Ultrasound simulator-assisted teaching of cardiac anatomy to preclinical anatomy students: A pilot randomized trial of a three-hour learning exposure

Anatomical knowledge enhancement through echocardiography and videos, with a spotlight on cognitive load, self-efficacy, and motivation

In recent years, there has been a growing recognition of the importance of integrating ultrasound into undergraduate medical curricula. However, empirical evidence is lacking as to its effect on anatomy learning and related student cognition. Therefore, the present study compared the impact of echocardiography-based instruction with narrated videos on students' understanding of anatomical relationships, as well as the interaction with students' autonomous motivation, self-efficacy beliefs, mental load, and attitudes. Second-year medical students were given the opportunity to enroll in a supplementary booster course about cardiac anatomy. On the base of a randomized controlled trial with a cross-over design, we studied the effect of taking this course on spatial anatomical knowledge. After completing a pre-test (T0), students were allocated randomly to either the echocardiography-based teaching condition (cohort A) or the narrated anatomy video condition (cohort B). Next, participants were crossed over to the alternative intervention. Immediately after each phase in the intervention, students were asked to rate their mental load. Additionally, a spatial anatomical knowledge test, an autonomous motivation scale, and a self-efficacy scale were administered before (T0) and after the first intervention (T1) and at the end of the study (T2). Finally, each student completed a perception-based survey. The study design allowed a comparative evaluation of both interventions at T1, while the cross-over design facilitated the assessment of the most optimal sequencing in the interventions at T2. A total of 206 students participated (cohort A: n = 99, cohort B: n = 107). At T1, no significant differences in the knowledge test and the autonomous motivation scale were observed between cohorts A and B. However, cohort A showed higher self-efficacy beliefs compared to cohort B (p = 0.043). Moreover, cohort A reported higher levels of perceived mental load (p < 0.001). At T2, the results showed that neither sequence of interventions resulted in significant differences in anatomy scores, autonomous motivation, or self-efficacy. However, a significant difference in mental load was found again, with students in cohort B reporting a higher level of mental load (p < 0.001). Finally, based on the perception-based survey, students reported favorably on the echocardiography experience. In conclusion, the hands-on echocardiography sessions were highly appreciated by the medical students. After participating in the ultrasound sessions, they reported higher levels of self-efficacy beliefs compared to the video-based condition. However, despite embodied cognition principles, students in the echocardiography condition did not outperform students in the narrated anatomy video condition. The reported levels of mental load in the ultrasound condition could explain these findings.

Ultrasound Incorporation in Gross Anatomy Labs in a Master of Medical Sciences Program: A Mixed-Methods Analysis of Student Performance and Perception

OBJECTIVES

Teaching ultrasound imaging is on the rise in undergraduate medical anatomy education. However, there is little research exploring the use of ultrasound in preparatory graduate programs. The purpose of this study is to identify the effects of ultrasound imaging inclusion in a graduate gross anatomy course.

METHODS

Master of Medical Sciences students were enrolled in a prosection-based anatomy course that included pinned cadaver stations and an ultrasound station. Using ultrasound, teaching assistants imaged volunteers demonstrating anatomical structures students previously learned at cadaver stations. Students answered one ultrasound image question on each practical exam and were asked to participate in a pre- and post-course survey. Student practical and lecture exam scores and final course grades from the 2022 cohort were compared to a historical control cohort from 2021 via statistical analysis, including a survey administered to the 2022 cohort.

RESULTS

Two hundred students from the 2021 cohort and 164 students from the 2022 cohort participated in this study. Students in the 2022 cohort had significantly higher scores in 1 of the 5 practical exams (P < .05, d = .289), and 2 of the 5 written exams (P < .05, d = .207), (P < .05, d = .311). Survey data revealed increased (P < .05, d = 1.203) learning outcome achievement from pre-survey to post-survey in the intervention cohort. Students who correctly answered the ultrasound question performed significantly better on practical's 3 (P < .05) and 4 (P < .05) than those who missed the ultrasound question.

CONCLUSIONS

These findings suggest that ultrasound imaging in a cadaver lab is beneficial to graduate students' learning and understanding of gross anatomy.

