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Herbert A, Russell FM, Ferre RM, Wilcox J, Peterson D, Davis J, Zakeri B, Hays M, Wallach PM. Two-week intensive medical student point-of-care ultrasound training impact on long term utilization. BMC MEDICAL EDUCATION 2024; 24:884. [PMID: 39152440 PMCID: PMC11330062 DOI: 10.1186/s12909-024-05866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND There is little to no data evaluating long term usage of point of care ultrasound (POCUS) after a training intervention for medical students. The purpose of this study was to examine the impact of an intensive POCUS training program on medical student's usage at 9-months post-program. METHODS This was a prospective cross-sectional study of rising second year medical students who participated in a 2-week summer POCUS training program. Instruction consisted of 8 h of asynchronous online didactic material, 2-4 h of daily hands-on instructor-led and independent scanning, and instruction on how to teach POCUS. Students were assessed pre- and post-program, and again at 9 months post-program to evaluate POCUS usage. RESULTS A total of 56 students participated in the program over 2 summers; 52 (92.9%) responded to the 9-month post-program survey. At 9 months, 49 (94.2%) of students taught POCUS after the program to peers or faculty. Students reported serving as a POCUS instructor in 283 subsequent teaching sessions accounting for 849 h of POCUS instruction time. Six (11.5%) students were involved in the creation of a POCUS interest group on their regional campus, 7 (13%) created a POCUS curriculum for their student interest group, and 4 (7.7%) created an opt-in co-curricular POCUS program for students at their regional campus. Three (5.8%) students did not serve as educators after the program and only one student reported not using POCUS again after the program. CONCLUSION After a 2-week intensive POCUS training program for medical students, the majority of students demonstrated continued involvement in POCUS learning and education at 9-month follow-up including serving as peer instructors and assisting with limitations in financial resources and trained faculty.
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Affiliation(s)
- Audrey Herbert
- Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FOB, 3rd Floor, Indianapolis, IN, 46202, USA.
| | - Frances M Russell
- Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Robinson M Ferre
- Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FOB, 3rd Floor, Indianapolis, IN, 46202, USA
| | - James Wilcox
- Assistant Professor of Clinical Family Medicine, Department of Family Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Dina Peterson
- Assistant Professor of Clinical Radiologic and Imaging Sciences, Department of Radiologic and Imaging Sciences, Indiana University School of Medicine, Indianapolis, USA
| | - Jean Davis
- RT, RDMS, Point of Care Ultrasound program manager, Indiana University School of Medicine, Indianapolis, USA
| | - Bita Zakeri
- Ph.D. Director of Professional Programs, Northeastern University, Boston, USA
| | - Matthew Hays
- MS, Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, and Richard M. Fairbanks School of Public Health, Indianapolis, USA
| | - Paul M Wallach
- Professor of Medicine, Indiana University School of Medicine, Executive Associate Dean for Educational Affairs and Institutional Improvement, Indiana University School of Medicine, Indianapolis, USA
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Robertson T, Meyer K, Kerr MS, Gibson J, Bradley L, Reeves R, Handler E. Ultrasound Incorporation in Gross Anatomy Labs in a Master of Medical Sciences Program: A Mixed-Methods Analysis of Student Performance and Perception. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:999-1011. [PMID: 38369775 DOI: 10.1002/jum.16427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
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.
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Affiliation(s)
- Taylor Robertson
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly Meyer
- School of Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Marcel Satsky Kerr
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - John Gibson
- Department of Family Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Libby Bradley
- Department of Radiology, Division of Anatomy, Michigan State University, Lansing, MI, USA
| | - Rustin Reeves
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emma Handler
- Department of Anatomy and Cell Biology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Slyvka Y, Gwilym JL. Teaching ultrasound in osteopathic medical schools. J Osteopath Med 2024; 124:107-113. [PMID: 38053432 DOI: 10.1515/jom-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023]
Abstract
CONTEXT An important diagnostic tool, ultrasound (US) has been incorporated into the curriculum of medical schools for more than 20 years. In the last decade, the interest in US educational research has experienced exponential growth but mostly from Medical Doctor (MD)-granted schools. The extent to which US is embedded in the curricula of the colleges of osteopathic medicine (COM) still requires a comprehensive evaluation. OBJECTIVES This survey is designed to evaluate the current status of US teaching in COMs with an emphasis on the inclusion of the US in osteopathic manipulative medicine (OMM) training. METHODS An anonymous, voluntary, 22-question online survey was created and administered to all COMs to collect data about the current state of US teaching. A descriptive analysis was performed to describe and summarize the final data. Fisher's exact test was utilized for the comparison of study variables. RESULTS We received responses from 36 of the 43 (83.7 %) COMs invited to participate in the survey, all of which had US training within their curriculum, most commonly integrated into the year 1 curriculum (86.1 %). Focused US training is incorporated into 83.3 % of these schools (30 of 36). Focused US training is covered in 83.3 % of schools (30 of 36). US is mostly taught in the anatomy course (38.8 %). US is incorporated in the OMM course in 12 of 36 schools (33.3 %). The majority of respondents feel that US training will make osteopathic students more competitive in the job market (88.9 %) and want more US in their curriculum (86.1 %). The idea that US is useful for a better understanding of the key OMM concepts is believed by 62.9 % of respondents. The major obstacle to the implementation of US in the curriculum is having appropriately trained faculty (86.1 %). The majority of the respondents did not feel that an adequate budget is a handicap to implementing US in the curriculum. CONCLUSIONS US is included within the curriculum of all respondents to our survey, a third of whom included US within their OMM curriculum. US is treated as a useful and important skill for future osteopathic physicians. The majority of COMs desire more US training in the curriculum. The main barrier to implementing US in the curriculum is the lack of appropriately trained faculty.
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Affiliation(s)
- Yuriy Slyvka
- Department of Biomedical Sciences, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Jennifer L Gwilym
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
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Wachira J, Matheka DM, Masheti SA, Githemo GK, Shah S, Haldeman MS, Ramos M, Bergman K. A training program for obstetrics point-of-care ultrasound to 514 rural healthcare providers in Kenya. BMC MEDICAL EDUCATION 2023; 23:922. [PMID: 38053123 DOI: 10.1186/s12909-023-04886-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Ultrasound is a crucial and effective diagnostic tool in medicine. Recent advancements in technology have led to increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low-and middle-income countries (LMICs) is limited. Despite the World Health Organization (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health applications has not been widely used in LMICs. We describe here the feasibility of implementation of a training of obstetrics point-of-care ultrasound (OB POCUS) for high-risk conditions in rural public healthcare facilities in Kenya with partnership from Butterfly Network, Global Ultrasound Institute, and Kenyatta University. METHODS As part of the initiation of a large-scale implementation study of OB POCUS, clinician trainees were recruited from rural Kenyan hospitals for participation in a series of five-day POCUS workshops held between September and December 2022. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for 5 OB POCUS applications. Instructor-observed assessment of students' scanning and image interpretation occurred over the training period. Assessment of knowledge and confidence was performed via an online pre-test and post-test as well as Objective Structured Clinical Examination (OSCE) was administered at course completion. RESULTS Five hundred and fourteen mid-level Health Care Providers (HCPs) in Kenya were trained over a three-month period through in-person didactic sessions, bedside instruction, and clinical practice over a 5-day period with a trainer: trainee ratio of approximately 1:5. Out of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. OB POCUS topics covered included: malpresentation, multiple gestation, fetal cardiac activity, abnormalities of the placenta and amniotic fluid volume. There was marked improvement in the post training test scores compared to the pretest scores. CONCLUSION Our implementation description serves as a guide for successful rapid dissemination of OB POCUS training for mid-level providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specific POCUS skills in efforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound in pregnancy through accessible OB POCUS training programs. An implementation study is currently underway to assess the patient and systems-level impact of the training.
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Affiliation(s)
- James Wachira
- Global Ultrasound Institute (GUSI), San Francisco, USA.
- Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya.
| | - Duncan Mwangangi Matheka
- Global Ultrasound Institute (GUSI), San Francisco, USA
- Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | | | - Sachita Shah
- Butterfly Network Inc, Massachusetts, USA
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, USA
| | | | - Mena Ramos
- Global Ultrasound Institute (GUSI), San Francisco, USA
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA
| | - Kevin Bergman
- Global Ultrasound Institute (GUSI), San Francisco, USA
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA
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Andersen CA, Brodersen JB, Graumann O, Davidsen AS, Jensen MB. Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics. BMJ Open 2023; 13:e077702. [PMID: 37848298 PMCID: PMC10582891 DOI: 10.1136/bmjopen-2023-077702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE The implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion of POCUS-users among general practitioners (GPs), (2) the current use of POCUS by GPs, (3) factors related to the implementation of POCUS in general practice and (4) GPs' concerns related to POCUS use in general practice. DESIGN An online survey was distributed in June 2019. SETTING General practice. PARTICIPANTS GPs working in office-based primary care clinics in Denmark. MAIN OUTCOME MEASURES The questionnaire was developed using mixed methods and included questions about participants' characteristics, past POCUS training and experience, capability, opportunity and motivation for using POCUS in the primary care setting. Results were summarised using descriptive statistics. Association between GPs' background characteristics and POCUS use was tested using logistics regression. RESULTS Responses were analysed from 1216 questionnaires corresponding to 36.4% of all GPs in Denmark. The majority (72.3%) of participants had previous POCUS experience, 14.7% had access to a POCUS device and 11.5% used POCUS. Several factors motivated participants to use POCUS. However, barriers existed such as lack of remuneration and high workload. Additionally, many GPs questioned their ability to scan with sufficient diagnostic accuracy and the impact of POCUS on the consultation. Of non-users, 28.7% believed they would be using POCUS in the future. CONCLUSION Although, the majority of GPs had past experience with POCUS and felt motivated to use it, few had implemented POCUS. Several factors influenced the GPs' capability, opportunity and motivation for using POCUS and several concerns were registered by non-users.
