Aus- und Weiterbildung in der Abdomen-Sonographie an den deutschen Universitäten

Evaluation of an elective ultrasound course for medical students

To evaluate the educational benefits of teaching ultrasound in an elective radiological course for medical students. We conducted a single-center retrospective analysis of a one-week elective ultrasound course in which 39 medical students (25 female; median age 25.8 ± 2.8 years, range 21-35, 4th and 5th years of undergraduate medical education) participated as part of their radiological training. The students completed a pre- and post-course questionnaire using a five-point Likert scale for self-assessment of technical knowledge, confidence in the procedure regarding different organs, motivation for performing ultrasound, and the importance of ultrasound in medical education. The students also assessed the value of ultrasound teaching in the context of their general medical degree. Pre-test and post-test scores showed significantly improved radiology knowledge (p ≤ 0.001) concerning all abdominal organs (liver, spleen, gallbladder, kidney, urinary bladder, aorta and retroperitoneum). A significant improvement was registered in performing ultrasound of peripheral arteries and venous structures (each p = 0.001), and also of the thyroid gland (p = 0.006). General surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments. Systematic training in ultrasound markedly improved the students' skills. This was especially pronounced for solid organ structures, while students requested more education regarding the retroperitoneum and vascular structures. Teaching ultrasound in an elective hands-on training course improves anatomical understanding and practical skills associated with increased motivation. The results affirm the necessity and clinical relevance of the course during the radiological training of medical students.

[Current state of under- and postgraduate education in abdominal ultrasonography at German university hospitals. A panel study over 20 years]

OBJECTIVE

 In Germany, there is no standardized ultrasound training. This study aims to provide a survey into the current state of abdominal ultrasonography training at German university hospitals as well as a comparative analysis of the results from studies conducted in 1999 and 2009.

METHODS

 Chief gastroenterologists from Germany's 34 university hospitals were invited to respond to a postal survey asking about technical equipment, the number of ultrasound scans, the role of professional societies and undergraduate as well as postgraduate training. The response rate was 79 %. In addition, 1183 medical students from 34 faculties completed a complementary online teaching evaluation.

RESULTS

 At university hospitals, abdominal ultrasonography is conducted in an increasingly interdisciplinary context. Today, 29 % of university hospitals have interdisciplinary ultrasound centers. The study shows that the number of available ultrasound machines has increased - each hospital has an average of 5.2 systems. This is an increase of 30 % in comparison to 2009 and of 27 % in comparison to 1999. However, the willingness to invest in modern ultrasound machines has decreased. The total number of ultrasound scans as well as the number of contrast-enhanced ultrasound scans have steadily increased over the past years - with a maximum increase of 28 % between 2009 and 2018. The German Society of Ultrasound in Medicine (DEGUM) is increasingly present at university hospitals. It has further strengthened its prominent role in quality assurance and specialist training. Today, 96 % of the chief gastroenterologists are members of DEGUM and 89 % have obtained further qualification offered by the society. Concerning the duration of the training, the number of mandatory examinations and the amount of supervision, there are still considerable differences among the departments. On average, more doctors are trained per department and year. A 6-month full-time training has been established at most hospitals. Sonography enjoys a high standing among students and the findings show a strong readiness for work in that field. The number of practical courses and students has been increasing over the past years. However, there is often an imbalance between the number of courses offered and students who want to enroll.

CONCLUSIONS

 Training conditions have improved for medical staff as well as students despite the fact that there are still considerable differences in quality among the hospitals. The number of ultrasound scans is steadily increasing in all departments. The study did not show any adequate improvement in the availability of technical equipment. The German Society of Ultrasound in Medicine (DEGUM) has further strengthened its leading position in the field of sonography.

Specific and non-specific measurements of tissue angiotensin II cascade members

Although angiotensin II (ANG II) has been the focal regulatory peptide of the renin-angiotensin system, its proteolytic fragments have recently been demonstrated to have biological effects. Conventional measurement of angiotensins involves radioimmunoassay (RIA), which is a sensitive binding technique capable of measuring low physiological concentrations. However, ANG II antibody cross-reacts with ANG II and its fragments (ANG II cascade), rendering RIA measurement alone to be a non-specific measure of immunoreactive ANG II (ir-ANG II). On the other hand, high-performance liquid chromatography (HPLC) is capable of separating immunoreactive ANG II cascade members, but may not be sensitive enough to detect these low peptide concentrations often present in biological samples. Consequently, a reverse-phase HPLC method, with triethylammoniun formate as an ion-pair reagent, was developed to separate ANG II and its fragments, ANG III, ANG IV and ANG V. This HPLC separation was applied to extracts from normal canine hearts and ANG II cascade immunoreactive fractions were collected. Collected fractions were quantified by RIA, with the use of separate standard curves. The isocratic HPLC separation of ANG II, ANG III, ANG IV and ANG V was achieved in less than 5 min with adjacent peaks having baseline resolution. Measured cardiac left ventricle ANG III, ANG IV and ANG V concentrations (mean+/-SD) were 5.3+/-2.2,4.0+/-1.0 and 3.1+/-1.0 fmol/g (n=9), respectively. There was a significant difference (P=0.003, n=9) between left ventricular immunoreactive ANG II and 'true' ANG II, corrected for recovery rates of 86.2+/-22.5 and 53.5+/-16.2 fmol/g, respectively. We conclude that the combination of HPLC with RIA ensures the specific measurement of the ANG II cascade family members while non-chromatographic processing of tissue renders ANG II measurement non-specific. In addition, the use of triethylammonium formate as mobile phase additive is superior in the HPLC separation of the angiotensins.