The effect of simulation of sectional human anatomy using ultrasound on students' learning outcomes and satisfaction in echocardiography education: a pilot randomized controlled trial

BACKGROUND

Effective teaching methods are needed to improve students' abilities in hand-eye coordination and understanding of cardiac anatomy in echocardiography education. Simulation devices have emerged as innovative teaching tools and exhibited distinctive advantages due to their ability to provide vivid and visual learning experiences. This study aimed to investigate the effect of simulation of sectional human anatomy using ultrasound on students' learning outcomes and satisfaction in echocardiography education.

METHODS

The study included 18 first-year clinical medical students with no prior echocardiography training. After randomization, they underwent a pre-test to assess basic knowledge. Following this, the students were divided into two groups: traditional teaching (traditional group) and simulation of sectional human anatomy using ultrasound (digital group). Each group received 60 min of instruction. Post-tests were assigned to students at two different time points: immediately after the lecture, and one week later (referred to as post-tests 1, and 2). In addition, anonymous questionnaires were distributed to students after class to investigate their satisfaction with teaching.

RESULTS

Both groups showed significant improvement in their scores on post-test 1 compared to pre-test (traditional group: from 33.1 ± 8.8 to 48.1 ± 13.1, P = 0.034 vs. digital group: from 35.0 ± 6.7 to 58.0 ± 13.2, P = 0.008). However, there were no significant differences between the two groups in several post-test comparisons. Student satisfaction ratings revealed that the digital group experienced significantly greater satisfaction in areas such as subject interest, teaching style, course alignment, and interaction compared to the traditional group. Additionally, 80% of the digital group strongly endorsed the use of simulation of sectional human anatomy using ultrasound for echocardiography teaching, highlighting its effectiveness.

CONCLUSIONS

Simulation of sectional human anatomy using ultrasound may improve students' understanding of echocardiography and satisfaction with the course. Our study provides evidence supporting the use of simulation teaching devices in medical education. Further research is needed to explore the long-term impact of this teaching method on students' learning outcomes and its integration into the medical curriculum.

TRIAL REGISTRATION

http://www.chictr.org.cn (registration number: ChiCTR2300074015, 27/07/2023).

Multiple stations in an integrated design of cardiovascular system morphology for medical undergraduate

The morphology knowledge is essential for clinical, diagnostic and surgical practice in medicine. However, it is a great challenge teaching this science in an integrated curriculum, since it has the need of active methods associated with technology, in a total impaired workload. Therefore, this work described an educational design of multiple practice stations in order to teach morphology of the cardiovascular system in the undergraduate medical education. This activity was conducted in the Multicampi School of Medical Sciences of Federal University of Rio Grande do Norte (UFRN) in Caicó/Brazil. Four anatomy stations and four embryology and histology stations of heart and blood vessels were drawn up. Anatomy stations approached cardiac cycle and cardiac valves (1 A); mediastinum and pericardium (2 A); internal morphology and heart conduction system (3 A) and external morphology of heart (4 A). Whereas embryology and histology stations approached embryogenesis of the heart (1B); cardiac microanatomy and fetal circulation (2B); and vascular microanatomy (3B;4B). All the stations emphasized cognitive and psychomotor fields associated with clinical correlations to active application of morphology knowledge. The multiple stations were considered as an organized, productive, enlightening and riveting alternative to medical students and teaching staff. This innovative experience integrated and energized the three areas of morphological sciences, resignifying the teaching and learning of cardiovascular system morphology.

Ultrasound versus videos: A comparative study on the effectiveness of musculoskeletal anatomy education and student cognition

