The word ultrasound
typically brings about visions of pregnancies and specialized technicians. But
John Kendall, MD, believes ultrasounds have unlimited potential. And thanks to
his point-of-care ultrasound curriculum, all graduates of the University of
Colorado School of Medicine learn not just how
to perform ultrasounds at a patient’s bedside—but also how this technology adds diagnostic and
therapeutic value to clinical encounters across almost every specialty.
The point-of-care ultrasound represents an entirely
different paradigm of ultrasound. This portable technology allows the provider
to incorporate ultrasonography into his or her thought process throughout the
“Sometimes the ultrasound is diagnostic; say, fluid around
the heart or a pregnancy. Other times, it’s going to be for therapeutic
purposes – using ultrasound to make procedures safer and more effective,” he
Ultrasound has been part of the formally-evaluated School of
Medicine curriculum for two years. It’s part of the Foundations of Doctoring
program, and is also taught in conjunction with the anatomy curriculum.
“Now, at the same time students are dissecting the head and
neck during lab, they are also learning how to perform an ultrasound on this
same area during a physical exam,” he said.
Dr. Kendall believes seeing how everything in the body
interrelates is part of the value of ultrasound.
“When you’re doing a
dissection, you’re not putting everything back together. Ultrasound allows you
to see the body and reconstruct the relationships again,” he explains. “It
isn’t just a cut—you can do an infinite number of constructions—which helps
students think three-dimensionally.”
Beyond the first year, ultrasound is threaded through
curriculum. There is a second-year clinical ultrasound rotation, and ultrasound
has become part of the third year’s surgery rotation. It’s also part of the
OB/GYN rotation, and it’s even being implemented in internal medicine, using
ultrasound as a guide during procedures.
The student response to this element of the curriculum has
been positive. “Universally, the students really like it. Because it has a
clinical application, students feel like clinicians right away, and it makes
learning procedures easier,” he said.
The new curriculum also benefits patients—and expands the
role clinicians have in their care. Since the use of portable ultrasound has
become relatively inexpensive, it has implications for underdeveloped nations
as well as rural areas that lack specialty care. Clinicians trained to use
ultrasound as part of an examination suddenly expand how they’re able to help
the patients they see.
According to Dr. Kendall, Colorado is at the forefront of
this movement. Not only are the students graduating each year from CU learning
point-of-care ultrasound, CU has also partnered with Rocky Vista to help train
their graduates as well, adding 150 additional providers trained in
“It’s an exciting thing for patients in Colorado.”
As an emergency medicine physician, Dr. Kendall’s ultrasound
training was largely self-taught, learning by scanning patients in his
department while completing his training in the early 1990s. He admits mistakes
were made along the way, but that’s one of the best things about portable
ultrasound: It’s a technology with a very positive risk-benefit ratio.
Incorporating ultrasound training into the curriculum was
something he began brainstorming more than 15 years ago. He’s thankful for the
support he’s received along the way.
“The deans at CU have been tremendously supportive, and we
share a vision of how ultrasound can empower clinicians to use these skills for
the patient’s benefit,” he said. “I feel fortunate.”
John Kendall, MD,
FACEP, is the Director of Ultrasound Curriculum at the University of Colorado
School of Medicine. He also serves as Director of Emergency Ultrasound and
staff physician at Denver Health Medical Center.