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Affiliation(s)
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice, Region Zealand, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette Sofie Davidsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Rathbun KM, Patel AN, Jackowski JR, Parrish MT, Hatfield RM, Powell TE. Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting. BMC MEDICAL EDUCATION 2023; 23:263. [PMID: 37076831 PMCID: PMC10113991 DOI: 10.1186/s12909-023-04227-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Point of care ultrasound (POCUS) is becoming a major extension of patient care. From diagnostic efficacy to its widespread accessibility, POCUS has expanded beyond emergency departments to be a tool utilized by many specialties. With the expansion of its use, medical education has begun to implement ultrasound education earlier in curricula. However, at institutions without a formal ultrasound fellowship or curriculum, these students lack the fundamental knowledge of ultrasound. At our institution, we set out to incorporate an ultrasound curriculum, into undergraduate medical education utilizing a single faculty member and minimal curricular time. METHODS Our stepwise implementation began with the development of a 3-hour fourth-year (M4) Emergency Medicine clerkship ultrasound teaching session, which included pre- and post-tests as well as a survey. The success with this session progressed to the development of a designated fourth-year ultrasound elective, which was evaluated with narrative feedback. Finally, we developed six 1-hour ultrasound sessions that correlated with first-year (M1) gross anatomy and physiology. A single faculty member was responsible for this curriculum and other instructors included residents, M4 students, and second-year (M2) near-peer tutors. These sessions also included pre- and post-tests and a survey. Due to curricular time limitations, all but the M4 Emergency Medicine clerkship session were optional. RESULTS 87 students participated in the emergency medicine clerkship ultrasound session and 166 M1 students participated in the voluntary anatomy and physiology ultrasound sessions. All participants agreed or strongly agreed that they would like more ultrasound training, that ultrasound training should be integrated into all four years of undergraduate medical education. Students were in strong agreement that the ultrasound sessions helped increase understanding of anatomy and anatomical identification with ultrasound. CONCLUSION We describe the stepwise addition of ultrasound into the undergraduate medical education curriculum of an institution with limited faculty and curricular time.
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Affiliation(s)
- Kimberly M Rathbun
- Department of Emergency Medicine, Augusta University, University of Georgia Medical Partnership, Athens, GA, Greece.
| | - Arjun N Patel
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Ryan M Hatfield
- Department of Emergency Medicine, Prisma Health, Columbia, SC, USA
| | - Tyler E Powell
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Akanuwe JN, Siriwardena AN, Bidaut L, Mitchell P, Bird P, Lasserson D, Apenteng P, Lilford R. Practitioners' views on community implementation of point-of-care ultrasound (POCUS) in the UK: a qualitative interview study. BMC Health Serv Res 2023; 23:84. [PMID: 36698100 PMCID: PMC9876652 DOI: 10.1186/s12913-023-09069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Implementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK. METHODS We conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12. RESULTS We interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals. Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience. CONCLUSIONS POCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.
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Affiliation(s)
- Joseph N.A Akanuwe
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Aloysius Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Luc Bidaut
- grid.36511.300000 0004 0420 4262School of Computer Science, College of Science, University of Lincoln, Lincoln, England
| | - Pauline Mitchell
- grid.36511.300000 0004 0420 4262School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Paul Bird
- grid.412563.70000 0004 0376 6589Institute for Translational Medicine Research & Development, University Hospitals Birmingham NHS Foundation Trust, West Midlands Academic Health Science Network, Birmingham, England
| | - Daniel Lasserson
- grid.7372.10000 0000 8809 1613Warwick Medical School, University of Warwick, Coventry, England ,grid.410556.30000 0001 0440 1440Department of Gerontology, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | | | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, England
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Sheppard G, Williams KL, Metcalfe B, Clark M, Bromley M, Pageau P, Woo M, Yi Y, Devasahayam AJ, Dubrowski A. Using Kane's framework to build an assessment tool for undergraduate medical student's clinical competency with point of care ultrasound. BMC MEDICAL EDUCATION 2023; 23:43. [PMID: 36658642 PMCID: PMC9854184 DOI: 10.1186/s12909-023-04030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Point-of-care ultrasonography (POCUS) is a portable imaging technology used in clinical settings. There is a need for valid tools to assess clinical competency in POCUS in medical students. The primary aim of this study was to use Kane's framework to evaluate an interpretation-use argument (IUA) for an undergraduate POCUS assessment tool. METHODS Participants from Memorial University of Newfoundland, the University of Calgary, and the University of Ottawa were recruited between 2014 and 2018. A total of 86 participants and seven expert raters were recruited. The participants performed abdominal, sub-xiphoid cardiac, and aorta POCUS scans on a volunteer patient after watching an instruction video. The participant-generated POCUS images were assessed by the raters using a checklist and a global rating scale. Kane's framework was used to determine validity evidence for the scoring inference. Fleiss' kappa was used to measure agreement between seven raters on five questions that reflected clinical competence. The descriptive comments collected from the raters were systematically coded and analyzed. RESULTS The overall agreement between the seven raters on five questions on clinical competency ranged from fair to moderate (κ = 0.32 to 0.55). The themes from the qualitative data were poor image generation and interpretation (22%), items not applicable (20%), poor audio and video quality (20%), poor probe handling (10%), and participant did not verbalize findings (14%). CONCLUSION The POCUS assessment tool requires further modification and testing prior before it can be used for reliable undergraduate POCUS assessment.
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Affiliation(s)
- Gillian Sheppard
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Kerry-Lynn Williams
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Brian Metcalfe
- Discipline of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Marcia Clark
- Division of Orthopedic Surgery, University of Calgary, Calgary, Canada
| | - Mark Bromley
- Division of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Michael Woo
- Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | - Adam Dubrowski
- Faculty of Health Sciences, Ontario Technology University, Oshawa, Canada
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Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, Abuhamad A, Noble V, Hussain A, Prosen G, Villen T, Via G, Nogue R, Goodmurphy C, Bastos M, Nace GS, Volpicelli G, Wakefield RJ, Wilson S, Bhagra A, Kim J, Bahner D, Fox C, Riley R, Steinmetz P, Nelson BP, Pellerito J, Nazarian LN, Wilson LB, Ma IWY, Amponsah D, Barron KR, Dversdal RK, Wagner M, Dean AJ, Tierney D, Tsung JW, Nocera P, Pazeli J, Liu R, Price S, Neri L, Piccirillo B, Osman A, Lee V, Naqvi N, Petrovic T, Bornemann P, Valois M, Lanctot JF, Haddad R, Govil D, Hurtado LA, Dinh VA, DePhilip RM, Hoffmann B, Lewiss RE, Parange NA, Nishisaki A, Doniger SJ, Dallas P, Bergman K, Barahona JO, Wortsman X, Smith RS, Sisson CA, Palma J, Mallin M, Ahmed L, Mustafa H. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14:31. [PMID: 35895165 PMCID: PMC9329507 DOI: 10.1186/s13089-022-00279-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
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Affiliation(s)
- Richard A. Hoppmann
- Internal Medicine, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Bldg 3, Room 306, Columbia, SC 29209 USA
| | - Jeanette Mladenovic
- Foundation for the Advancement of International Medical Education and Research, Philadelphia, USA
| | - Lawrence Melniker
- Quality Emergency Department, NewYork-Presbyterian Health System, New York, USA
| | - Radu Badea
- Internal Medicine and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Blaivas
- Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Miguel Montorfano
- Ultrasound and Doppler Department, Hospital de Emergencias “Dr. Clemente Alvarez”, Rosario, Argentina
| | | | - Vicki Noble
- Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Arif Hussain
- Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gregor Prosen
- Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Tomás Villen
- Francisco de Vitoria University School of Medicine, Madrid, Spain
| | - Gabriele Via
- Department of Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ramon Nogue
- Emergency Medicine, University of Lleida School of Medicine, Lleida, Spain
| | - Craig Goodmurphy
- Ultrasound Education, Penn State College of Medicine, Hershey, USA
| | - Marcus Bastos
- Ultrasound Point of Care, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, Brazil
| | - G. Stephen Nace
- Medical Education and Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Giovanni Volpicelli
- Internal Medicine, Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Steve Wilson
- University of South Carolina School of Medicine, Columbia, USA
| | | | - Jongyeol Kim
- Neurology, School of Medicine Texas Tech University Health Sciences Center, Lubbock, USA
