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I was looking to bridge the gap between the holidays and when students and housestaff are looking for online #meded content again, so I recorded myself making evidence-free predictions on how medicine will change between now and 2123.
tl;dr Medicine in 2123 will resemble medicine of 2023 as much as 2023 resembles 1923.
The image below was generated by AI (I gave DALL-E 2 the prompt: "robot doctor treating a human patient, digital art")
@EricStrong Loved this discussion Eric - particularly the AI impact on radiology and the length of time it will take for #ultrasound to fully replace the stethoscope :)
@zedunow Thanks! I wish I thought POCUS becoming a standard part of the med school curriculum was right around the corner, but I felt that way 7-8 years ago and it doesn't seem like much progress has happened since (at least here in the US).
I don't know if it's because probes are still too expensive, or because core teaching faculty are not sufficiently skilled in ultrasound to teach it, or for some other reason.
@EricStrong
The slow integration of ultrasound isn’t for lack of desire of students & physicians.
As you say, the past 7-8 years have not witnessed the degree of progress that the #POCUS champions have desired - anywhere in the world.
With the advent of lower cost handheld solutions it’s not necessarily an access issue any longer - but based on our experience & recent studies it’s a lack of critical mass of trainers & insufficient supervision that is slowing uptake.
@EricStrong
Everyone learning and refining their skills has indicated they value/need feedback from qualified ultrasound experts. There are so few trainers with sufficient skills/knowledge of the clinical applications unique to each specialty that those who do train are stretched.
Another factor that affects uptake is the myth (often repeated) that ultrasound is easy.
@EricStrong
Sure - pattern recognition is something that can be developed through passive observation, but performing the scan and troubleshooting in real time with a living breathing patient is not simple.
Oftentimes enthusiasm to learn is then overtaken by disappointment as the clinical demands of the workplace intervene and prevent investment in skills development.
There is no simple solution to this issue - it will just take time (longer than anticipated)
BTW - the US utilisation of #POCUS is decades ahead of many countries including here in Australia. Here part of the issue is that - unlike the US - there are few (if any) ways to bill for #POCUS scans (depending on who is doing the scanning), meaning it’s difficult to make a business case based on income/avoided costs.
@EricStrong
PS - we haven’t even touched on the credentialing debate - that’s for another day!
@EricStrong from my experience in training, it’s because we’re overwhelmed with ticking off the basic ward work on CTU nevermind taking the time to incorporate ultrasound and have feedback on it. I was fortunate to be able to do an ultrasound elective focused on seeing CTU patients for assessments and procedures.
@geranyl I was thinking more about preclerkship years when, at least in the US, many med schools have dedicated time for physical exam training.
We spend ~8 hrs on auscultation, and maybe 2-3 on POCUS.
That ratio feels inverted to me.
@EricStrong @zedunow - as someone who would like to be teaching this more, another huge issue (besides the ones you mention) is time. You can only teach so many students at once because of physical space limitations. If you are teaching 20-25 students at a time, you have to have a large number of sessions to get them all through. Then, if you want to have them get really proficient, you need to have many sessions. Still struggling to figure this out.
@EricStrong @TamiRitsema
Absolutely Tami - time is the enemy- that’s what I was alluding to re: encroachment of clinical demands impacting skills development. It affects outcomes for both learners & teachers.
Unfortunately teaching/learning #ultrasound isn’t simply an ‘attend a course & go!’ affair. It is a longitudinal exercise.
Time to teach is the single biggest issue raised in our #POCUS support network on FB (https://m.facebook.com/groups/2320595437975758) - you’re welcome to join us 
Time management strategies also forms part of our TRain the UltraSound Trainer (TRUST) program.
https://www.ultrasoundtraining.com.au/instructor-courses/train-the-ultrasound-trainer/