Ultrasound imaging is a dynamic imaging technique that uses high-frequency sound waves to capture live images of the structures beneath the skin. In addition to its growing use in diagnosis and interventions, ultrasound imaging has the potential to reinforce concepts in the undergraduate medical curriculum. However, research assessing the impact of ultrasound on anatomy learning and student cognition is scarce. The purpose of this study was to compare the impact of ultrasound-based instruction versus narrated videos on students' understanding of anatomical relationships, as well as the role of intrinsic motivation, self-efficacy beliefs, and students' attitudes in this process. A booster course on anterior leg and wrist anatomy was offered to second-year medical students. A randomized controlled trial with a cross-over design allocated students to either an ultrasound-based teaching condition (cohort A) or a narrated anatomy video condition (cohort B). Next, participants were crossed to the alternative intervention. At the start of the study (T0), baseline anatomy knowledge, intrinsic motivation, self-efficacy beliefs, and spatial ability were measured. After the first intervention (T1) and at the end of the study (T2), both cohorts were administered an anatomy test, an intrinsic motivation scale, and a self-efficacy scale. In addition, each student was asked to fill out a perception survey after the ultrasound intervention. Finally, building on the cross-over design, the most optimal sequence of interventions was examined. A total of 181 students participated (cohort A: n = 82, cohort B: n = 99). Both cohorts performed comparably on the baseline anatomy knowledge test, spatial ability test, intrinsic motivation, and self-efficacy scale. At T1, cohort B outperformed cohort A on the anatomy test (p = 0.019), although only a small effect size could be detected (Cohen's d = 0.34). Intrinsic motivation and self-efficacy of both cohorts were similar at T1. At T2, the anatomy test, intrinsic motivation, and self-efficacy scale did not reflect an effect after studying either sequence of the interventions. Students reported favorably about the ultrasound experience, but also mentioned a steep learning curve. Medical students found the hands-on ultrasound sessions to be valuable, increasing their interest in musculoskeletal anatomy and ultrasound imaging. However, the addition of ultrasound did not result in superior spatial anatomy understanding compared to watching anatomy videos. In addition, ultrasound teaching did not have a major effect on student cognition. Ultrasound-based teaching of musculoskeletal anatomy is regarded as difficult to learn, and therefore it is hypothesized that too high levels of cognitive load might explain the presented results.

3D-Printing-Based Fluoroscopic Coronary Angiography Simulator Improves Learning Capability Among Cardiology Trainees

Aim

One of the essential competencies of cardiology trainees is the ability to perform coronary angiography with good projection.

Purpose

This study is a research and development study aimed at testing the effectiveness of 3D-printing-based fluoroscopic coronary angiography simulator as a learning medium for diagnostic coronary angiogram.

Methods

Thirty-four cardiology trainees randomly were divided into two groups. Both groups took a pretest before the intervention. The first group (group A) studied using conventional learning media and underwent the first post-test. Afterward, they switched to a 3D-printing-based fluoroscopic coronary angiography simulator and underwent a second post-test. The second group (group B) studied using a 3D-printing-based fluoroscopic coronary angiography simulator, underwent the first post-test, switched to the conventional learning media, and underwent a second post-test.

Results

The delta between the post-test I and the pretest of group B was 8.53, higher than the delta between the post-test I and the pretest of group A (5.21) with a significant difference (p = 0.003). In group A, the delta between post-test II and pretest was 9.65, higher than the delta between post-test I and pretest (5.21) with a significant difference (p < 0.001).

Conclusion

3D-printing-based fluoroscopic coronary angiography simulator is effective as a learning medium for coronary angiogram diagnostics.

Utilizing Simulation as a Means to Teach Diagnostic Medical Sonography: A Multi-Site Discipline-Based Educational Research Project

Objective:

This discipline-based educational research (DBER) project was designed to longitudinally study the influence of high-fidelity computer-based sonography simulators (HFCBSSs) on student learning. The research question was: Can the implementation of HFCBSS improve clinical skills for sonography students, beyond traditional methods?

Materials and Methods:

HFCBSSs were shipped to three educational sites for implementation. A quasi-experimental design was utilized across the three educational sites. Educational materials, simulator guides, and assessment templates were developed for implementation. The educational sites revised their standard curricula to allow for students to develop skills with HFCBSS, low-fidelity simulation (e.g. phantoms), and sonographic evaluation of peer classmates. A control group of graduating sonography students was assessed having no HFCBSS experience. Those assessment scores were used as an educational threshold. Successive cohorts of students across the educational sites were assessed as they progressed through their first year.

Results:

First-year sonography students, exposed to the revised simulation curricula, demonstrated higher median assessment scores, on most sonographic examinations, than the control-group student scores. Those student cohorts that were exposed to the revised simulation curricula but demonstrated a lower median assessment score were remediated to make sure they were ready for clinical placement. Students, across all three educational sites, rated their experience with the HFCBSS as second only to gaining patient examinations in their sonography clinical placements.

Conclusion:

This educational research project spanned three educational sites, with varied curricula, but it did demonstrate HFCBSS is a useful and effective educational tool. It also demonstrated how preclinical sonographic skill assessments can ensure students get lab-based remediation prior to clinical placement. These results are exclusive to this cohort and should be replicated at other sites, for concurrence.

