Clive Smith's Take on Stethoscope Design for Auscultation Education
The medical education community was one of my most interesting challenges as I decided what features to design into One.
Auscultation is really difficult to teach with an old-fashioned stethoscope. So clinical skills have eroded over the years, calling into question the value of the stethoscope as a diagnostic tool. I've lost count of the doctors who have told me they listen only to please patients, since they don't know what they're hearing. Eric Topol has argued that the stethoscope is dead in an ultrasound age.
But a funny thing happened on the way to this new "hear-no-evil" world. Healthcare costs spun out of control and medical schools decided it was time for doctors to learn physical exams rather than simply ordering tests. I've heard these sentiments from people at Harvard, Johns Hopkins and many other esteemed institutions.
And when the telemedicine folks started showing the new high tech world of remote healthcare, doctors immediately said, "How am I supposed to do an exam if I can't listen to the patient?" At which point we got calls from telemedicine providers asking for solutions.
As an engineer, I'm not qualified to take sides on this argument, but as one who has done his fair share of signal analysis, looking for intelligence buried in noise, I conclude that if legendary physicians a few decades ago could figure out complex pathologies with their stethoscopes, the signals must be there. This is not to say the echo isn't more definitive, but it does suggest that students with better skills could learn to be better at deciding when to order an echo or make a smarter referral. Why not give them the tools to do that?
With that in mind, I've taken seriously the auscultation educational challenge. I've also decided that we need to leverage the amazing technologies that students and faculty now carry. So our solution is to make the stethoscope part of the mobile/tablet ecosystem. Connect One to your iPad and you have a system for wirelessly sharing sounds around the bedside or the classroom. Upload the sounds to the cloud to share with peers and students, and you no longer have the problem that interesting sounds are too difficult to find.
I look forward to seeing where this goes and working with innovative educators who want to improve auscultation skills.
As for the stethoscope-is-obsolete camp, the technology historian in me thinks that technology doesn't obsolete so quickly. What usually happens is that someone sitting in a garage somewhere, figures out how to take something old and give it new life. Ridden a bicycle lately?
Thinklabs One gives you new tools to educate at the patient bedside, in the classroom and online. Connect One
to mobile devices or iPads and you
have a transformative system for capturing, displaying and sharing sounds.
Group Teaching at the Bedside
Broadcast sounds using Thinklabs Wave on iPad/iPhone/Mac or Android. Record sounds and share instantaneously via wifi sharing apps, Dropbox upload, etc. Students can listen to a live broadcast or record and listen via headphones on their own iPads or phones. In addition to "live listening", you can record the patient and students can play back sounds multiple times around the bedside after you've stepped back from the patient. Either way this is superior to having to spend time repositioning your stethoscope for each student in the correct location on the body while the group tries to listen and learn. You also get to save recordings for later teaching. So interesting patients get catalogued in your uploaded library.
Teaching in the Classroom
Broadcast or record sounds using the Thinklabs Wave App on iPad/iPhone or Android. Then share instantaneously via Wave or other wifi sharing apps, email, or with live patients. Sounds can be uploaded and shared with students online from your set of sounds. Students listen live via headphones on their own devices and can also access the saved set of sounds. Again, students can also play and replay sounds and access the material later, outside the classroom.
Student Mentoring - Simultaneous Listening
Broadcast the stethoscope audio to students using our App.
Connect a headphone splitter to your One and have the student listen on her own headphones while you auscultate, or reverse roles to monitor the student's ability to place the stethoscope correctly and locate sounds.
You can also connect One to a loudspeaker (Jambox, Beats Pill XL, NYNE, etc.) for listening with small to large groups at the bedside.
Now you can talk about heart sounds and listen simultaneously!
The key was to create a stethoscope with an open systems philosophy - give users the power to easily connect and they will leverage the world of mobile devices, apps, wireless networks, the internet and the cloud to invent creative new ways to teach auscultation and use stethoscopes. We offer a few ideas here for using One in the academic and research setting.
Record sounds and save them on your mobile device or upload them to a cloud repository. Now you can capture sounds from far-flung populations, as we've seen Johns Hopkins and the Gates Foundation do with Thinklabs stethoscopes.
Do serial studies, recording patient progress over time, record artificial heart valves or LVADs over time to find sound signatures for changes or impending failures. Analyze signals using Matlab or other advanced signal processing software.
Record sounds and create a MOOC (massive open online course) so you can teach heart or lung sounds, blood pressure measurement, veterinary heart sounds, or any other subject.