education

Mobile Medical Media

iPod

Dr. Daniel Price admits that he’s genetically unable to wait to buy a new product that interests him, so when the video-enabled iPod came out, he bought one right away. That’s when “The light just went on,” he recalls. “It was immediately obvious that all of the video we developed to use in our classroom presentations could be taken to the bedside where teaching is much more effective and where patients and providers need it most.”

Price teaches ultrasound — a dynamic, graphically-oriented technology itself — to attending physicians, residents and medical students all over the world. Because the use of ultrasound in emergency medicine, critical care, anesthesiology and other medical specialties is relatively new, physicians typically take a two-day course on performing ultrasound exams and procedures.

Later, when they return to their hospitals and the patient’s bedside, Price explains, “physicians and students may need to review exactly what they’re looking for in terms of how to do the exam, what normal anatomy looks like and what specific pathologies look like, whether it’s blood in the abdomen, blood around the heart, or stones in the gall bladder.

“What’s been missing,” Price adds “is some sort of follow-up review of the crucial elements of the exams physicians have already learned in a formal setting. For doctors and medical trainees to be able to review core procedures with short, instructional videos on the iPod before stepping into the patient’s room and performing the exam,” says Price, “is a real breakthrough in terms of teaching medicine, and specifically teaching bedside ultrasound.”

Five-Minute Tutorials

Recognizing the potential of the iPod as a way to bring medical education closer to the bedside, Price co-founded Mobile Medical Media LLC with fellow physician educators and content developers David H. Adler, MD, MPH, Michael B. Stone, MD, RDMS, Ralph Wang, MD, and Samuel R. Brooks. “We’re taking very complex devices,” Price says, “that are used by everyday healthcare providers and creating portable educational videos that communicate the core, essential information in a very concise and compelling way.”

Mobile Medical Media has already seen an improvement in physician confidence and the quality of patient care through the use of portable educational videos delivered on iPods. The videos, Price says, can also be used on other handheld devices, but “The iPod is nice because it’s such a mature and well-developed format, and the image quality is so good.”

Testing the concept, Drs. Stone and Price launched a study at Highland Hospital with 14 emergency medicine interns and residents. “We showed them a two-minute audio/video tutorial that Dr. Stone had created for the iPod on finding the supraclavicular brachial plexus, a bundle of nerves in the neck. We use portable ultrasound to guide the injection of anesthesia around this group of nerves so we can perform emergency procedures like suturing complex wounds, draining large abscesses or reducing shoulder dislocations.”

Without ultrasound, Price adds, it’s very difficult to reliably find this group of nerves. “There are a lot of other structures in the neck that one doesn’t want to hit with a needle — like the carotid artery or the internal jugular vein or the subclavian artery — and ultrasound allows the provider to visualize and avoid these structures. Prior to real-time ultrasound guidance, this procedure could not be safely performed at the bedside by emergency physicians.”

New Supplement to Classroom Training

Dr. Stone presented the results of the experimental study at the Second World Congress on Ultrasound and Emergency and Critical Care in New York in June 2006. “All 14 of the health care providers were able to find the brachial plexus within about 15 seconds from the time they placed the ultrasound transducer on the patient’s skin, which is really quite amazing,” Price notes. “The brachial plexus is a relatively subtle and difficult finding, and they were able to find it in less than 15 seconds after a short, two-minute presentation on the iPod.”

Price emphasizes that Mobile Medical Media’s goal is not to replace traditional classroom training — typically a one-hour lecture for each application followed by a hands-on laboratory sessions. “Our role is to boil down the absolute essentials of a procedure that may not be performed frequently, and correctly interpret the findings. The physician in the emergency department is not going to have a half an hour — or even 15 minutes — to review a procedure that is not commonly performed. A video three to seven minutes long on an iPod can provide the critical information the doctor needs when they need it most.”

1 2

At a Glance

Medical science is generally taught in the classroom, the laboratory, and the bedside. However, in today’s healthcare environment where an attending physician’s time is limited, teaching at the bedside has become more difficult. What’s more, certain patient exams and procedures are better taught using a dynamic modality such as video, which previously was unavailable at the bedside.

Apple Solution

The iPod has come to the bedside. Working with four colleagues at Mobile Medical Media LLC, Dr. Daniel D. Price, who is the Director of the Emergency Ultrasound Fellowship at the Alameda County Medical Center at Highland Hospital in Oakland, California, and teaches at the University of California, San Francisco, is educating physicians using short, instructional videos on the iPod so they can learn more effectively at the bedside. The effort also promises to benefit health care in developing countries. Training modules are produced on Macs in Final Cut Pro.