Does ultrasound education improve anatomy learning? Effects of the Parallel Ultrasound Hands-on (PUSH) undergraduate medicine course

BACKGROUND

As ultrasound has become increasingly prominent in medicine, portable ultrasound is perceived as the visual stethoscope of the twenty-first century. Many studies have shown that exposing preclinical students to ultrasound training can increase their motivation and ultrasound competency. However, few studies have discussed the effect of ultrasound training on anatomy learning.

METHOD

The Parallel Ultrasound Hands-on (PUSH) course was designed to investigate whether or not ultrasonography training affects anatomy knowledge acquisition. The PUSH course included anatomical structures located in the chest and abdomen (target anatomy) and was conducted in parallel to the compulsory gross anatomy course. Learners (n = 140) voluntarily participated in this elective course (learners in the course before the midterm examination (Group 1, n = 69), or after the midterm examination (Group 2, n = 71)). Anatomy examination scores (written and laboratory tests) were utilized to compare the effects of the PUSH course.

RESULT

Group 1 obtained significantly higher written test scores on the midterm examination (mean difference [MD] = 1.5(7.6%), P = 0.014, Cohen's d = 0.43). There was no significant difference in the final examination scores between the two groups (Written Test: MD = 0.3(1.6%), P = 0.472). In Laboratory test, both mid-term (MD:0.7(2.8%), P = 0.308) and final examination (MD:0.3(1.5%), P = 0.592) showed no significant difference between two groups. Students provided positive feedback in overall learning self-efficacy after the PUSH course (Mean = 3.68, SD = ±0.56 on a 5-point Likert scale). Learning self-efficacy in the cognitive domain was significantly higher than that in the affective domain (MD = 0.58; P < 0.001) and psychomotor domain (MD = 0.12; P = 0.011).

CONCLUSION

The PUSH course featured a hands-on learning design that empowered medical students to improve their anatomy learning.

Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University

The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.

Canine Skull Digitalization and Three-Dimensional Printing as an Educational Tool for Anatomical Study

This article aims to standardize 3D scanning and printing of dog skulls for educational use and evaluate the effectiveness of these anatomical printed models for a veterinary anatomy course. Skulls were selected for scanning and creating 3D-printed models through Fused Deposition Modeling using acrylonitrile-butadiene-styrene. After a lecture on skull anatomy, the 3D-printed and real skull models were introduced during the practical bone class to 140 students. A bone anatomy practical test was conducted after a month; it consisted in identifying previously marked anatomical structures of the skull bones. The students were divided into two groups for the exam; the first group of students took the test on the real skulls, whereas the second group of students took the test on 3D-printed skulls. The students' performance was evaluated using similar practical examination questions. At the end of the course, these students were asked to answer a brief questionnaire about their individual experiences. The results showed that the anatomical structures of the 3D-printed skulls were similar to the real skulls. There was no significant difference between the test scores of the students that did their test using the real skulls and those using 3D prints. In conclusion, it was possible to construct a dynamic and printed digital 3D collection for studies of the comparative anatomy of canine skull species from real skulls, suggesting that 3D-digitalized and-printed skulls can be used as tools in veterinary anatomy teaching.

Digitalização e Impressão Tridimensional de Crânio Canino como Ferramenta Educacional para Estudo Anatômico

Este trabalho teve como objetivo padronizar a digitalização e impressão 3D de crânios de cães para uso educacional e avaliar a eficácia de modelos anatômicos impressos na disciplina de anatomia do curso de medicina veterinária. Os crânios foram selecionados para escaneamento e criação dos modelos impressos 3D modelados por fusão de deposição (FDM) utilizando acrilonitrila butadieno estireno. Após uma aula teórica sobre anatomia do crânio os modelos impressos 3D e os modelos reais do crânio de cães foram apresentados aos 140 alunos durante a aula prática de ossos. Uma avaliação prática de osteologia foi realizada após um mês que consistiu na identificação de estruturas anatômicas dos ossos do crânio identificados por alfinetes. Os alunos foram divididos em duas turmas para a realização da avaliação; o primeiro grupo fez os testes usando os crânios reais, enquanto o segundo grupo os crânios impressos 3D. O desempenho dos alunos foi avaliado conforme as suas performances no exame prático. No final da disciplina, eles foram convidados a responder a um breve questionário sobre suas experiências individuais. Os resultados do estudo demonstram que as estruturas anatômicas dos crânios impressos 3D eram semelhantes aos crânios reais. Não houve diferença significativa quando se analisou o grau de acertos e erros durante a realização do exame entre aqueles que identificaram as estruturas nos crânios reais ou nos impressos 3D. Conclui-se que é possível construir um acervo dinâmico digital e impresso tridimensional (3D) para estudos da anatomia comparada da espécie canina a partir de crânios reais, e que os crânios 3D podem ser usados como uma excelente ferramenta alternativa ao ensino na anatomia veterinária.

