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

An Assessment of the Imaging Performance of Hand-Held Ultrasound Scanners Using the Edinburgh Pipe Phantom

OBJECTIVE

Although hand-held ultrasound devices (HHUSDs) are currently used for a diverse range of diagnostic and interventional applications the imaging performance of such scanners is rarely considered. The aim of this study was to assess the imaging performance of a wide-range of HHUSDs and compare their imaging performance to cart-based systems utilized for the same clinical applications.

METHODS

The grayscale imaging performances of 19 HHUSDs from eight different manufacturers, manufactured between 2016 and 2021, were measured using a figure-of-merit known as the resolution integral. The imaging performance of the HHUSDs were compared to 142 cart-based ultrasound scanners.

RESULTS

The HHUSD with the overall highest resolution integral (66) was a Butterfly (Burlington, MA, USA) wired phased array for small parts applications, followed by a Philips (Bothell, WA, USA) Lumify wired curvilinear transducer (57) for abdominal applications, a Butterfly wired phased array (56) for abdominal applications, a GE (Freiburg, Baden-Wurttemberg, Germany) VScan Air wireless linear array (56) for small parts applications, and a Healcerion (Seoul, Korea) Sonon 300L wireless linear array (56) for small parts applications. A GE VScan Extend wired phased array had the highest resolution integral (44) for cardiac applications.

CONCLUSIONS

The Butterfly phased array had the highest resolution integral of all the 19 HHUSDs, although this value is still less than the majority of cart-based cardiac and abdominal ultrasound scanners manufactured from 2010 to 2017. Clinical users of HHUSDs should be mindful of the limitations in imaging performance of hand-held ultrasound devices.

Development and evaluation of a point-of-care ocular ultrasound curriculum for medical students - a proof-of-concept study

BACKGROUND

Point-of-care Ocular Ultrasound (POCOUS) has gained importance in emergency medicine and intensive care in recent years. This work aimed to establish and evaluate a dedicated ultrasound education program for learning POCOUS-specific skills during medical studies at a university hospital.

METHODS

The blended learning-based program (6 teaching units) based on recent scientific publications and recommendations was developed for students in the clinical part of their medical studies. Experts and trainers consisted of physicians from the Ear-Nose-Throat, radiology, ophthalmology and neurology specialties as well as university educational specialists. Lecture notes containing digital video links for preparation was produced as teaching material. In total, 33 students participated in the study. The education program, including the teaching materials, motivation and subjective gain in competency, was evaluated with the aid of a questionnaire (7-point Likert response format). Objective learning success was assessed on the basis of pre- and post-tests. These covered the skill areas: "anatomical basics", "ultrasound basics", "understanding of cross-sectional images", "normal findings" and "pathology recognition".

RESULTS

In the objective assessment of image interpretation, the participants improved significantly (p < 0.001) from pre- to post-test with a large effect size (Cohen's d = 1.78, effect size r = 0.66). The evaluations revealed a high level of satisfaction with the course concept, teaching materials and the tutors. In addition, a high level of motivation was recorded in relation to continuing to study "ultrasound diagnostics" and "ophthalmologic diseases". A significant (p < 0.01) positive gain was also achieved in terms of the subjective assessment of competency. This covers areas such as expertise, sonographic anatomy and performing a POCOUS examination as well as recognizing retinal detachment, globe perforation and increased optic nerve sheath diameter.

CONCLUSION

The results of this feasibility study show that medical students accept and support a POCOUS-specific education program and are able to develop a higher objective and subjective level of competency. Future transfer to other sites and larger groups of participants seems feasible.

Ultrasound skills teaching in UK medical education: A systematic review

BACKGROUND

Sonography is increasingly integrated into medical curricula to prepare students for clinical practice. In 2022, we conducted a systematic review to explore the degree to which ultrasound skill acquisition is incorporated into undergraduate medial education in the United Kingdom.

METHODS

A search of Medline and Embase databases from 2003 to 2022 identified 15 relevant articles. Studies were included if they described ultrasound skills training in UK undergraduate medical education.