| | - David Bahner
- Department of Emergency Medicine, The Ohio State University, Columbus, USA
| | - Chris Fox
- Department Emergency Medicine, University of California Irvine, Irvine, USA
| | - Ruth Riley
- Library Services, University of South Carolina School of Medicine, Columbia, USA
| | | | - Bret P. Nelson
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Pellerito
- Radiology and Science Education, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Levon N. Nazarian
- Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - L. Britt Wilson
- Physiology, University of South Carolina School of Medicine, Columbia, USA
| | - Irene W. Y. Ma
- Medicine, Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - David Amponsah
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, USA
| | - Keith R. Barron
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Renee K. Dversdal
- Internal Medicine, Oregon Health & Science University, Portland, USA
| | - Mike Wagner
- Medicine, University of South Carolina School of Medicine-Greenville, Greenville, USA
| | - Anthony J. Dean
- Emeritus Department of Emergency Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David Tierney
- Internal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
| | - James W. Tsung
- Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paula Nocera
- Anesthesiologist, Hospital Sírio Libanês, São Paulo, Brazil
| | - José Pazeli
- Nephology and Critical Care, Barbacena’s School of Medicine, Barbacena, Brazil
| | - Rachel Liu
- Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Susanna Price
- Cardiology and Intensive Care, Royal Brompton Hospital, London, England
| | - Luca Neri
- Emergency and Intensive Care Medicine, King Fahad Specialist Hospital Dammam, Ad Dammām, Saudi Arabia
| | | | - Adi Osman
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri, Ipoh, Perak Malaysia
| | - Vaughan Lee
- Medical Education, University of South Alabama College of Medicine, Mobile, USA
| | - Nitha Naqvi
- Royal Brompton Hospital Part of Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Paul Bornemann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Maxime Valois
- Medicine, McGill and Sherbrooke Universities, Montreal, Canada
| | | | - Robert Haddad
- Ultrasound Education - Ultrasound Institute, University of South Carolina School of Medicine, Columbia, USA
| | - Deepak Govil
- Critical Care Medicine, Medanta - The Medicity, Gurgaon, India
| | | | - Vi Am Dinh
- Emergency Medicine and Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Robert M. DePhilip
- Emeritus Biomedical Education and Anatomy, The Ohio State University, Columbus, USA
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Harvard Medical School, Boston, USA
| | - Resa E. Lewiss
- Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, USA
| | - Nayana A. Parange
- Medical Sonography, University of South Australia Allied Health and Human Performance, Adelaide, Australia
| | - Akira Nishisaki
- Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Stephanie J. Doniger
- Pediatric Emergency Medicine, Children’s Hospital in Orange California, Orange, USA
| | - Paul Dallas
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kevin Bergman
- Family and Community Medicine, University of California - San Francisco, Martinez, USA
| | - J. Oscar Barahona
- Greenwich Ultrasound Services, Greenwich Ultrasound Associates, PC, Greenwich, USA
| | - Ximena Wortsman
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. Stephen Smith
- Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Craig A. Sisson
- Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James Palma
- Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Liju Ahmed
- King Faisal Specialist Hospital and Research Center, Madinah, Kingdom of Saudi Arabia
| | - Hassan Mustafa
- Internal Medicine, University of Manitoba, Manitoba, Canada
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Cho E, Han YM, Kang Y, Kim JH, Shin MS, Oh M, Cho NG, Jung HJ, Leem J. Implementation of Objective Structured Clinical Examination on Diagnostic Musculoskeletal Ultrasonography Training in Undergraduate Traditional Korean Medicine Education: An Action Research. Diagnostics (Basel) 2022; 12:diagnostics12071707. [PMID: 35885609 PMCID: PMC9323213 DOI: 10.3390/diagnostics12071707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to report the specific methods and investigate the educational effects of diagnostic musculoskeletal ultrasound training and the Objective Structured Clinical Examination (OSCE) for traditional medicine students. Scanning volar wrist and diagnosing carpal tunnel syndrome were selected for musculoskeletal ultrasound to train students to use the basic functions of the ultrasound device and scan various structures including tendons, nerves, and arteries. The students were divided into two groups: one group had 8 weeks of training with mock OSCE experience and received feedback about their scan images, and the other group had 3 weeks of training with flipped learning. The OSCE was implemented on the last day of the training. The subjective learning outcomes were analyzed as students’ evaluation with a 5-point scale, and the objective learning outcomes were analyzed using OSCE scores evaluated with a pre-validated checklist. Of the 111 students, 60 (54.1%) responded to the questionnaire. Overall satisfaction with this ultrasound training was high (4.5 ± 0.60). The average OSCE score in the 8-week group was significantly higher than that in the 3-week group. The students’ self-assessment showed no significant differences between the two groups. Proficiency in using ultrasound is affected by the practice time and feedback. Ultrasound training should be further expanded as a required curriculum to meet students’ needs and achieve learning objectives in the clinical skills education of Korean medicine colleges. Further studies are needed on ultrasound education, especially guided interventions for traditional medicine students.
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Affiliation(s)
- Eunbyul Cho
- College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.C.); (Y.K.); (J.-H.K.); (N.-G.C.)
| | - Young-Min Han
- Cheoncheon Public Health Center Branch, 35, Songtan-ro, Cheoncheon-myeon, Jangsu 55607, Korea;
| | - Yeonseok Kang
- College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.C.); (Y.K.); (J.-H.K.); (N.-G.C.)
- Center for International Cooperation & Education on Korean Medicine, Wonkwang University, Iksan 54538, Korea
| | - Jae-Hyo Kim
- College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.C.); (Y.K.); (J.-H.K.); (N.-G.C.)
- Traditional Medicine Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea
| | - Min-Seop Shin
- Shin Min Seop Korean Medicine Clinic, 163, Geomapyeong-ro, Jeonju 55056, Korea;
| | - Myungjin Oh
- Keumkang Korean Medical Clinic, 714, Naesu-ro, Cheongju 28145, Korea;
| | - Nam-Geun Cho
- College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.C.); (Y.K.); (J.-H.K.); (N.-G.C.)
| | - Hyun-Jong Jung
- College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.C.); (Y.K.); (J.-H.K.); (N.-G.C.)
- Traditional Medicine Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea
- Correspondence: (H.-J.J.); (J.L.); Tel.: +82-063-850-6914 (J.L.)
| | - Jungtae Leem
- College of Korean Medicine, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea; (E.C.); (Y.K.); (J.-H.K.); (N.-G.C.)
- Traditional Medicine Research Center, Wonkwang University, 460, Iksan-daero, Iksan 54538, Korea
- Correspondence: (H.-J.J.); (J.L.); Tel.: +82-063-850-6914 (J.L.)
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11
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Ma R, McHaffie A, Subramaniam RM, Anakin M. Student and Educator Experiences of an Integrated Medical Imaging Curriculum. Acad Radiol 2022; 30:765-770. [PMID: 35672236 DOI: 10.1016/j.acra.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Medical imaging is integrated across all years in the medical programs at the Medical School, in our country. Little is known about this pedagogical approach from the perspective of those who participate in it. This study investigated how students and educators experience an integrated medical imaging curriculum. METHODS One-on-one interviews were conducted with nine educators and three undergraduate medical students and analyzed using a reflexive thematic approach. Educators included radiologists, non-radiologists clinicians, and scientists and health professionals from the medical program. RESULTS The integrated medical imaging curriculum appears to be incoherently experienced by educators and students as learning opportunities that were 'everywhere and nowhere'. Teaching events were 'repetitive and patchy' and featured a transmission-oriented pedagogy emphasizing 'exposure and absorption'. Educators expressed paradoxical views of their responsibility for teaching medical imaging reflected in this sentiment: 'I don't teach medical imaging… (but I do)'. DISCUSSION When medical imaging is integrated into learning resources and course work across the undergraduate program, it may lose its visibility and importance as a distinct learning area despite its crucial role in medical practice. An integrated curriculum may inadvertently separate knowing about medical imaging from learning to apply medical imaging knowledge in clinical practice. CONCLUSIONS Further work is required to construct an integrated medical imaging curriculum that explicitly emphasizes medical imaging learning outcomes, so they are experienced coherently and consistently by medical students and those who prepare them for practice as doctors.
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Affiliation(s)
- Ray Ma
- Otago Medical School, University of Otago, Dunedin, New Zealand (R.M.)
| | - Alexandra McHaffie
- Department of Radiology, University of Otago, Christchurch, New Zealand (A.M.)
| | - Rathan M Subramaniam
- Department of Medicine, University of Otago Medical School, Dunedin, New Zealand (R.M.S.); Department of Radiology, Duke University, Durham, NC (R.M.S.)
| | - Megan Anakin
- Education Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (M.A.).