Ultrasound in Medical Education: Can Students Teach Themselves?

INTRODUCTION

A new technology in medical education is ultrasound simulation, which has been shown to help students learn while reducing load on clinical instructors. The goal of this study is to compare the efficacy of teaching using ultrasound simulators versus more traditional instructor-led sessions with ultrasound machines.

METHODS

Ultrasound was used to teach cardiac anatomy and physiology to medical students. Volunteers in one group were instructed using an ultrasound simulator (SonoSim) with built-in lessons; the other group received a traditional instructor-led session with an ultrasound machine. Efficacy of each type of teaching was assessed by measuring improvement from a pre-session test to a post-session test, using a one-sample paired t-test to compare averages between groups. Participants were given a survey to solicit opinions of the lessons.

RESULTS

Twenty-one medical students participated, with 12 in the instructor-led group and 9 in the simulator group. Both groups increased their test scores from pre-session to post-session; the average increase was 5% in the instructor-led and 10% in the simulator group (p = 0.437). There was no statistically significant difference between groups in how effective or enjoyable the lesson felt. Participants from either group who tried both methods were likely to prefer the traditional ultrasound teaching.

CONCLUSION

Self-guided learning with simulators and traditional instructor-led lectures are both effective for teaching basic cardiac anatomy and physiology via ultrasound. However, most students prefer learning with instructors if given the opportunity. Self-guided ultrasound simulators may serve as an effective standalone learning method or an adjunct to instructor-led sessions.

Ultrasound's Impact on Preclinical Medical Student Neurology Unit Grades: Findings After 2 Years

OBJECTIVES

Ultrasound is a valuable tool for anatomy education, but limited evidence exists for using ultrasound to teach neuroanatomy and neurophysiology. Previous work demonstrated a potential increase in medical knowledge in preclinical medical students participating in a neurology ultrasound workshop, however, without comparison to a control group. After 2 years, we assessed how a neurology ultrasound workshop affected the medical knowledge of participating preclinical medical students compared to a traditional curriculum control group.

METHODS

This quasiexperimental study compared academic performance of ultrasound workshop participants to nonparticipant classmates. The primary outcome was the overall neurologic disorders unit total score. An analysis of covariance was conducted to test for statistically significant differences while controlling for the average quiz score.

RESULTS

A total of 360 medical students were included in the study. The intervention group (n = 57) showed no significant difference in the total unit score (F = 3.206; P = .074), with averages for the control and experimental groups being 87.3% ± 5.0% and 88.4% ± 4.8%, respectively. Additionally, anatomy practical scores and written final examination scores were not significantly different between groups (F = 1.035; P = .310; F = 2.035; P = .155).

CONCLUSIONS

Participation in a neurologic disorders ultrasound workshop did not appear to be correlated with improved curricular performance in our cohort. Further research should continue to assess ultrasound workshops in other organ systems to elucidate the relationship between learning ultrasound and the impact on medical school academic performance.

Introducing echocardiography to medical students: A novel echocardiography E-Learning experience

BACKGROUND

Echocardiography is fundamental in the understanding of cardiology; however, echocardiography is not routinely taught in medical schools. The aim of this study is to assess whether teaching echocardiography to preclinical medical students using an e-learning software (ELS) is practical and appropriate.

METHODS

From 2017 to 2019, 1084 second-year medical students at Indiana University School of Medicine were introduced to echocardiography by using the ELS. In 2017 and 2018 students had a postcourse survey to assess echocardiography appropriateness and cardiology learning. Students in 2018 and 2019 were assessed for any association between the use of the ELS and learning cardiology by comparing examination scores.

RESULTS

In 2017-2018, 127 students responded to the survey (18% response rate). In 2017, 79% of responders and in 2018, 89% reported that introducing echocardiography to medical students is appropriate. In 2017, 78% and in 2018, 87% reported that it improved the understanding of cardiology. Student ELS usage was high for 2017-2018 (93% and 70%) but dropped in 2019 (30%). In 2018 and 2019, students who used ELS did statistically significantly better on the examination (total scores 84% vs. 82% (P = .008) in 2018; 84% vs. 81% (P = .002) in 2019).

