“30 teams, 3 rounds, 1 Champion!” The American Institute of Ultrasound in Medicine (AIUM), used this slogan to advertise its March 24, 2018 SonoSlam competition to medical school students. While this competition, held in New York City, did not get as much attention as the NCAA Men’s Basketball Elite Eight tournament games played on the same day, there was great excitement among the participants, including two teams of Yale School of Medicine (YSM) students. Samara Fox, Keval Desai, and Michael Boyle, all third-year students, took second place honors, while Cortlandt Sellers, Andrew Silverman, and Nancy Huynh, all in their fourth year at YSM, finished sixth, in this national event with 24 teams competing. This was the first time in SonoSlam’s three-year history that a Yale team has finished in the top ten.
Andrew Silverman found the ultrasound elective he took prior to the competition and SonoSlam to be among “the best and most practical highlights of my med school experience thus far! I had a blast in NYC competing and look forward to practicing the skills we learned in the emergency room soon.”
Rachel Liu, BAO, MBBCh, FACEP, assistant professor of emergency medicine, who serves as director of Point-of-Care Ultrasound Education at YSM said she “would not have expected this outstanding performance in her wildest dreams” and believes it reflects how smart and how motivated the students who participated are, particularly because they did not spend months training for the event as some competitor schools had done.
Liu, along with a faculty member at Ohio State, co-created SonoSlam in 2016. The launch was motivated by a national movement to bring ultrasound into core curricular medical school education. They saw this competition as a fun way to provide Just-In-Time learning to both students and faculty alike, and a way for students to engage in ultrasound at the national level.
The competition is held during AIUM’s annual convention, and it emphasizes a multidisciplinary approach, since today ultrasound is used across disciplines, focusing on issues ranging from the head, lungs, and heart, to muscles, nerves, and tendons.
While 17 teams from 12 different schools participated in the inaugural SonoSlam in 2016, this year there were 24 teams from 22 schools. Beyond these numbers demonstrating the growing buzz around this competition, it reflects the expanding role of ultrasound in practice, in part because of technological advances, and the increasing focus of ultrasound in medical education in the United States, including at YSM.
The day-long SonoSlam event takes place in three rounds. Round 1 is very knowledge-based, focused on basic physics, anatomy, and physiology. As participants respond to questions, there are many teaching opportunities as proctors provide feedback. All teams continue onto Round 2, which is more focused on clinical applications of ultrasound, and includes games designed to require the students to demonstrate teamwork and think about ultrasound principles in new ways. For example, in one contest, the student performing the ultrasound was blindfolded, while a second teammate moved the probe, and the third team member described what was being imaged. Dr. Margarita Revzin, Assistant Professor of Radiology and Biomedical Imaging at YSM, was a creator of a Round 2 station that tested students on procedural skills using ultrasound guidance.
Only the top three teams moved on to Round 3, which tests scanning and advanced knowledge. Samara Fox described the high-intensity of Round 3: “It was Jeopardy style and we were going head to head against the other two best teams in the competition. We lost to the UConn team by a matter of seconds because we just did not scan as fast as them.”
The creation of SonoSlam is part of AIUM’s support of the integration of ultrasound into medical school education. Doctors in France were the first to significantly use ultrasound beyond the traditional ob-gyn specialty, and this practice spread to many parts of Europe in the 1990s, as doctors began to recognize its broad lifesaving applications. While the United States did not lead this movement, today it is the leader in incorporating and emphasizing ultrasound in medical education.
Liu agreed to be the champion for this effort to incorporate ultrasound into medical education at YSM. She found a receptive audience with the Medical Education leadership at the school, because her goal fit with the increasing focus on technology in medical education, while maintaining an emphasis on physical examination. Because of equipment and faculty limitations, YSM decided to start the integration effort with a point-of-care ultrasound longitudinal preclinical pilot for 16 students. For this curricular initiative, Liu combed the broader curriculum so that she could match it with ultrasound uses, and students met every two weeks to review and analyze clinical scans related to their other course work. This longitudinal preclinical course is now in its fifth year and the number of students applying for the course, whose membership is determined by lottery, has grown from 36 when it launched, to 80 this year. Additionally, about 70 YSM rotators participate in the ultrasound elective during their fourth year.
Fox participated in the ultrasound pilot her first year at YSM, and in part credited her strong performance at SonoSlam to her experience scanning in the emergency department with Dr. Chris Moore, MD associate professor of emergency medicine, who is section chief of emergency ultrasound and director of the emergency ultrasound fellowship. Moore has stated that with advances reducing machine size and improving technology, the characterization of ultrasound as a key tool in diagnosis is finally beginning to be a reality. He emphasizes, however, that “ultrasound is a user-dependent technology whose efficacy is largely dependent on the training of the person obtaining and interpreting images.” This reflects why ultrasound education is so important.
Ironically, while now an advocate, Liu originally was skeptical of ultrasound. She did her undergraduate medical training at Trinity College in Dublin, Ireland, a country where the practice was to rely more on the physical exam than on imaging. However, while in the U.S. during her residency, she had an experience which altered the focus of her career: neither Liu or her program director could find the heart in a critically ill patient who was a clinical conundrum and near death. This experience showed her the necessity of having life-saving imaging that shows exactly what is happening with regard to the patient’s pathophysiology in real time. She said that today, almost on a daily basis, the use of ultrasound impacts decisions she makes in patient care. Moreover, almost every doctor she knows has had an experience where ultrasound had a life and death impact on their treatment of a patient.
Beyond the influence ultrasound has on patient care, it also helped Liu to better understand medical concepts. For example, while in medical school and during her residency, she could state the difference between right and left side heart failure based on her memorization skills, but she never truly understood the concept. It was not until she was able to actually observe what happens during heart failure, in real time using ultrasound, that she grasped the medical concepts behind right side and left side heart failure. This added to her dedication to ensuring ultrasound was incorporated into medical education.
Michael L Schwartz, PhD, associate professor of neuroscience and associate dean for curriculum, congratulated the students who participated in SonoSlam, saying “we are very proud of you and humbled to be able to have you represent YSM in such a terrific manner.” At the same time, he noted the significant impact Liu has had on the school. YSM is “lucky to have Dr. Liu leading our curricular efforts in the application and interpretation of ultrasound. Her skill, commitment and passion as an educator has allowed you and many of your colleagues to achieve and learn in ways that are truly remarkable.”
At this year’s AIUM Annual Meeting, Liu and her colleague from Ohio State were honored by AIUM leadership with the “Carmine M. Valente Distinguished Service Award” for creation of this event and the impact it has in medical student education at the national level.