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12
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Development of an Objective Structured Clinical Examination Checklist and a Post-Education Questionnaire for Musculoskeletal Ultrasound Training Focusing on Volar Wrist and Carpal Tunnel Syndrome. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2022.00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The objective structured clinical examination (OSCE) is used in the colleges of Korean Medicine, but few studies have validated the OSCE evaluation criteria or post-education questionnaires. Diagnostic ultrasound is used in Korean medicine treatment including acupuncture, acupotomy, and pharmacopuncture to increase the safety and efficacy of treatment. We aimed to develop and validate a OSCE checklist and questionnaire for diagnostic musculoskeletal ultrasound training.Methods: A OSCE checklist and rubric for diagnostic ultrasound training, and questionnaire was developed using literature research. Eight expert panelists verified each draft item in a single-round survey. Items with a content validity ratio (CVR) < 0.75 were excluded or modified to reflect the experts’ opinions.Results: The OSCE checklist and rubric for diagnostic ultrasound training focusing on volar wrist and carpal tunnel syndrome included: 15 items revised according to CVR and expert opinions, the pre-examination procedure, structures to be identified by ultrasound, scans with 2 diagnostic criteria for carpal tunnel syndrome, an explanation of the exam results, and the post exam procedure. The questionnaire consisted of 15 items, including the overall evaluation of training, the effect of the OSCE, and the perception of the ultrasound. All 6 self-evaluation items were not revised, as they had a CVR of ≥ 0.75.Conclusion: An ultrasound OSCE for scanning the volar wrist and diagnosing carpal tunnel syndrome was developed using 15 validated tasks, 15 survey questions about ultrasound training, and 6 questions for selfevaluation. These results may be used in the future for education in diagnostic ultrasound.
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Herbert A, Russell FM, Zahn G, Zakeri B, Motzkus C, Wallach PM, Ferre RM. Point-of-Care Ultrasound Education During a Pandemic: From Webinar to Progressive Dinner-Style Bedside Learning. Cureus 2022; 14:e25141. [PMID: 35747012 PMCID: PMC9206505 DOI: 10.7759/cureus.25141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Point-of-care ultrasound (POCUS), traditionally, requires the proximity of learners and educators, making POCUS education challenging during the COVID-19 pandemic. We set out to evaluate three alternate approaches to teaching POCUS in UME. Sessions progressed from an online seminar to a remote, interactive simulation to a “progressive dinner” style session, as precautions evolved throughout the pandemic. Methods: This prospective study details a series of three POCUS workshops that were designed to align with prevailing social distancing precautions during the COVID-19 pandemic. Overall, 656 medical students were included. The first and second workshops used web-based conferencing technology with real-time ultrasound imaging, with the second workshop focusing on clinical integration through simulation. As distancing precautions were updated, a novel “progressive dinner” technique was used for the third workshop. Surveys were conducted after each session to obtain feedback on students’ attitudes toward alternative teaching techniques and quantitative and qualitative analyses were used. Results: The initial, remote POCUS workshop was performed for 180 medical students. Ninety-nine (177) percent of students felt the session was “intellectually challenging” and “stimulating.” Ninety-nine percent of students (340/344), after the second workshop, indicated the session was intellectually challenging, stimulating, and a positive learning experience. Students' ability to correctly identify pathologic images increased post-session evaluation from in-session polling. For workshop three, 99% (107/108) of students indicated that the session was “informative.” There was a significant improvement in pre- to post-workshop knowledge regarding image acquisition, interpretation, and clinical integration. Conclusion: While image acquisition skills are best conveyed at the bedside, these modified POCUS teaching techniques developed and delivered in alignment with COVID-19 pandemic restrictions during a series of three workshops were shown to be effective surrogates for traditional teaching approaches when social distancing requirements, a large learner pool, or lack of local expertise exist.
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14
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Olivares-Perez ME, Graglia S, Harmon DJ, Klein BA. Virtual anatomy and point-of-care ultrasonography integration pilot for medical students. ANATOMICAL SCIENCES EDUCATION 2022; 15:464-475. [PMID: 34748279 DOI: 10.1002/ase.2151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
Despite its significant clinical use, there is no standardized point-of-care ultrasonography (POCUS) curriculum in undergraduate medical education. As Covid-19 abruptly mandated the use of virtual education, instructors were challenged to incorporate and improve POCUS education within these new constraints. It was hypothesized that integrating POCUS into anatomy via brief video lessons and a subsequent interactive virtual lesson would lead to an objective understanding of POCUS concepts, improved understanding of the corresponding anatomy, and subjective improvement of student confidence with POCUS. A cross-sectional descriptive study assessed first-year medical students' perspectives and performance before and after the interventions (n = 161). The intervention was split into two parts: (1) three optional 10-minute POCUS videos that reinforced anatomy concepts taught in the laboratory sessions, and (2) a subsequent two-hour interactive virtual session reviewing POCUS and anatomy concepts. Students completed a knowledge and confidence assessment tool before and after the interactive session. Survey responses (n = 51) indicated that 94% of students felt the optional videos improved their understanding of POCUS and were educationally valuable. One half of medical students (50%) indicated that the demonstrations improved their anatomy understanding. Initial self-reported confidence was low after the optional video lessons, despite an average score of 58% on the knowledge assessment (n = 130). However, confidence increased significantly along with an increase in score performance to 80% after the interactive session (n = 39, P < 0.01). Results suggest that the virtual integration pilot enhanced student learning of both anatomy and POCUS.
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Affiliation(s)
- Marcus E Olivares-Perez
- Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California, USA
| | - Sally Graglia
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Derek J Harmon
- Department of Anatomy, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Barbie A Klein
- Department of Anatomy, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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15
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Brown CC, Arrington SD, Olson JF, Finch CA, Nydam RL. Musculoskeletal ultrasound training encourages self-directed learning and increases confidence for clinical and anatomical appreciation of first-year medical students. ANATOMICAL SCIENCES EDUCATION 2022; 15:508-521. [PMID: 34674381 DOI: 10.1002/ase.2145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 09/12/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Best-practice guidelines have incorporated ultrasound in diagnostic and procedural medicine. Due to this demand, the Arizona College of Osteopathic Medicine initiated a comprehensive integration of ultrasound into its first-year anatomy course attended by more than 280 students. Ultrasound workshops were developed to enhance student conceptualization of musculoskeletal (MSK) anatomy through visualizing clinically important anatomical relationships, a simulated lumbar puncture during the back unit, carpal tunnel and shoulder evaluations during the upper limb unit, and plantar fascia, calcaneal tendon, and tarsal tunnel evaluations during the lower limb unit. A 5-point Likert scale survey evaluated if ultrasound improved students' self-perceived anatomical and clinical comprehension of relevant anatomy, improved students' ability to orient to ultrasound imagery, and prompted further independent investigation of the anatomical area. Ultrasound examination questions were added to the anatomy examinations. Two-tailed one-sample t-tests for the back, upper limb, and lower limb units were found to be significant across all Likert survey categories (P < 0.001). Positive student responses to the Likert survey in conjunction with examination question average of 84.3% (±10.3) demonstrated that the ultrasound workshops are beneficial to student education. Ultrasound enhances medical students' clinical and anatomical comprehension and ability to orient to ultrasound imagery for MSK anatomy. This study supports early ultrasound education as a mechanism to encourage students' independent learning as evidenced by many undertaking voluntary investigation of clinical concerns associated with MSK anatomy. This study establishes the successful integration of MSK ultrasound into a large medical school program and its benefit to student clinical education.
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Affiliation(s)
- Casey C Brown
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Shalynn D Arrington
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
- Universal Health Services (UHS) Southern California Medical Education Consortium, Temecula Valley Hospital, Temecula, California, USA
| | - Jay F Olson
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
- Comanche County Memorial Hospital, Lawton, Oklahoma, USA
| | - Charles A Finch
- Department of Integrated Medicine, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
| | - Randall L Nydam
- Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
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16
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Russell FM, Zakeri B, Herbert A, Ferre RM, Leiser A, Wallach PM. The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:723-727. [PMID: 34789665 DOI: 10.1097/acm.0000000000004512] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the current state of point-of-care ultrasound (POCUS) integration in undergraduate medical education (UME) at MD-granting medical schools in the United States. METHOD In 2020, 154 clinical ultrasound directors and curricular deans at MD-granting medical schools were surveyed. The 25-question survey collected data about school characteristics, barriers to POCUS training implementation, and POCUS curriculum details. Descriptive analysis was conducted using frequency and percentage distributions. RESULTS One hundred twenty-two (79%) of 154 schools responded to the survey, of which 36 were multicampus. Sixty-nine (57%) schools had an approved POCUS curriculum, with 10 (8%) offering a longitudinal 4-year curriculum. For a majority of schools, POCUS instruction was required during the first year (86%) and second year (68%). Forty-two (61%) schools were teaching fundamentals, diagnostic, and procedural ultrasound. One hundred fifteen (94%) schools identified barriers to implementing POCUS training in UME, which included lack of trained faculty (63%), lack of time in current curricula (54%), and lack of equipment (44%). Seven (6%) schools identified no barriers. CONCLUSIONS Over half of the responding medical schools in the United States had integrated POCUS instruction into their UME curricula. Despite this, a very small portion had a longitudinal curriculum and multiple barriers existed for implementation, with the most common being lack of trained faculty. The data from this study can be used by schools planning to add or expand POCUS instruction within their current curricula.