FINDINGS

A range of teaching methods were reported including didactic demonstrations, hands-on experience and combinations thereof. Portable machines were more common than cart-based machines, and most demonstrators were ultrasound-trained clinicians. Ultrasound teaching is well received, with improvements in confidence using ultrasound, motivation to learn anatomy and retention of knowledge.

DISCUSSION

Obstacles to integration were noted including training, cost, curriculum time constraints and the issue of incidental pathology. One study demonstrated that anatomists with appropriate training could provide ultrasound teaching, reducing the need for clinicians or sonographers. Costs may be reduced by renting machines or purchasing portable/hand-held devices. Allowing access to machines during student's free time may address scheduling difficulties. A final recommendation is to pre-scan volunteers prior to the teaching session.

CONCLUSION

We have outlined approaches to ultrasound skills teaching and the inherent hurdles to this, as well as potential solutions. This may aid educators wishing to augment their curricula. Although there are relatively few studies from the United Kingdom, there is consensus that students enjoy the incorporation of ultrasound practice and believe it complements existing teaching, especially in a small group setting.

Radiology for anatomy educators: Success of an online, 2-day course for radiology training

Incorporation of radiology training into anatomy education from community college to health professional schools is becoming increasingly popular. However, anatomy educators generally lack training in common radiology modalities, including X-ray, CT, MRI, and ultrasound. Professional development or continuing education courses provide current and new educators the chance to gain new skills within a short timeframe. Here, a 2-day, online course for anatomy educators was created. The goals of which were for the participants: to gain basic knowledge of different radiology modalities, recognize normal radiographic images, and apply that information to common diseases or injuries in interactive case studies. Each day focused on different modalities, where Day 1 studied X-ray, CT, and MRI; and Day 2 studied Ultrasound. A 10-question pre- and post-test was taken by attendees for each day of instruction on a voluntary basis. Following the completion of the course, attendees were provided a survey to determine their perceptions on course content and knowledge acquired. Most attendees instructed undergraduates at 4-year universities, though several attendees came from community colleges and high schools. All attendees showed a significant improvement in knowledge from their pre- to post-test scores in X-ray, CT, MRI, and ultrasound following training. This was also reflected in their survey responses, where attendees felt the course was effective in increasing their knowledge and confidence in radiology. Overall, this study demonstrates the effectiveness of online continuing education courses and the need for more introductory radiology courses for anatomy educators.

Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards

BACKGROUND

A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills.

METHODS

Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed.

RESULTS

A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor's didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05).

CONCLUSION

These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.

Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School-A Prospective Study

INTRODUCTION

Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses.

METHODS

From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum".

RESULTS

Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills.

CONCLUSIONS

Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.

Self-learning followed by telepresence instruction of focused cardiac ultrasound with a handheld device for medical students: a preliminary study

Purpose

This study aimed to assess the feasibility and efficiency of self-learning with or without self-training (subjects performed scans on themselves) and telepresence instruction in focused cardiac ultrasound (FOCUS) education for medical students.

Methods

This study included 24 medical students. The participants initially completed a written pre-test and were randomized into a video lecture (participants watched a video lecture) or self-training (participants watched a video lecture and self-performed FOCUS) group. After finishing self-learning, they completed a written post-test. Then they undertook a skill pre-test and a first perception survey. Telepresence instruction was then provided. Finally, they undertook a skill post-test and a second perception survey.

Results

The written post-test total scores were significantly higher than the pre-test total scores (P < 0.001). In the skill pre-test, the scores for the video lecture and self-training groups were not significantly different (P = 0.542). The skill post-test total scores were significantly higher than the skill pre-test total scores (P = 0.008). Forty-two percent of the video lecture group participants agreed that the video lecture was effective preparation for the skill pre-test, while all participants in the same group agreed that the combination of the video lecture and telepresence instruction was effective preparation for the skill post-test.

Conclusion

This study demonstrated the feasibility and efficiency of self-learning followed by telepresence instruction on FOCUS for medical students.