CONCLUSIONS

Many 2nd year medical students felt learning echocardiography with ELS was appropriate and enhanced their learning cardiology. Using echocardiography to help learn cardiology appears to be supported with an association of ELS usage and improved examination scores. Our study suggests that echocardiography learning can and probably should begin in medical school.

A Hands-On Organ-Slicing Activity to Teach the Cross-Sectional Anatomy

The presentation of pre-sliced specimens is a frequently used method in the laboratory teaching of cross-sectional anatomy. In the present study, a new teaching method based on a hands-on slicing activity was introduced into the teaching of brain, heart, and liver cross-sectional anatomy. A randomized, controlled trial was performed. A total of 182 third-year medical students were randomized into a control group taught with the prosection mode (pre-sliced organ viewing) and an experimental group taught with the dissection mode (hands-on organ slicing). These teaching methods were assessed by testing the students' knowledge of cross-sectional specimens and cross-sectional radiological images, and analyzing students' feedback. Using a specimen test on three organs (brain, heart, and liver), significant differences were observed in the mean scores of the control and experimental groups: for brain 59.6% (±14.2) vs. 70.1% (±15.5), (P < 0.001, Cohen's d = 0.17); for heart: 57.6% (±12.5) vs. 75.6% (±15.3), (P < 0.001, d = 0.30); and for liver: 60.4% (±14.5) vs. 81.7% (±14.2), (P < 0.001, d = 0.46). In a cross-sectional radiological image test, better performance was also found in the experimental group (P < 0.001). The mean scores of the control vs. experimental groups were as follows: for brain imaging 63.9% (±15.1) vs. 71.1% (±16.1); for heart imaging 64.7% (±14.5) vs. 75.2% (±15.5); and for liver imaging 61.1% (±15.5) vs. 81.2% (±14.6), respectively. The effect sizes (Cohen's d) were 0.05, 0.23, and 0.52, respectively. Students in the lower tertile benefited the most from the slicing experiences. Students' feedback was generally positive. Hands-on slicing activity can increase the effectiveness of anatomy teaching and increase students' ability to interpret radiological images.

Teaching neurological disorders with ultrasound: A novel workshop for medical students

INTRODUCTION

The goal of this study was to assess if a neurological disorder ultrasound workshop for the first-year medical students significantly enhanced the students' ability to retain and apply concepts related to neuroanatomy and neurophysiology.

MATERIALS AND METHODS

We performed a prospective study to evaluate student performance before and after an optional ultrasound workshop. Data were collected through a within-population pretest-posttest design. Purposive sampling was used to recruit first-year medical students for this study. The six stations were transcranial doppler ultrasound, ocular ultrasound, ultrasound-guided external ventricular drain placement, high-intensity focused ultrasound for brain lesions, carotid artery scan with ultrasound, and ultrasound-guided central line placement. We used a pre-post workshop survey to identify opinions and perceptions about ultrasound and a pre-post workshop test to assess knowledge about neuroanatomy, neurophysiology, and related ultrasound topics.

RESULTS

Twenty-two 22 first-year medical students consented to participate in this study. The Wilcoxon signed-rank test showed a statistically significant difference in pre- and posttest scores, suggesting that participants demonstrated higher levels of medical knowledge related to neurological physiology, anatomy, and ultrasound after participating in the workshop. The analysis of the pre-post survey showed participants attributed greater value to ultrasound as a useful tool for their future medical practice after participation in the event (Z = -2.45, P = 0.014).

CONCLUSIONS

There is value in integrating experiences with ultrasound into the neurological disorder block of medical school. Future studies, with a larger sample size, are needed to further explore the efficacy of this workshop in enhancing knowledge retention.

The Use of Ultrasound Simulators to Strengthen Scanning Skills in Medical Students: A Randomized Controlled Trial

OBJECTIVES

This study evaluates the use of ultrasound simulators for retaining and improving ultrasound skills acquired in undergraduate ultrasound training.

METHODS

Fourth-year medical students (n = 19) with prior training in point-of-care sonography for shock assessment were recruited for this study. Students were randomly assigned to a study group (n = 10) that followed an undergraduate ultrasound training curriculum, then used a simulator to complete 2 self-directed practice ultrasound sessions over 4 weeks. The control group (n = 9) followed the same undergraduate ultrasound training curriculum and received no additional access to a simulator or ultrasound training. A blinded assessment of the students was performed before and after the 4-week study period to evaluate their image acquisition skills on standardized patients (practical examination). To evaluate the student's clinical understanding of pathological ultrasound images, students watched short videos of prerecorded ultrasound scans and were asked to complete a 22-point questionnaire to identify their findings (visual examination).