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Affiliation(s)
- Frances M Russell
- F.M. Russell is ultrasound research director and co-director of ultrasound education, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bita Zakeri
- B. Zakeri is director of continuing medical education, Division of Continuing Medical Education, Indiana University School of Medicine, Indianapolis, Indiana; ORCID: https://orcid.org/0000-0002-9654-1156
| | - Audrey Herbert
- A. Herbert is co-director of ultrasound education, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robinson M Ferre
- R.M. Ferre is director of ultrasound and co-director of ultrasound education, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Abraham Leiser
- A. Leiser is a medical student, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul M Wallach
- P.M. Wallach is executive associate dean, Educational Affairs and Institutional Improvement, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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17
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Slader M, Young H, Barker M, Prentice K, Bogaard K, Yuan C, Saadat S, Lahham S. A comparison of handheld and standard ultrasound in Swiss medical students. World J Emerg Med 2022; 13:85-90. [PMID: 35237360 PMCID: PMC8861347 DOI: 10.5847/wjem.j.1920-8642.2022.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/20/2021] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The use of ultrasound (US) within healthcare has inspired the development of new US technology. There have been few studies comparing the use of handheld US to standard US for medical education. This research aims to determine whether a handheld US device can provide a comparable primary learning experience to that of a standard US machine. METHODS Over two days of instruction, participants were taught and evaluated on core US fundamentals. The standard group received instruction on standard US machines, while the handheld group received instruction on handheld US devices. Participants completed a qualitative survey regarding their experience. Six hundred and four images were obtained and graded by two emergency medicine physicians. RESULTS A total of 119 Swiss medical students were enrolled in our study. There was no statistically significant difference in the US assessment measurements, except for faster endpoint septal separation (EPSS) vascular setup time in the handheld group (P=0.001). There was no statistically significant difference in participants' perceived difficulty of US learning (P=0.198), comfort level (P=0.188), or self-estimated capability to perform US in the future (P=0.442). There was no statistically significant difference in the percentage of correctly obtained images (P=0.211) or images that were clinically useful (P=0.256). The median quality score of images obtained by the standard group was eight compared to seven in handheld group (P<0.01). CONCLUSION Our data suggest a handheld US machine can perform as well as a standard US machine as an educational tool despite sacrifices in image quality.
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Affiliation(s)
- Mark Slader
- School of Medicine, University of California, Irvine 92617, USA
| | - Hayley Young
- School of Medicine, University of California, Irvine 92617, USA
| | - Margot Barker
- School of Medicine, University of California, Irvine 92617, USA
| | - Kylie Prentice
- School of Medicine, University of California, Irvine 92617, USA
| | | | - Charlene Yuan
- School of Medicine, University of California, Irvine 92617, USA
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine 92868, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California, Irvine 92868, USA
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18
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Nicholas E, Ly AA, Prince AM, Klawitter PF, Gaskin K, Prince LA. The Current Status of Ultrasound Education in United States Medical Schools. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2459-2465. [PMID: 33448471 DOI: 10.1002/jum.15633] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/18/2020] [Accepted: 01/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Ultrasound is used by nearly every medical specialty. Medical schools are integrating ultrasound education into their curriculum but studies show this to be inconsistent. The purpose of this study was to provide an updated description of ultrasound in the curricula of United States Accredited Medical Schools (USAMS). METHODS In 2019, USAMS curricular offices were contacted. Institutions were asked about the presence of ultrasound curriculum and for contact information for faculty involved with education. Schools reporting ultrasound curriculum were surveyed regarding details of their curriculum. RESULTS Two hundred USAMS were contacted with a response rate of 84%. Of 168 schools, 72.6% indicated they have an ultrasound curriculum. For schools with a curriculum, 79 (64.8%) completed our survey. The majority of survey respondents, 66 (83.5%), indicated having mandatory ultrasound. Ultrasound is primarily integrated into courses (73.8% in basic science courses, 66.2% in clinical skills courses, and 35.4% in clinical rotations). Emergency medicine physicians accounted for 54.7% of course directors. Ten or fewer faculty participate in education in 68.4% of schools and mostly as volunteers. Dedicated machines for education were reported by 78.5% of schools. CONCLUSIONS Compared to prior studies, this study had a higher response rate at 84%, and more schools reported ultrasound in their curricula. Emergency medicine represents the majority of leadership in ultrasound education. Despite increased integration of ultrasound into American medical school curricula, its instruction is still inconsistent.
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Affiliation(s)
- Elizabeth Nicholas
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
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Camilo GB, Toledo GC, Olímpio H, Dias EN, Oliveira BLD, Ferreira JP, Mendes PDFB, Bastos MG. Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students. J Pediatr (Rio J) 2021; 97:651-657. [PMID: 33713629 PMCID: PMC9432132 DOI: 10.1016/j.jped.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The authors aim to evaluate the "point-of-care" transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. METHODS The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. RESULTS The cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. CONCLUSION Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.
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Affiliation(s)
- Gustavo Bittencourt Camilo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil.
| | - Gabriela Cumani Toledo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil; Hospital e Maternidade Teresinha de Jesus (HMTJ), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Hebert Olímpio
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil
| | - Eleusa Nogueira Dias
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Bianca Lopes de Oliveira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Júlia Perches Ferreira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | | | - Marcus Gomes Bastos
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade Federal de Juiz de Fora (UFJF), Departamento de Nefrologia, Juiz de Fora, MG, Brazil
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20
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Chahley T, Lam AW, Halman S, Watson K, Ma IW. First year internal medicine residents' self-report point-of-care ultrasound knowledge and skills: what (Little) difference three years make. BMC MEDICAL EDUCATION 2021; 21:476. [PMID: 34493276 PMCID: PMC8422684 DOI: 10.1186/s12909-021-02915-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND With increasing availability of point-of-care ultrasound (POCUS) education in medical schools, it is unclear whether or not learning needs of junior medical residents have evolved over time. METHODS We invited all postgraduate year (PGY)-1 residents at three Canadian internal medicine residency training programs in 2019 to complete a survey previously completed by 47 Canadian Internal Medicine PGY-1 s in 2016. Using a five-point Likert scale, participants rated perceived applicability of POCUS to the practice of internal medicine and self-reported skills in 15 diagnostic POCUS applications and 9 procedures. RESULTS Of the 97 invited residents, 58 (60 %) completed the survey in 2019. Participants reported high applicability but low skills across all POCUS applications and procedures. The 2019 cohort reported higher skills in assessing pulmonary B lines than the 2016 cohort (2.3 ± SD 1.0 vs. 1.5 ± SD 0.7, adjusted p-value = 0.01). No other differences were noted. CONCLUSIONS POCUS educational needs continue to be high in Canadian internal medicine learners. The results of this needs assessment study support ongoing inclusion of basic POCUS elements in the current internal medicine residency curriculum.
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Affiliation(s)
- Tanner Chahley
- Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Alberta, AB T2N 4N1, Calgary, Canada
| | - Ada W Lam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Samantha Halman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathryn Watson
- Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Alberta, AB T2N 4N1, Calgary, Canada
| | - Irene Wy Ma
- Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Alberta, AB T2N 4N1, Calgary, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
- W21C, University of Calgary, Alberta, Calgary, Canada.
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21
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Tadros A, Manning P, Smitaman E, Chong A, Wang K, Tamayo-Murillo D. Starting a Free Ultrasound Clinic for the Underserved: Considerations and Overcoming Challenges. Acad Radiol 2021; 28:938-943. [PMID: 34130923 DOI: 10.1016/j.acra.2021.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022]
Abstract
Many radiologists are interested in providing affordable care to underserved populations but are unsure how to accomplish it. We present a model for providing imaging services to the underserved with an emphasis on the challenges we encountered and strategies we used to overcome them. In partnership with our medical school's student-run free clinic, we developed a community-based ultrasound service that provides diagnostic ultrasound examinations to an uninsured urban population to address the need of timely access to care and integrated follow-up care. Image storage and reporting were fully integrated with our existing imaging informatics and electronic medical record systems. Radiology residents play a central role in the operation of the service while gaining hands-on ultrasound experience, in partnership with volunteer sonographers, radiology attendings, and medical students.
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Affiliation(s)
- Anthony Tadros
- Department of Radiology, University of California, San Diego School of Medicine, San Diego, California.
| | - Paul Manning
- Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Edward Smitaman
- Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Alice Chong
- Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Kang Wang
- Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
| | - Dorathy Tamayo-Murillo
- Department of Radiology, University of California, San Diego School of Medicine, San Diego, California
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22
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Andersen CA, Brodersen J, Rudbæk TR, Jensen MB. Patients' experiences of the use of point-of-care ultrasound in general practice - a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:116. [PMID: 34144701 PMCID: PMC8214303 DOI: 10.1186/s12875-021-01459-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/10/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The use of point-of-care ultrasonography (POCUS) performed by general practitioners (GPs) in primary care settings is increasing. Previous studies have focused on GP-reported outcomes and little is known about patients' perspectives on the use of POCUS technology within the general practice consultation. The purpose of this study was to examine patients' experiences with POCUS in general practice within the areas where GPs have indicated that POCUS affected aspects of the consultation. METHODS A questionnaire was developed using a mixed methods sequential design. Analytical themes from interviews with GPs were converted into items in a questionnaire by the research team. The questionnaire was then further developed in several rounds of pilot tests involving both patients and GPs. The final questionnaire was used in a cohort study conducted in 18 Danish office-based general practice clinics from January 2018 to August 2018. All patients examined with POCUS were asked to complete the questionnaire on tablets immediately after their consultation. RESULTS Out of 691 patients examined, 564 (81.6%) questionnaires were available for analysis. The patients reported that they were well informed about the purpose (98%) and the results (97%) of the POCUS examination; however, 29% reported that they were not informed about the difference between POCUS and an imaging-specialist's ultrasound examination. Almost all patients (99%) reported that POCUS was integrated naturally into the consultation, and 45% reported that POCUS improved the doctor-patient relationship. The majority of patients felt that they had been more thoroughly examined (92%) and taken more seriously (58%) when POCUS was part of the consultation. They felt POCUS gave them a better understanding of their health problem (82%), made them feel more secure (86%) and increased their trust in the physician's assessment (65%). Moreover, the patients reported that POCUS use improved the level of service (95%) they experienced and the quality of care (94%) in general practice. CONCLUSION We found that an examination including POCUS in general practice was a positive experience overall for the majority of patients. Future research should further explore reasons for patient confidence in POCUS and whether or not the reassuring value of POCUS is valid. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03416608.
