Date: 18th January 2025

The familiar red glow of the ATEM Mini illuminates my dark teaching space as I prepare for another 'Echo Rounds' session. As I adjust the multiple HDMI feeds — one from the HeartWorks simulator showing a 2D and 3D beating heart in perfect clarity, another from the overhead camera capturing probe manipulation techniques, and a third displaying the teaching materials — I reflect on how far we've come in ultrasound education since 2019.
The transformation from traditional bedside teaching to sophisticated virtual PoCUS teaching hasn't been a simple journey of digitising existing practices. Instead, it has demanded a fundamental rethinking of how we teach, learn, and mentor in the field ultrasound education. This evolution, born from necessity but refined through experience, has created something entirely new: a robust, accessible, and highly effective approach to ultrasound education that often surpasses traditional methods in unexpected ways.
The Birth and Evolution of Virtual PoCUS Teaching
When we first established our virtual teaching programme, aptly named Echo Rounds, in 2018/19, the concept of remote ultrasound instruction raised more than a few sceptical eyebrows. How could we possibly teach such a hands-on skill through a screen? The answer lay not in trying to replicate the physical classroom experience, but in leveraging technology to create something different — and in many ways, more powerful.
Our initial sessions were relatively simple affairs, using basic video conferencing tools and whatever technology we had at hand. Yet even these early attempts revealed something fascinating: the virtual environment offered unique advantages. Students could see probe positioning in perfect detail through carefully placed cameras, watch real-time demonstrations of scanning techniques, and participate in case discussions from anywhere in the world. The limitations we feared became opportunities for innovation.
Technical Architecture and Implementation
The sophistication of our current setup evolved through countless iterations, each refined by experience and participant feedback. At its heart lies the ATEM Mini, a piece of equipment that has transformed how we deliver ultrasound education (Fig 1). This isn't just about switching between video feeds — it's about creating a seamless educational experience that allows learners to simultaneously observe multiple crucial aspects of ultrasound scanning.

During a typical Echo Round, participants experience something akin to watching a carefully conducted symphony. The main screen might show a live 2D image from our HeartWorks simulator, whilst a picture-in-picture overlay demonstrates precise probe positioning from our overhead GoPro camera. This simultaneous visualisation of internal cardiac structures and external probe manipulation creates a unique learning opportunity that even traditional bedside teaching struggles to match.
When explaining complex concepts like the assessment of regional wall motion abnormalities, we can seamlessly transition between live demonstrations and pre-recorded cases, allowing learners to compare normal and pathological findings side by side. This ability to juxtapose different cases and perspectives has transformed how we teach pattern recognition and clinical interpretation.
Building an Interactive Learning Environment
The success of remote ultrasound teaching relies heavily on thoughtful preparation and meaningful engagement. Early in our journey, we recognised that maintaining participant involvement in a virtual environment required more than just clear audiovisual feeds. The introduction of real-time audience participation forms during case presentations transformed passive observers into active participants. As volunteers present their cases, other participants complete structured assessments, forcing active engagement with the material and providing immediate feedback on understanding.
This approach creates a dynamic learning environment where every participant, whether presenting or observing, remains actively involved in the educational process. During a recent teaching session, as the HeartWorks simulator displayed a complex case of right ventricular dysfunction, a participant asked about probe positioning for the best subcostal view. Rather than simply explaining verbally, I could switch to the overhead camera feed, demonstrating the exact hand position and probe manipulation required. This real-time, multi-angle demonstration exemplifies how remote teaching can sometimes surpass traditional methods in clarity and detail.
Remote Mentoring Excellence
Whilst Echo Rounds provides an excellent platform for group learning, we quickly realised the need for more personalised instruction. Remote mentoring emerged as a natural extension of our virtual teaching platform, though it required its own distinct approach (Fig 2). Using SonoClipShare, we developed a system that allows for both synchronous and asynchronous review of cases, providing flexibility whilst maintaining educational rigour

The mentoring process has evolved to include detailed image quality assessment, measurement verification, and interpretation guidance. What surprised us was how the digital format enhanced certain aspects of mentoring. The ability to annotate images, provide frame-by-frame analysis, and create detailed documentation of feedback has actually improved the precision of our teaching compared to traditional face-to-face sessions.
During a recent mentoring session, a critical care trainee struggled with obtaining adequate subcostal views. Through our virtual platform, we could break down the scanning technique into discrete steps, using the HeartWorks simulator to demonstrate the relationship between probe position and cardiac anatomy. This ability to pause, rewind, and repeat demonstrations has proven invaluable for learners grappling with complex scanning techniques.
Global Impact and Community Building
One unexpected benefit of our remote teaching platform has been its ability to foster an international community of learners. During a recent session, we had participants joining from three continents, each bringing their unique perspectives and experiences to the discussion. This global reach has enriched our educational environment, allowing us to explore how different healthcare systems approach PoCUS implementation and training.
The global reach of our remote teaching platform has revealed fascinating variations in ultrasound practice across different healthcare systems. During a recent session focusing on lung ultrasound, participants from three continents shared their approaches to COVID-19 assessment. Such exchanges enrich our understanding and help establish best practices that transcend geographical boundaries.
Remote ultrasound education isn't without its challenges. Network stability, equipment reliability, and maintaining consistent engagement across different time zones all present ongoing hurdles. However, these challenges have sparked innovative solutions. When network issues threatened to disrupt a recent session, our backup recording system allowed us to continue seamlessly, whilst our interactive assessment tools kept participants engaged despite the technical difficulties.
Future Directions and Upcoming Research
As we stand at this exciting juncture in PoCUS education, several developments promise to shape its future. The forthcoming publication of our experiences with Echo Rounds since 2019 will provide valuable insights into the sustainability and effectiveness of remote ultrasound teaching programmes. Additionally, the REMOTE study, investigating real-time remote mentoring using the REACTS platform, represents an important step in validating these educational approaches.
Throughout our journey, maintaining high educational standards has remained paramount. Our approach to quality assurance has evolved alongside our teaching methods. Each Echo Round session generates rich data about participant engagement, understanding, and areas of confusion. This information feeds back into our programme development, allowing us to continuously refine our teaching approach.
Looking ahead, several exciting possibilities emerge. The integration of artificial intelligence for image quality assessment, virtual reality for spatial understanding, and advanced analytics for performance tracking all promise to further enhance remote learning capabilities. However, the core principle remains unchanged: technology serves as a tool to enhance, not replace, effective teaching methodology.
Conclusion: A New Chapter in Medical Education
The journey from traditional bedside teaching to sophisticated remote education represents more than just a technological shift. It marks a fundamental evolution in how we approach medical education. Through careful integration of technology, structured educational frameworks, and continuous refinement based on experience, we've developed sustainable approaches to virtual ultrasound education that complement and sometimes surpass traditional teaching methods.
As we await the publication of comprehensive research into these methodologies, including the REMOTE study and our longitudinal experience with Echo Rounds, the future of PoCUS education looks increasingly bright. The barriers of distance and time that once limited access to quality ultrasound education are dissolving, replaced by virtual platforms that connect learners and educators across the globe.
The success of remote PoCUS education reminds us that innovation in medical education often comes not from replicating traditional methods in a new medium, but from reimagining what's possible with new tools at our disposal. As we continue to refine and improve these approaches, we're not just teaching ultrasound — we're shaping the future of medical education itself.
About the writer

Hannah Conway, a clinical-academic and National FUSIC Heart Lead for the UK.
Interests lie in PoCUS education, Echocardiography, RV injury and telemedicine
Follow me on Twitter/X for more PoCUS related educational content https://x.com/cardiacaccp
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