RESULTS

All results were adjusted to pretest performance. The students in the study group performed better than those in the control group on the visual examination (80.1% versus 58.9%; P = .003) and on the practical examination (77.7% versus 57.0%; P = .105) after the 4-week study period. The score difference on the postintervention practical examinations was significantly better for the study group compared to the control group (11.6% versus -9.9%; P = .0007).

CONCLUSION

The use of ultrasound simulators may be a useful tool to help previously trained medical students retain and improve point-of-care ultrasound skills and knowledge.

Hands-on or no hands-on training in ultrasound imaging: A randomized trial to evaluate learning outcomes and speed of recall of topographic anatomy

Medical students have difficulties in interpreting two-dimensional (2D) topographic anatomy on sectional images. Hands-on and no hands-on training in ultrasound imaging facilitate learning topographic anatomy. Hands-on training is linked with active search for patterns of anatomical structures and might train pattern recognition for image interpretation better although the added value on learning outcomes is unclear. This study explores first year medical students' knowledge in topographic anatomy of the upper abdomen after attending hands-on or no hands-on training in ultrasound in a randomized trial. While students in the hands-on ultrasound group (N = 21) generated and interpreted standardized planes of ultrasound imaging, students in the no hands-on seminar group (N = 22) interpreted provided ultrasound images by correlation to three-dimensional (3D) anatomical prosections. Afterwards knowledge in topographic anatomy was measured repetitively by text and ultrasound image-based multiple choice (MC) examinations. As surrogate for pattern recognition, students rated whether answers were known after reflection or instantly. While intrinsic motivation was higher in the ultrasound group, no differences in the MC-examination score were found between ultrasound and seminar group instantly (66.5 ±10.9% vs. 64.5% ±11.0%, P = 0.551) or six weeks (62.9% ±12.3% vs. 61.5% ±11.0%, P = 0.718) after training. In both groups scores in text-based questions declined (P < 0.001) while scores in image-based questions remained stable (P = 0.895) with time. After six weeks more image-based questions were instantly known in the hands-on ultrasound compared to seminar-group (28% ±17.3% vs. 16% ±13.5%, P = 0.047). Hands-on ultrasound-training is linked with faster interpreting of ultrasound images without loss in accuracy. The added value of hands-on training might be facilitation of pattern recognition.

Comparison of learning outcomes for teaching focused cardiac ultrasound to physicians: A supervised human model course versus an eLearning guided self- directed simulator course

PURPOSE

Focused cardiac ultrasound (FCU) training in critical care is restricted by availability of instructors. Supervised training may be substituted by self-directed learning with an ultrasound simulator guided by automated electronic learning, enabling scalability.

MATERIALS AND METHODS

We prospectively compared learning outcomes in novice critical care physicians after completion of a supervised one-and-a-half-day workshop model with a self-guided course utilizing a simulator over four weeks. Both groups had identical pre-workshop on-line learning (20h). Image quality scores were compared using FCU performed on humans without pathology. Interpretive knowledge was compared using 20MCQ tests.

RESULTS

Of 161 eligible, 145 participants consented. Total Image quality scores were higher in the Simulator group (95.2% vs. 66.0%, P < .001) and also higher for each view (all P < .001). Interpretive knowledge was not different before (78.6% vs. 79.0%) and after practical training (74.7% vs. 76.1%) and at 3 months (81.0% vs. 77.0%, all P > .1). Including purchase of the simulator and ultrasound equipment, the simulator course required lower direct costs (AUD$796 vs. $1724 per participant) and instructor time (0.5 vs.1.5 days) but similar participant time (2.8 vs. 3.0 days).

CONCLUSIONS

Self-directed learning with ultrasound simulators may be a scalable alternative to conventional supervised teaching with human models.

Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review

The clinical applications of point-of-care ultrasound (US) have expanded rapidly over the past decade. To promote early exposure to point-of-care US, there is widespread support for the integration of US curricula within undergraduate medical education. However, despite growing evidence and enthusiasm for point-of-care US education in undergraduate medical education, the curricular design and delivery across undergraduate medical education programs remain variable without widely adopted national standards and guidelines. This article highlights the educational and teaching applications of point-of-care US with a focus on outcomes. We then review the evidence on curricular design, delivery, and integration and the assessment of competency for point-of-care US in undergraduate medical education.