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Affiliation(s)
- Camilla Aakjær Andersen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 13, 9220, Aalborg Øst, Denmark.
| | - John Brodersen
- Research Unit for General Practice and Section of General Practice Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, P. O. Box 2099, DK-1014, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | | | - Martin Bach Jensen
- Center for General Practice, Aalborg University, Fyrkildevej 7, 13, 9220, Aalborg Øst, Denmark
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23
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Bashir K, Azad AM, Hereiz A, Bashir MT, Masood M, Elmoheen A. Current Use, Perceived Barriers, and Learning Preference of Point of Care Ultrasound (POCUS) in the Emergency Medicine in Qatar - A Mixed Design. Open Access Emerg Med 2021; 13:177-182. [PMID: 34040459 PMCID: PMC8140913 DOI: 10.2147/oaem.s304153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Point of care ultrasound (POCUS) has been a part of emergency medicine (EM) training for almost two decades. EM training program has a very broad and rigorous POCUS curricula which, in several cases, does not translate to routine application in clinical settings. This study therefore sought to compare the indications, utilization, barriers, and preferred POCUS educational method in a large Middle Eastern academic EM. Methodology A validated questionnaire was emailed to 50 EM faculties between April and May 2019. Volunteer faculty members partook in a semi-structured interview to better understand the indications, current use, barriers, and preferred learning method. Responses were anonymous, and data were analyzed with descriptive statistics. Results This was a mixed design study. 30/50 (60%) of faculty responded to the survey, with a mean age of 39.2 years and a mean number of years in practice, 13.1. 55% (n=28) completed POCUS training in less than five years, while 45% completed more than five years ago and 5% never completed it. Forty percent of EM physicians were trained in Africa, while 55% were qualified in Asia and 5% completed their training in Europe. The indications and frequently performed procedures were consistent with the previous research. The common barrier reported was lack of time, lack of credentialing, lack of quality assurance, and national guidelines. The majority of the faculty preferred a blended learning approach for POCUS. Conclusion POCUS perceived barriers to its full use include time constraints, lack of national guidelines, and credentialing (awarding POCUS qualifications) of the faculty. Blended learning appears to be the preferred approach towards acquiring the knowledge and skills of POCUS.
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Affiliation(s)
- Khalid Bashir
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Ayman Hereiz
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Maarij Masood
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | - Amr Elmoheen
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
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24
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Weiskittel TM, Lachman N, Bhagra A, Andersen K, St Jeor J, Pawlina W. Team-Based Ultrasound Objective Structured Practice Examination (OSPE) in the Anatomy Course. ANATOMICAL SCIENCES EDUCATION 2021; 14:377-384. [PMID: 33710791 DOI: 10.1002/ase.2069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
The clinical use of ultrasound has dramatically increased, necessitating early ultrasound education and the development of new tools in ultrasound training and assessment. The goal of this study was to devise a novel low-resource examination that tested the anatomical knowledge and technical skill of early undergraduate medical students in a gross anatomy course. The team-based ultrasound objective structured practice examination (OSPE) was created as a method for assessing practical ultrasound competencies, anatomical knowledge, and non-technical skills such as teamwork and professionalism. The examination utilized a rotation of students through four team roles as they scanned different areas of the body. This station-based examination required four models and four instructors, and tested ultrasound skills in the heart, abdominal vessels, abdominal organs, and neck regions. A Likert scale survey assessed student attitudes toward the examination. Survey data from participants (n = 46) were examined along with OSPE examination grades (n = 52). Mean and standard deviations were calculated for examination items and survey responses. Student grades were high in both technical (96.5%). and professional (96.5%) competencies with structure identification scoring the lowest (93.8%). There were no statistical differences between performances in each of the body regions being scanned. The survey showed that students deemed the examination to be fair and effective. In addition, students agreed that the examination motivated them to practice ultrasound. The team-based OSPE was found to be an efficient and student-favored method for evaluating integrated ultrasound competencies, anatomical knowledge, team-work, and professional attributes.
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Affiliation(s)
- Taylor M Weiskittel
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Nirusha Lachman
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Anjali Bhagra
- Department of General Internal Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Kylie Andersen
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Jeff St Jeor
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Wojciech Pawlina
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
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25
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Glass C, Sarwal A, Zavitz J, Nitsche J, Joyner J, Johnson LL, Garcia-Vargas J, O'Brien MC. Scoping review of implementing a longitudinal curriculum in undergraduate medical education: The wake forest experience. Ultrasound J 2021; 13:23. [PMID: 33871741 PMCID: PMC8055803 DOI: 10.1186/s13089-021-00206-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hands-on ultrasound experience has become a desirable component for undergraduate medical education (UGME) curricula throughout medical schools in the United States (US) to enhance readiness for future training. Ultrasound integration can be a useful assistive educational method in undergraduate medical education to improve anatomy and physiology skills. Relatively few medical schools have integrated ultrasound experiences formally into their 4-year medical school curriculum due to limitations of a resource intensive set up. METHODS We undertook a scoping review of published UGME ultrasound curricula integrated into all four years in peer-reviewed as well online literature. In addition, we provide a narrative review of our institutional experience in conceptualization, design and implementation of UGME ultrasound curriculum driven by need to address the fading knowledge in anatomy and physiology concepts beyond pre-clinical years. RESULTS Integrated ultrasound curriculum at WFSOM utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science concepts taught in the medical school curriculum. We found 18 medical schools with ultrasound curricula published in peer-reviewed literature with a total of 33 ultrasound programs discovered by adding Google search and personal communication CONCLUSIONS: The results of the review and our institutional experience can help inform future educators interested in developing similar curricula in their undergraduate programs. Common standards, milestones and standardized competency-based assessments would be helpful in more widespread application of ultrasound in UGME curricula.
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Affiliation(s)
- Casey Glass
- Department of Emergency Medicine, Medical Center, Wake Forest School of Medicine, 1 Winston-Salem, Boulevard, NC, 27157, USA
| | - Aarti Sarwal
- Department of Neurology, Medical Center, Wake Forest School of Medicine, 1 Winston-Salem, Boulevard, NC, 27157, USA
| | - Joshua Zavitz
- Department of Emergency Medicine, Medical Center, Wake Forest School of Medicine, 1 Winston-Salem, Boulevard, NC, 27157, USA
| | - Joshua Nitsche
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Medical Center, 1 Winston-Salem, Boulevard, NC, 27157, USA
| | - JaNae Joyner
- Department of Medical Education, Wake Forest School of Medicine, Medical Center , 1 Winston-Salem, Boulevard, NC, 27157, USA
| | - Leilani L Johnson
- Department of Neurology, Medical Center, Wake Forest School of Medicine, 1 Winston-Salem, Boulevard, NC, 27157, USA.
| | - Julia Garcia-Vargas
- Department of Neurology, Medical Center, Wake Forest School of Medicine, 1 Winston-Salem, Boulevard, NC, 27157, USA
| | - Mary Claire O'Brien
- Department of Emergency Medicine, Medical Center, Wake Forest School of Medicine, 1 Winston-Salem, Boulevard, NC, 27157, USA
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26
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Andersen CA, Frandsen AK, Valentiner-Branth C, Lykkegaard J, Løkkegaard T, Thomsen JL, Jensen MB, Hansen MP. Introducing point-of-care ultrasound in Danish general practice-elucidating the use through a medical audit. Fam Pract 2021; 38:80-87. [PMID: 32839822 DOI: 10.1093/fampra/cmaa080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Point-of-care ultrasonography (PoCUS) is increasingly used across the medical field. PoCUS is also being implemented in general practice despite a lack of clinical guidelines and training programs for general practitioners (GPs). OBJECTIVES This study aimed to elucidate the employment of PoCUS by Danish GPs following a short training program. METHODS Thirty GPs were enrolled in a short ultrasound training program and taught how to perform 22 selected scanning modalities. In the following 3 months, the GPs registered all performed PoCUS examinations according to the Audit Project Odense method. After 5 months, the GPs were invited to participate in an evaluation seminar, where questionnaires were distributed. RESULTS During the registration period, 1598 patients were examined with PoCUS. A total of 1948 scanning modalities were registered, including 207 examinations outside the taught curriculum. The majority of the ultrasound examinations were performed within 10 minutes (89%), most were considered to be conclusive (87%) and/or to increase diagnostic certainty (67%), whereas one in four examinations entailed a change in patient management. Most GPs attending the evaluation seminar continued to use PoCUS and found the scanning modalities included in the course curriculum relevant in their daily work. CONCLUSION The GPs found several indications for performing PoCUS following the attendance of a 2-day basic training program. The majority of examinations were registered to be conclusive and/or increase diagnostic certainty. However, few GPs used PoCUS on a daily basis and not all examinations were registered to have an impact on patient care.
