Thursday, April 27, 2017

See One, Do One, Teach One in Mirebalais, Haiti

Oren Johnson, MD 
Resident in Diagnostic Radiology at Brigham and Women’s Hospital 

See One, Do One, Teach One in Mirebalais, Haiti

My days have been busy. The clinical teams are not used to having radiologists on site, and have been keen to involve us in their clinical work.  At morning report, we were asked by the medicine team to ultrasound one of their patients for lower extremity deep venous thrombosis (DVT).  The patient had presented with sudden onset leg pain and swelling. She had been started on anticoagulation, but the team wanted to make sure she had a DVT. The patient lived hours away and logistically checking her INR would be nearly impossible.

Hopital Universitaire de Mirebalais Resident Learn to Perform DVT Ultrasound
I met the residents in the Women’s Ward around 5pm. When I got there, they had the ultrasound machine setup for me, or at least, that’s what I thought when I saw the machine near the patient. I picked up the ultrasound probe to start and scan the patient’s leg, when I was quickly stopped. The resident asked if he could scan. He wanted to show me his understanding of DVT ultrasound and asked me to correct him as he proceeded. This proved to be a great lesson for me on many fronts.

First, there was no point in me just doing the ultrasound without building his capacity to perform/interpret them on his own. Second, it allowed me to gauge the resident’s baseline knowledge and tailor my teaching. Third, I had no idea how to turn their machine on. The resident proceeded to scan and make a finding in the patient’s posterior calf.  He knew it wasn’t a DVT, but also knew it wasn’t normal. The patient had a ruptured Baker’s cyst, explaining her pain/swelling, and allowing them to stop anticoagulation. It was a fun finding to make, and it had immediate impact. I gave feedback on the resident’s technique, showed him how I would have scanned, and figured we could call it a day.

I was wrong. The resident then asked me if we could scan the other 3 patients on that side of the ward.  He wanted to reinforce what he learned. I was impressed with the initiative and was happy to oblige. All 3 patients were normal, but the resident improved each time on his ability to obtain the images he needed.

The next day after Morning Report, the resident asked if I would check another patient for DVT. He was pretty sure he diagnosed a popliteal DVT.  I double-checked him, and sure enough he had diagnosed a DVT. He called the other residents on the ward over and proudly showed them his finding.  I couldn’t have been happier.
Hopital Universitaire de Mirebalais Resident Performs DVT Ultrasound


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