1. IPHONE AND IPAD TECHNOLOGY AS A QUANTITATIVE METHOD FOR MEASURING AND DOCUMENTING CLINICAL COMPETENCY IN ULTRASOUND TEACHING. John R. MacMillan Rodney, M.D Maternal Child Health Fellow Department of Family Medicine Affiliate University of Texas, Southwestern John Peter Smith Hospital Fort Worth, Texas Kelly R. Arnold, M.D Assistant Professor, Family Medicine University of Tennessee Chattanooga, TN Robert K. Sigman, M.D. Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology University of North Texas Health Sciences Center Fort Worth, Texas Wm. MacMillan Rodney Director, Surgical Family Medicine Obstetrics Medicos para la Familia Fellowship Memphis, TN

2. Disclosure Neither I nor my partners have any relevant financial interests, arrangements, or affiliations with a commercial interest.

3. Global Use of OB-GYN Ultrasound Basic ultrasound competency is necessary for the practice of obstetrics and gynecology in any setting. These settings range from primary care clinics to tertiary subspecialty settings. – Family Medicine Clinics – Labor and Delivery – Maternal Fetal Medicine – Rural, Remote, Underserved Areas

4. Global Need to Assess and Establish Competency As technology has improved, ultrasound has become more portable and available. As a result, bedside and outpatient sonography are increasingly common. Yet there are no easily established methods to assess, research, and establish competency.

5. Application Development To facilitate appropriate documentation To verify structural identification To validate common measurements To quantify competency To permanently store faculty sign off on resident reports

6. iPhone and iPad Interfaces

7. Camera Function: How are the images obtained and processed? Using camera function built into iPhone and iPad Accessing native files from the camera roll These files can be cropped, rotated, and transmitted to this app.

8. Camera Function: How are the images obtained and processed?

9. Camera Function Examples: 5 Common Biometric Markers Crown Rump Length Biparietal Diameter Head Circumference Abdominal Circumference Femur Length

10. 1 st Trimester Crown Rump Length

11. 2nd Trimester Biparietal Diameter

12. 2nd Trimester Head Circumference

13. 2nd Trimester Abdominal Circumference

14. 2 nd Trimester Femur Length

15. Student 2 nd /3 rd Trimester Report

16. Final Documentation By Student

17. Faculty Edit Student 2 nd /3 rd Tri Report

18. Faculty Sign Off “The student has fulfilled documentation of competencies or deficiencies for the following areas.” CompetentDeficient Crown Rump Length Biparietal Diameter Head Circumference Abdominal Circumference Femur Length

19. This program is NOT designed to: Replace existing ultrasound reporting programs. Generate a billing matrix. Replace AIUM criteria for various levels of examinations.

20. This program IS designed to show: The resident’s educational progress in response to a curriculum. The resident’s limitations and deficiencies as they progress through training. The resident’s knowledge that she has not completed the entire program until signed off by faculty. The faculty’s permanent documented confidence in the student’s ability.

21. Future Applications The initial app was constructed for the most basic competency. It does not preclude more advanced teaching by the ultrasound program in the future. Cine-looping and organogenesis surveys are currently in development.

22. Acknowledgements Dr. Robert K. Sigman, Maternal Fetal Medicine, Senior Presenter Department of Family Medicine at JPS Department of Obstetrics and Gynecology JPS Department of Academic Affairs at JPS Dr. Kelly Arnold, Assistant Professor, University of Tennessee, Chattanooga Dr. Patricia S. Poole, Radiology Resident University of California, San Diego Dr. Wm Rodney, Director Obstetrics Fellowship, Medicos para la Familia Dr. John O. Gibson, Director Global Health Fellowship, JPS Dr. David E. McRay, Director Maternal Child Health Fellowship, JPS Dr. Daniel Casey, Program Director Family Medicine, JPS Dr. Joane Baumer, Chairman Family Medicine, JPS Dr. David Moreland, Program Director Obstetrics and Gynecology, JPS Dr. G. Sealy Massingill, Chairman Obstetrics and Gynecology, JPS Dr. Elwyn Grimes, Former Chair Obstetrics and Gynecology, JPS

23. QUESTIONS?