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Affiliation(s)
| | | | | | - Jesper Lykkegaard
- Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | | | | | | | - Malene Plejdrup Hansen
- Center for General Practice at Aalborg University, Aalborg.,Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Sohaey R, Di Salvo DN, Bluth EI, Lockhart ME, Cohen HL, Pellerito JS, Baltarowich OH, Nisenbaum HL, Coleman BG. Medical Student Ultrasound Education: The Radiology Chair Weighs In. Ultrasound Q 2021; 37:3-9. [PMID: 33661796 DOI: 10.1097/ruq.0000000000000557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To assess the radiology department chairs' opinions concerning current status and plans for teaching ultrasound to medical students, the American College Taskforce on Radiology Ultrasound Education, commissioned by the American College of Radiology, distributed a survey to 142 radiology chairs and a medical school dean subgroup.The response rate was 30% (42/142), and 76% indicated ultrasound was currently part of the medical student curriculum. In preclinical years, radiology involvement was only 6.4%. During clinical years, radiology led ultrasound education with 51.7% in general and 82.9% in elective rotations. Regarding actual content, top 4 results were evenly distributed between learning hands-on scanning (81.1%), diagnostic use of ultrasound (75.7%), anatomy/pathology (75.7%), and ultrasound guidance for procedures (54.0%). Educational leaders in preclinical courses were emergency medicine (72.7%) followed by radiology (45.4%) physicians. During clinical years, leaders were radiology (52.6%) and emergency medicine (47.4%) physicians. Most chairs stated that knowledge of diagnostic ultrasound should be mandatory (76.2%), stressing the importance of teaching the diagnostic capabilities and uses of ultrasound as the primary goal (78.8%). Perceived barriers to implementation were evenly distributed between lack of space in the curriculum (55.6%), lack of faculty (48.2%), lack of resources (44.4%), and lack of institutional support (40.7%). The American College Taskforce on Radiology Ultrasound Education survey shows that radiology's role in ultrasound undergraduate education occurs almost exclusively during clinical years, and the chairs voice a desire to improve upon this role. Barriers include both intradepartmental (faculty and resources) and institutional (curricular) factors.
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Affiliation(s)
- Roya Sohaey
- Oregon Health & Science University, Portland, OR
| | | | | | | | - Harris L Cohen
- University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Harvey L Nisenbaum
- Hospital of the University of Pennsylvania and Presbyterian Medical Center of Philadelphia
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28
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Allocca M, Furfaro F, Fiorino G, Peyrin-Biroulet L, Danese S. Point-of-Care Ultrasound in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:143-151. [PMID: 32674146 DOI: 10.1093/ecco-jcc/jjaa151] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], are chronic, relapsing and destructive inflammatory disorders of the gastrointestinal tract which can lead to organ damage and impair quality of life. A 'treat-to-target' strategy based on activity and severity of disease and response to treatment with close monitoring of intestinal inflammation is recommended. Ileocolonoscopy [CS] is considered the first-line procedure for the assessment of IBD, and magnetic resonance enterography [MRE] is the current standard for assessing the small bowel and complications in CD, and has been proposed as an alternative procedure to CS in the evaluation of both ileo-colonic CD and UC. As that both CS and MRE are invasive and expensive procedures and unappealing to patients, they are unfeasible as frequent and repetitive tools for the monitoring of disease activity. Bowel ultrasound [US] represents a well-tolerated, non-invasive and cost-effective modality to manage IBD patients in clinical practice. Compared to CS and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both CD and UC. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. Point-of-care ultrasound [POCUS] is suggested as the stethoscope of the future and is gaining interest and diffusion in the medical field because it can be used for the bedside examination of patients. The aim of this review is to discuss point-of-care bowel ultrasound [POCBUS] in the management of patients with IBD.
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Affiliation(s)
- Mariangela Allocca
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
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29
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Position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee. Insights Imaging 2020; 11:115. [PMID: 33165666 PMCID: PMC7652945 DOI: 10.1186/s13244-020-00919-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
This document summarises best practice recommendations for medical imaging use of ultrasound in Europe, representing the agreed consensus of experts from the Ultrasound Subcommittee of the European Society of Radiology (ESR), the European Union of Medical Specialists (UEMS) Section of Radiology, and the European Federation of Societies for Ultrasound in Medicine and Biology. Recommendations are given for education and training, equipment and its maintenance, documentation, hygiene and infection prevention, and medico-legal issues.
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30
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Ma IWY, Steinmetz P, Weerdenburg K, Woo MY, Olszynski P, Heslop CL, Miller S, Sheppard G, Daniels V, Desy J, Valois M, Devine L, Curtis H, Romano MJ, Martel P, Jelic T, Topping C, Thompson D, Power B, Profetto J, Tonseth P. The Canadian Medical Student Ultrasound Curriculum: A Statement From the Canadian Ultrasound Consensus for Undergraduate Medical Education Group. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1279-1287. [PMID: 31943311 PMCID: PMC7317450 DOI: 10.1002/jum.15218] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study sought to establish by expert review a consensus-based, focused ultrasound curriculum, consisting of a foundational set of focused ultrasound skills that all Canadian medical students would be expected to attain at the end of the medical school program. METHODS An expert panel of 21 point-of-care ultrasound and educational leaders representing 15 of 17 (88%) Canadian medical schools was formed and participated in a modified Delphi consensus method. Experts anonymously rated 195 curricular elements on their appropriateness to include in a medical school curriculum using a 5-point Likert scale. The group defined consensus as 70% or more experts agreeing to include or exclude an element. We determined a priori that no more than 3 rounds of voting would be performed. RESULTS Of the 195 curricular elements considered in the first round of voting, the group reached consensus to include 78 and exclude 24. In the second round, consensus was reached to include 4 and exclude 63 elements. In our final round, with 1 additional item added to the survey, the group reached consensus to include an additional 3 and exclude 8 elements. A total of 85 curricular elements reached consensus to be included, with 95 to be excluded. Sixteen elements did not reach consensus to be included or excluded. CONCLUSIONS By expert opinion-based consensus, the Canadian Ultrasound Consensus for Undergraduate Medical Education Group recommends that 85 curricular elements be considered for inclusion for teaching in the Canadian medical school focused ultrasound curricula.
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Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Peter Steinmetz
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Kirstin Weerdenburg
- Department of Pediatric Emergency MedicineIWK Health Center and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Michael Y. Woo
- Department of Emergency MedicineUniversity of Ottawa and Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Paul Olszynski
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Claire L. Heslop
- Division of Emergency Medicine, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Stephen Miller
- Department of Emergency Medicine, Skilled Clinician Program, Undergraduate Medical EducationDalhousie UniversityHalifaxNova ScotiaCanada
| | - Gillian Sheppard
- Department of Emergency MedicineMemorial University of NewfoundlandSt John'sNewfoundlandCanada
| | - Vijay Daniels
- Division of General Internal MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Janeve Desy
- Division of General Internal MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Maxime Valois
- Department of Emergency MedicineMcGill UniversityMontrealQuebecCanada
- Department of Emergency MedicineSherbrooke UniversitySherbrookeQuebecCanada
| | - Luke Devine
- Division of General Internal MedicineUniversity of TorontoTorontoOntarioCanada
| | - Heather Curtis
- Department of Diagnostic ImagingDalhousie UniversityHalifaxNova ScotiaCanada
| | - Michael J. Romano
- Division of Emergency Medicine, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Patrick Martel
- Department of Emergency Medicine, Thunder Bay Regional Health Sciences CenterNorth Ontario School of MedicineThunder BayOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Claude Topping
- Departments of Family Medicine and Emergency MedicineLaval University, QuebecQuebecCanada
| | - Drew Thompson
- Department of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Barbara Power
- Department of Medicine, EducationUniversity of OttawaOttawaOntarioCanada
| | - Jason Profetto
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Pete Tonseth
- Department of RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Abstract
Background: Focused cardiac ultrasound (FCU) is widely used by healthcare providers to answer specific questions about cardiac structure and function at the bedside. Currently, no widely accepted FCU image acquisition checklist exists to assess learners with varying skill levels from different specialties. Objective: The primary objective of this project was to develop a consensus-based FCU image acquisition checklist using a multispecialty group of point-of-care ultrasound (POCUS) experts. Methods: The essential components of an FCU examination were identified on the basis of published recommendations from echocardiography and international ultrasound societies. A checklist of the essential components of an FCU examination was drafted. A panel of POCUS experts from different medical specialties in the United States and Canada was convened to vote on each checklist item by answering two questions: 1) Is this item important to include in a checklist of essential FCU skills applicable to any medical specialty? and 2) Should the learner be required to successfully complete this item to be considered competent? A modified Delphi approach was used to assess the level of agreement for each checklist item during four rounds of voting. Checklist items that achieved an agreement of 80% or greater were included in the final checklist. Results: Thirty-one POCUS experts from seven different medical specialties voted on sixty-five items to be included in the FCU image acquisition assessment tool. The majority of POCUS experts (61%) completed all four rounds of voting. During the first round of voting, 59 items reached consensus, and after revision and revoting, an additional 3 items achieved 80% or greater consensus. A total of 62 items were included in the final checklist, and 57 items reached consensus as a requirement for demonstration of competency. Conclusion: We have developed a multispecialty, consensus-based FCU image acquisition checklist that may be used to assess the skills of learners from different specialties. Future steps include studies to develop additional validity evidence for the use of the FCU assessment tool and to evaluate its utility for the translation of skills into clinical practice.
