12 years ago, handheld ultrasound allowed medical students with 2 days training make more accurate diagnoses than specialist cardiologists with decades of experience. Why has virtually nothing changed in the 12 years since this study?

“The diagnostic accuracy of medical students using an handheld ultrasound device after brief (18 hours) echocardiographic training to detect valvular disease, left ventricular dysfunction, enlargement, and hypertrophy was superior to that of experienced cardiologists performing cardiac physical examinations.”


I have to look at this article every now and then to remind myself of the power of technology and the limitations of our “traditional methods”. I read it and feel amazed at how far science has progressed in taking medicine from the age of quackery and patent medicines, to the era of bedside ultrasound, where even a med student with just 2 days training can look deep into the body and figure out its story. With greater expertise than an expert cardiologist.

Then I remember that this article is 12 years old! And I realise that our medical students still get only the most minimal education in ultrasound. The don’t come out of med school comfortable, or even proficient. Even our most advanced trainee hospital registrars often don’t learn to perform ultrasound competently before leaving training.

And that’s when I remind myself that tradition and arrogance go hand in hand.

“This is how we do things here.”

The very people that set the agenda, the ones that build the curriculum, head the departments and medical schools, and make the big decisions, are almost by definition the ones who have been there the longest and mastered the old ways. They are entrenched. Whether those old ways are better or worse, they are not keen to change them.

What’s the answer? A/B testing.

This is a concept that comes from the loathsome world of marketing, where people learn to manipulate people to sell things and make money. But the A/B test concept is a good one.

Set up a mini-experiment with Group A trying the old way, and Group B trying the new way. See which one “wins”. Then bring in another new idea, to compete against the winner. It’s cheap, quick, and effective. And we virtually never do it in medical education. Or hospital administration, to be honest.

If we set up mini experiments more often we could answer questions quickly and accurately. Which method leads to greater accuracy? Which traditional training techniques work? And which ones just have seemed effective all these years but actually aren’t.

We could apply A/B testing everywhere. Which methods of documentation are faster and more efficient? Which consent forms are more easily understood by patients undergoing surgery? Which tests are useful in our specific setting, and which are a waste of money, pain, and time?

A/B testing allows us to figure out the answer to a question in real life. What we do instead in medicine is to almost always leave it up to the most senior doctors, educators, and administrators to come up with their best ideas and write them up in a policy.

A policy that never gets tested against anything else. Madness.


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