Ultrasound in undergraduate medical education: a systematic and critical review

CONTEXT

The use of point-of-care ultrasound (POCUS) in clinical care is growing rapidly and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically.

OBJECTIVES

We conducted a critical and systematic review framed by the rationales enumerated in academic publications by advocates of ultrasound in UME.

METHODS

This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified from an archive of 403 academic publications using techniques from Foucauldian critical discourse analysis (CDA). We then sought empirical evidence in support of these rationales, using a critical synthesis methodology also adapted from CDA.

RESULTS

We identified four dominant discursive rationales with different levels of evidentiary support. The use of ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve the quality of patient care was difficult to evaluate.

CONCLUSIONS

Our analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimises them and may preclude further primary research. As the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

Cognitive load imposed by ultrasound-facilitated teaching does not adversely affect gross anatomy learning outcomes

Ultrasonography is increasingly used in medical education, but its impact on learning outcomes is unclear. Adding ultrasound may facilitate learning, but may also potentially overwhelm novice learners. Based upon the framework of cognitive load theory, this study seeks to evaluate the relationship between cognitive load associated with using ultrasound and learning outcomes. The use of ultrasound was hypothesized to facilitate learning in anatomy for 161 novice first-year medical students. Using linear regression analyses, the relationship between reported cognitive load on using ultrasound and learning outcomes as measured by anatomy laboratory examination scores four weeks after ultrasound-guided anatomy training was evaluated in consenting students. Second anatomy examination scores of students who were taught anatomy with ultrasound were compared with historical controls (those not taught with ultrasound). Ultrasound's perceived utility for learning was measured on a five-point scale. Cognitive load on using ultrasound was measured on a nine-point scale. Primary outcome was the laboratory examination score (60 questions). Learners found ultrasound useful for learning. Weighted factor score on "image interpretation" was negatively, but insignificantly, associated with examination scores [F (1,135) = 0.28, beta = -0.22; P = 0.61]. Weighted factor score on "basic knobology" was positively and insignificantly associated with scores; [F (1,138) = 0.27, beta = 0.42; P = 0.60]. Cohorts exposed to ultrasound had significantly higher scores than historical controls (82.4% ± SD 8.6% vs. 78.8% ± 8.5%, Cohen's d = 0.41, P < 0.001). Using ultrasound to teach anatomy does not negatively impact learning and may improve learning outcomes. Anat Sci Educ 10: 144-151. © 2016 American Association of Anatomists.

Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis

Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real-time visualization of anatomic structures and relationships in vivo, holds potential for pre-clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound-based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176-189. © 2016 American Association of Anatomists.

Use of 3D printed models in medical education: A randomized control trial comparing 3D prints versus cadaveric materials for learning external cardiac anatomy

Three-dimensional (3D) printing is an emerging technology capable of readily producing accurate anatomical models, however, evidence for the use of 3D prints in medical education remains limited. A study was performed to assess their effectiveness against cadaveric materials for learning external cardiac anatomy. A double blind randomized controlled trial was undertaken on undergraduate medical students without prior formal cardiac anatomy teaching. Following a pre-test examining baseline external cardiac anatomy knowledge, participants were randomly assigned to three groups who underwent self-directed learning sessions using either cadaveric materials, 3D prints, or a combination of cadaveric materials/3D prints (combined materials). Participants were then subjected to a post-test written by a third party. Fifty-two participants completed the trial; 18 using cadaveric materials, 16 using 3D models, and 18 using combined materials. Age and time since completion of high school were equally distributed between groups. Pre-test scores were not significantly different (P = 0.231), however, post-test scores were significantly higher for 3D prints group compared to the cadaveric materials or combined materials groups (mean of 60.83% vs. 44.81% and 44.62%, P = 0.010, adjusted P = 0.012). A significant improvement in test scores was detected for the 3D prints group (P = 0.003) but not for the other two groups. The finding of this pilot study suggests that use of 3D prints do not disadvantage students relative to cadaveric materials; maximally, results suggest that 3D may confer certain benefits to anatomy learning and supports their use and ongoing evaluation as supplements to cadaver-based curriculums. Anat Sci Educ 9: 213-221. © 2015 American Association of Anatomists.