EP6: Dr. Chris Fox on Advancing Point-of-Care Ultrasound Education for Clinicians and Med Students

In this episode… 

Ohad speaks with Dr. Chris Fox, Chair of Emergency Medicine at UC Irvine. They discuss how Chris became “one of the fathers of the point of care revolution in ultrasound” and his passion for teaching practicing physicians and med students the skill of ultrasound. They also talk about how education is the biggest barrier to unlocking ultrasound’s potential today, why appropriately-classified reimbursements are key to further adoption, and how ultrasound is expanding to primary care physicians and potentially into patient homes.

Topics discussed:

  • How Chris got into emergency medicine, and how his early adoption of ultrasound led him to become “one of the fathers of the point of care revolution in ultrasound.”
  • Why education is one of the biggest barriers today to unlocking the potential of ultrasound, and how that can change by starting ultrasound training in med school.
  • The ways in which AI could develop to instruct the operator on how to use it, closing the gap in education.
  • How the first revolution in ultrasound — a political one that needed to break down barriers between specialities claiming ultrasound as their own — has been won, but how the next revolution will be around creating more standardized, widespread education for all.
  • The challenges to getting reimbursed for ultrasound use today, and why point-of-care ultrasound needs to be categorized correctly.
  • Why primary care physicians are using ultrasound more in their practices, and how ultrasound may extend to in-home patient monitoring.
  • The patient impact on using ultrasound, and how patients remember the doctors who “went a little step further” by using ultrasound.

Why Ultrasound’s Next Revolution is Educational: A Conversation with Dr. Chris Fox

“I love it, drink it in every chance I get.  Super fun to do it clinically, super fun to teach and also do research on it,” which communicates Dr. Chris Fox’s excitement about his everyday experiences with point-of-care ultrasound, which he spoke about in a recent episode of our podcast.

Over two decades ago, he found ultrasound — or, as he says, “ultrasound found me” — when looking at options for a more academic track upon finishing his emergency medicine residency. His program director replied “Ultrasound,” and in 2000 Chris started his ultrasound fellowship in Chicago, where he “learned, drank it all in, loved it.” Since then, he’s been at UC Irvine teaching ultrasound, and witnessing the evolution of ultrasound size, technology, and acceptance. Today, he’s the Chair of Emergency Medicine at UC Irvine. He also delivered a TED Talk on the subject, entitled “The Point of Care Revolution: Ultrasound,” as part of TEDxUCIrvine.

On a recent episode of our Medical Imaging for All podcast, Chris shared his passion for point-of-care ultrasound, how he’s seen ultrasound evolve over the past two decades, and how education will truly unlock ultrasound use and adoption.

A Passion for Ultrasound Education

“What I like about ultrasound and emergency medicine is that it definitely makes me a better doctor.” Having used ultrasound for as long and extensively as Chris has, one of the best advantages is that ultrasound allows him to fine tune his patient care. He can use it on the whole body, it makes him less dependent on other testing, and allows him to be more engaged with the patient. He also finds that patients remember the doctors who use ultrasound to go “a little step further and tried to figure it out before ordering all the tests.”

But despite the advantages that ultrasound offers, the biggest hurdle holding ultrasound back today is education. As Chris explains, ultrasound is hard to learn and it takes time to become confident in how to use it to acquire and interpret images. But many physicians practicing today may only be learning the very basics in courses that last only a few days. This is why, Chris believes, ultrasound education should begin in med school.

“Now I’ve got four years with people. I can stretch the curriculum out and get them a lot of hands-on experience in a lot of different types of patient body habitus. They can get used to how hard to push, how to angle the transducer,” so that they can become really comfortable with and confident in acquiring the image, Chris says. It’s not only about more education, but about ensuring that there’s standardized education across medical school curricula as well. As it stands today, some schools teach ultrasound for all four years, yet some barely teach it at all.

The Many Revolutions of Point-of-Care Ultrasound

How far has ultrasound come over the past twenty years? For Chris, the first revolution was a political one, with ” each specialty wanting to claim their own organ and the use of ultrasound on that organ. Since then a lot of those political barriers have been broken down.” Today, point-of-care ultrasound has extended to every specialty, but the next revolution “is probably the educational side of it and getting it so that not only are we allowed to do it, but we’re good at it and we know how to do it right. Getting it in the hands of just more and more people earlier on.”

Where does ultrasound go from here? Chris talked about the new demand rising from primary care physicians to learn ultrasound. “We were just approached by our own primary care doctors saying, ‘Hey, can you guys teach us? We want to learn this in our clinic. We’ve got the machines now. We really want to learn how they work,’” he says.

Not only can primary care physicians take ultrasound into the community, but ultrasound may become part of “the medical home, where a patient is basically avoiding the hospital at all costs and getting all their care provided to them at their house in various modalities and ultrasonic care.”

The Place of AI in the Ultrasound Revolution

One of the biggest technological trends today is AI, which is also making its way into ultrasound devices for better image guidance and acquisition. For Chris, AI could mean closing the gap on the educational component of ultrasound. “I think you can build all that into AI to teach it what to look for and then to tell the person doing the ultrasound what to do,” he explains, like having AI instruct you on how to position the patient and where to put the probe. “If the AI was so basic that it could teach somebody who’s a non medical person how to scan themselves, that level of basic sort of instruction, I think, would truly democratize the use of this device to its fullest extent.”

Conclusion

Considered one of the fathers of the revolution in point-of-care ultrasound, Dr. Chris Fox is spreading his passion for using ultrasound to patients, fellow physicians, and students. If what point-of-care ultrasound needs to truly unlock its potential is more education, then Chris is doing his part to advance the revolution and win the war.

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