Even a device that can look into the bodies of patients has to be pointed in the right direction to be effective. That was the object of point-of-care ultrasound training undertaken by faculty and residents in the KU School of Medicine-Wichita Family Medicine Residency Program at Wesley Medical Center last month.

In the training, conducted at Wesley Family Medicine, participants took turns using hand-held ultrasound devices on a half dozen standardized patients.

“I would slide your hand down to make contact with his chest,” Devin Penny, D.O., volunteer clinical assistant professor in the Department of Family & Community Medicine, suggested as Jo Leatherman, M.D., a second-year resident, moved a probe over the chest of a standardized patient.

“There it is,” Leatherman said, spotting the patient’s heart on a computer screen wirelessly connected to the probe.

“That’s great movement and thickness,” Penny said, referring to the contractions and width of the heart’s walls.

As the conversation indicated, the other part of the training involved understanding the views offered by the ultrasound probes.

POCUS has been gradually making its way into more areas of medicine as mobile and hand-held devices become more accessible and affordable. POCUS training, previously recommended for family medicine programs, is now required by the Accreditation Council for Graduate Medical Education Review Committee for Family Medicine.

“It wasn’t in any of our training when I went through residency,” Penny said.

The training was an example of cooperation between the family medicine residency programs based at Wesley and Ascension Via Christi and the Standardized Patient Program at KU School of Medicine-Wichita, where people have been trained to simulate patient symptoms, characteristics and medical history.

Penny co-facilitated the training with his wife, Melissa Penny, D.O., a volunteer clinical assistant professor in the Department of Family & Community Medicine. Faculty members of the KUSM-W Family Medicine Residency Program at Ascension Via Christi were asked by Aaron Sinclair, M.D., director of the Wesley residency program, to bring the training there.

Devin Penny credited Scott Stringfield, M.D., former assistant director of the Ascension residency program, for getting the POCUS training ball rolling there about two years ago. It’s also been offered to physicians who aren’t on faculty, “and I think it has probably shown its usefulness in the community,” Penny said.

During the training, the Pennys first familiarized faculty and standardized patients with the session’s goals, then conducted a didactic teaching session followed by hands-on practice. Other POCUS training sessions focus on the lungs, vascular system, abdomen and obstetrics.

In his remarks, Devin Penny covered the standard views of the heart that physicians should obtain while assessing a patient’s heart.

“There are two things you’re really trying to assess — the left ventricle function would be one and the other would be heart pressure.”

The views or “windows” to the heart that are available vary from patient to patient, he noted. One way to bring the probe closer to the patient’s heart is to have the patient lie on their left side. Another technique is to have the patient breathe deeply.

Because the probe records the view, which can then be played back, “you only need a beat or two of a really crisp view” to evaluate the heart’s condition, he said.

Penny later explained that physicians at Via Christi use POCUS “a ton in the hospital for people that are coming in sick.”

For patients with low blood pressure, it can be used to quickly determine whether the heart is to blame.

“For years and years, we just started pumping them full of fluids. In some cases, the ultrasound really helps tell us when that’s not a good idea.”

POCUS has also proven invaluable in medical missionary settings, he said.

Physicians should not be afraid to apply some pressure to a patient’s chest while using the probe, he said, noting that there is a difference between a patient experiencing pressure and one experiencing pain. The standardized patients “know you’re learners,” he told residents.

A hand-held POCUS device can now be bought for as little as $2,000, although more expensive models offer higher quality views. POCUS devices can save physicians time by eliminating the need to send patients to radiology for X-rays.

“It often takes quite a long time” to get those results, said Gavin Hayashi, M.D., another resident taking part in the training.

“At first it’s difficult,” Hayashi said of using the POCUS probe. “It’s about being careful with subtle movements.”

Leatherman said her ability to find the right views of the heart grew with every standardized patient.

“On the second patient, I was able to get them more quickly and find the specific parts we’re looking for.”

Devin Penny said a POCUS may not lead to a definitive diagnosis, but, “At least you can say, ‘I think it’s abnormal’ and go from there.”