THE WHY:
Ultrasound is a beneficial and critical imaging modality because of its affordability and effectiveness in the imaging of non-communicable and infectious diseases. Ultrasound can be successfully integrated into community health partnerships but must be thoughtfully supported by assessment, training, and human capacity development. Ultrasound education is in demand across all specialties, from emergency medicine to primary care. A diverse group of providers, including physicians, nurses, and advanced practice providers, use ultrasound clinically, and in some cases, users have little or no access to formal ultrasound training. Dr. Joia S Mukherjee, associate professor at Harvard Medical School, stated, “Few tools have proven more valuable in the hands of well-trained health care workers than ultrasound…. It is our firm belief that providing the tool of ultrasound and adequate training and support is a critical component in global health delivery and should be part of the evolving pedagogy of global health.” Improving access to high-quality ultrasound and ultrasound education is a key component of any successful ultrasound outreach program.
When considering the target audience for ultrasound education, American Indian/Alaskan Native (AI/AN)patients, overall, have poor access to healthcare with substantial health inequities that begin in childhood, along with excessive disease rates intimately impacted by the relevant social determinants of health. The Indian Health Service (IHS) is the principal federal health care provider and health advocate in the United States for Indian people, facilitating a comprehensive health delivery system for more than 2.6 million AI/AN who belong to 564 federally recognized tribes in 34 states. The IHS provides care in 12 areas via 27 hospitals, 59 health centers, 9 school health centers, and 32 health stations. The provision of health services to federally recognized tribes was established in 1787 and can be described in Section 8 of the Constitution.The impact of ultrasound on the health outcomes of the underserved and the healthcare needs of the AI/AN create a unique intersection leading to the why.
WHERE DO WE START:
The selected pilot site is WhiteRiver Indian Hospital in White River, Arizona, on the Fort Apache Indian Reservation. The hospital is about three miles north of Whiteriver and serves approximately 17,000 tribal members and other Native American communities. It is designated as a Baby Friendly Hospital, The Joint Commission (TJC) accredited and staffed by 22 physicians, podiatrist, five nurse practitioners, five dentists, two optometrists, and about 79 nursing staff members. The hospital is a 40-bed facility, providing general medical, pediatrics, alcohol treatment, mental health, obstetric services and ambulatory surgery. Patients requiring inpatient surgical procedures and complex medical care are referred to Phoenix Indian Medical Center or contract-care hospitals. Ground and air transport are available. The Whiteriver Hospital is also the base for major research projects that include gastroenteritis and pneumococcal diseases.
The target audience for teaching includes more than 20 providers, including nurses, sonographers, advanced practice providers, and physicians across multiple specialties, including family medicine, obstetrics, and emergency medicine, who provide inpatient and outpatient services. The ultrasound will be provided by highly skilled sonographers, advanced practice providers, and physicians through a train-the-trainer pathway over an 18-month period. The goal is to provide high-quality, diagnostic, and point-of-care ultrasound through a hybrid education model, including online self-guided learning, frequent hands-on education in one-on-one teaching, workshops, mentorship, image review, and a standardized pathway to obtain certification. The project is further fortified through the generous support of the community stakeholders within the IHS and Whiteriver Indian Hospital, Inteleos Foundation, POCUS Certification Academy, Global Ultrasound Institute, and dedicated volunteers with a passion for improved patient outcomes through ultrasound acess.
NO SUCH THING AS A SMALL VICTORY:
The pilot project’s initial phase has been completed. This was accomplished virtually and during an assessment trip to White River. We spent five days meeting staff and stakeholders on the ground, identifying needs, potential learners, and available resources. We were warmly welcomed and treated like a member of the team from the very beginning. Shortly after our return, we began to secure educational content, identify volunteers with a unique background in ultrasound education, and identify the initial cohort for participation. Demographics and ultrasound experience information was gathered from the initial cohort. They were further divided into smaller groups and assigned to a specific educator with expertise relevant to their training pathway.
SLOW and STEADY WINS THE RACE:
We are currently in the second phase of the pilot project, which is expected to span six months and comprise approximately six months of self-guided, asynchronous learning through an elite online POCUS education program. This will be augmented with regular check-ins and virtual education provided within each cohort. It is also likely that some initial participant testing will begin to allow for certification after this project. Plans are being made to become volunteers within IHS to ease our ability to provide hands-on education to the cohort throughout the 18 months. We plan to make our first trip for hands-on education in the Fall of 2024. In the meantime, we can track progress within the education platform to better support the learners.
