China has increased the development of primary medical and health undertakings, and the supporting hardware equipment has also kept pace with the demand for diagnosis and treatment. However, there is still a shortage of primary medical personnel, especially experienced sonographers. Some clinicians are part-time sonographers. Due to lack of systematic theoretical knowledge training and clinical practice operation, it is easy to miss diagnosis and misdiagnosis, and the quality of ultrasound examination is greatly reduced, which has a negative impact on grassroots hospitals. A lot of patients, even after seeing common diseases in a grassroots hospital, then still question the diagnosis result and then go to a higher hospital for repeated examination, which consumes precious time, increases the economic burden, and causes a waste of medical resources.
In the past, the methods to improve the level of ultrasonic diagnosis and treatment at the grassroots level mainly include: grassroots doctors go to higher hospitals for further study; The superior hospital visits the basic level and lectures; Formulate the ultrasonic inspection specification, and the quality control center conducts regular inspection. However, due to lack of human resources in primary hospitals, the study time is short and progress is slow. Superior doctors teach and give lectures in basic hospitals, but they only stay at the theoretical level and the scope is limited. The formulation of ultrasonic diagnosis and treatment standards can improve the level of ultrasonic diagnosis and treatment at the grassroots level to a certain extent, but it has little effect on the development of grassroots ultrasonic medicine at the early stage.
The training is initiated by the Department of Ultrasound of Zhejiang Provincial People's Hospital and the Vocational Training Center for Ultrasound Medicine of Zhejiang Province, based on the 12 grassroots health centers of the Taishun County People's Hospital. The establishment of 5G ultrasound remote consultation mode between provincial-level Grade A hospitals and grassroots hospitals -- relying on the information system of county, town, village and first aid linkage ultrasonic comprehensive service station -- can better serve grass-roots patients[4-5]. Since planning training, the instructor has understood the characteristics and requirements of local medicine in advance, and has taken "how to use handheld ultrasound quickly and accurately" as the teaching goal. The theoretical training focuses on the basic principle and usage method of the handheld ultrasound, and the most practical and most urgently needed of ultrasonic knowledge for the grassroots doctors. Practice training students are divided into small groups "hand in hand teaching". After passing the theoretical and practical assessment, the students' practical scores were significantly improved. After obtaining the training certificates, they carried out the diagnosis and treatment work in their respective areas. Through the feedback of students and their suggestions on our training course, we found that: (1) Students believe that this type of training is very practical, but the class are compact and the system of knowledge points is huge. They hope that the class can be extended to give enough time for digestion. (2)The theoretical courses is difficult, so the principles of ultrasound physics can be appropriately deleted. For general practitioners who have no ultrasound foundation, they prefer to have quick and simple introductory courses. (3) Instructor responsibility system is implemented in training, with one tutor leading 2-3 students. Small class teaching are optimized, and there is enough training time to refine to each aspect, and pass the test one by one.
At present, we have completed a total of 148 cases of consultation through the remote ultrasound "Visualization apparatus". Abdominal ultrasound was the main method，mainly fatty liver, liver cyst, gallstone, kidney stone. Due to the weak health awareness and lack of medical resources at the grassroots level, some patients have not ultrasound examination for more than 5 years. "Visualization apparatus" as a newly developed thing, different from static images such as radiation and electrocardiogram, real-time dynamic scanning is very important. The quality of the images is largely determined by the manipulation, and clearer and more comprehensive images will lead to more accurate diagnosis. Provincial experts can observe the size, shape, peripheral tissue relationship and blood flow signal of lesions in real time through the remote consultation system, and guide the operation techniques of grassroots doctors[6-7].On the basis of voice and video, experts can not only communicate with patients to ask for a brief history, but also make simple visual examination, such as body mass, location of pain and other relevant auxiliary information. In addition, through real-time explanation and guidance from experts, grassroots doctors can greatly improve the diagnostic coincidence rate. This process is also conducive to the expansion of their own diagnostic ideas and the improvement of the accuracy of operation techniques, so as to attract patients to seek medical treatment. Common cases can be solved in grassroots hospitals, which is conducive to the development of hierarchical diagnosis and treatment in the grassroot hospitals. There are also relevant literature reports that 5G remote ultrasound can be used to examine COVID-19 patients, transmit images to experts outside the isolation area, which can not only reduce the contact of medical staff, but also obtain better diagnosis and treatment resources, with good clinical and scientific research value.