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Prosch H, Radzina M, Dietrich CF, Nielsen MB, Baumann S, Ewertsen C, Jenssen C, Kabaalioğlu A, Kosiak W, Kratzer W, Lim A, Popescu A, Mitkov V, Schiavone C, Wohlin M, Wüstner M, Cantisani V. Ultrasound Curricula of Student Education in Europe: Summary of the Experience. Ultrasound Int Open 2020; 6:E25-E33. [PMID: 32885138 PMCID: PMC7458842 DOI: 10.1055/a-1183-3009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Despite the increasing role of ultrasound, structured ultrasound teaching is only slowly being integrated into the curricula of medical schools and universities all over Europe. Aim To survey the current situation at European universities regarding the integration of ultrasound in student medical education and to report on models of student ultrasound training from selected European universities. Methods A questionnaire survey focusing on the implementation of curricular ultrasound education was sent out to the 28 presidents of the national ultrasound societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the questionnaires to the medical universities of their countries. Results Overall, 53 questionnaires were returned from 46 universities in 17 European countries. In most of the universities (40/46 universities, 87%), the theoretical background of ultrasound is taught. However, in only a minority of universities is ultrasound integrated in anatomy courses (8/46 universities, 17%) or basic science courses (16/46 universities, 35%). Practical skills in ultrasound are taught in 56% of the universities (26/46 universities) and tested in a practical exam in seven of the responding universities (15%). The number of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The respondents reported that lack of time and limited faculty funding were major hurdles. Conclusion According to our survey, only a minority of European universities has integrated ultrasound into the preclinical curriculum thus far. Future EFSUMB initiatives will continue to promote the introduction of ultrasound as an integrative part of the core curriculum of student medical education, and the preparation of proper teaching material.
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Affiliation(s)
- Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical
University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Maija Radzina
- Riga Stradins University, Radiology department, Riga,
Latvia
- University of Latvia, Medical Faculty, Paula Stradina clinical
university hospital, Diagnostic Radiology Institute Riga, Latvia
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site,
Salem und Permanence, Bern, Switzerland
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen,
Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen,
Denmark
| | - Sven Baumann
- Department of Internal Medicine I, Ulm University Hospital, Ulm,
Germany
| | | | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland,
Strausberg, and Brandenburg Institute for Clinical Ultrasound, Neuruppin,
Germany
| | | | - Wojciech Kosiak
- Department of Paediatrics, Haematology and Oncology, Medical University
of Gdansk, Poland
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Ulm,
Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare Trust,
UK
| | - Alina Popescu
- Department of Gastroenterology, "Victor Babeș"
University of Medicine and Pharmacy Timișoara, Timișoara, Romania
| | - Vladimir Mitkov
- Diagnostic Ultrasound Department, Russian Medical Academy of Continuous
Professional Education, Moscow, Russian Federation)
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of
Aging, „G. d’Annunzio“ University, Chieti,
Italy
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala Universitet, Uppsala,
Sweden
| | - Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen
Brüder Trier, Germany
| | - Vito Cantisani
- Department of Radiological, Oncologic and Anatomo-pathologic Sciences,
University of Rome La Sapienza, Roma, Italy
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Torralba KD, Cannella AC, Kissin EY, Bolster MB, Salto LM, Higgs J, Samuels J, Nishio MJ, Kaeley GS, Evangelisto A, De Marco P, Kohler MJ. Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs. Arthritis Care Res (Hoboken) 2020; 72:859-870. [PMID: 28777891 DOI: 10.1002/acr.23336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasound (MSUS) in rheumatology in the US has advanced by way of promotion of certifications and standards of use and inclusion of core fellowship curriculum. In order to inform endeavors for curricular integration, the objectives of the present study were to assess current program needs for curricular incorporation and the teaching methods that are being employed. METHODS A needs-assessment survey (S1) was sent to 113 rheumatology fellowship program directors. For programs that taught MSUS, a curriculum survey (S2) was sent to lead faculty. Programs were stratified according to program size and use of a formal written curriculum. RESULTS S1 (108 of 113 respondents; response rate 96%) revealed that 94% of programs taught MSUS, with 41% having a curriculum. Curricular implementation was unaffected by program size. Formal curricular adoption of MSUS was favored by 103 directors (95.3%), with 65.7% preferring such adoption to be optional. S2 (74 of 101 respondents; response rate 73%) showed that 41% of programs utilized a formal curriculum. Multiple teaching strategies were used, with content that was generally similar. Use of external courses, including the Ultrasound School of North American Rheumatologists course, was prevalent. Fewer barriers were noted compared to past surveys, but inadequate time, funding, and number of trained faculty still remained. Lack of divisional interest (P = 0.046) and interest of fellows (P = 0.012) were noted among programs without a formal curriculum. CONCLUSION MSUS is taught by a significantly larger number of rheumatology fellowship programs today. Multiple teaching strategies are used with common content, and barriers still remain for some programs. Most program directors favor inclusion of a standardized MSUS curriculum, with many favoring inclusion to be optional.
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Affiliation(s)
| | | | | | - Marcy B Bolster
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jay Higgs
- San Antonio Uniformed Services, San Antonio, Texas
| | | | | | | | - Amy Evangelisto
- Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey
| | - Paul De Marco
- Georgetown University School of Medicine, Washington, DC
| | - Minna J Kohler
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Leidi A, Rouyer F, Marti C, Reny JL, Grosgurin O. Point of care ultrasonography from the emergency department to the internal medicine ward: current trends and perspectives. Intern Emerg Med 2020; 15:395-408. [PMID: 32034674 DOI: 10.1007/s11739-020-02284-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Abstract
The advent of portable devices in the early 80s has brought ultrasonography to the patient's bedside. Currently referred to as 'point of care ultrasonography' (POCUS), it has become an essential tool for clinicians. Initially developed in the emergency and critical care settings, POCUS has gained increasing importance in internal medicine wards in the last decade, with both its growing diagnostic accuracy and portability making POCUS an optimal instrument for everyday clinical assessment and procedures. There is large body of evidence to confirm POCUS' superiority when compared to clinical examination and standard X-ray imaging in a variety of clinical situations. On the contrary, only few indications, such as procedural guidance, have a proven additional benefit for patients. Since POCUS is highly user-dependent, pre- and post-graduate curricula are needed and the range of use should be clearly defined. This review focuses on trends and perspectives of POCUS in the management of diseases frequently encountered in emergency and internal medicine. In addition, questions are raised regarding the teaching and supervision of POCUS needing to be addressed in the near future.
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Affiliation(s)
- Antonio Leidi
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Rouyer
- Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland.
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35
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Tomasi R, Stark K, Scheiermann P. Efficacy of a certified modular ultrasound curriculum. Anaesthesist 2020; 69:192-197. [PMID: 32055882 PMCID: PMC7056694 DOI: 10.1007/s00101-020-00730-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/13/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022]
Abstract
Background In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated. Objective The main objective of this study was to determine whether there is an increase of knowledge and of psychomotor skills for the trainees in this curriculum. Material and methods After ethical committee approval, 41 anesthesia physicians were enrolled. To determine the increase of knowledge and of practical skills theoretical and practical tests performed were evaluated before and after two different US courses. Results Comparing before and after course tests, the participants showed significant improvement in theoretical multiple choice tests (p = 0.008). Regarding psychomotor skills following course 1, the trainees improved significantly in the time needed to perform the two practical tests (p = 0.03), but not in the performance of the test. Better needle visualization during simulated US-guided vessel puncture (p = 0.52) and better identification of the anatomical structures in the axillary region (p = 0.56) could not be achieved. Conclusion This study shows that although this US course curriculum has positively enhanced the trainees’ theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course. Electronic supplementary material The online version of this article (10.1007/s00101-020-00730-9) provides the two questionnaires in German. The article and additional material are available at www.springermedizin.de. Please enter the title of the article in the search field, the additional material can be found under “Ergänzende Inhalte”. ![]()
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Affiliation(s)
- R Tomasi
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - K Stark
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - P Scheiermann
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Kumar A, Weng Y, Wang L, Bentley J, Almli M, Hom J, Witteles R, Ahuja N, Kugler J. Portable Ultrasound Device Usage and Learning Outcomes Among Internal Medicine Trainees: A Parallel-Group Randomized Trial. J Hosp Med 2020; 15:e1-e6. [PMID: 32118565 DOI: 10.12788/jhm.3351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/03/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known about how to effectively train residents with point-of-care ultrasonography (POCUS) despite increasing usage. OBJECTIVE This study aimed to assess whether handheld ultrasound devices (HUDs), alongside a year-long lecture series, improved trainee image interpretation skills with POCUS. METHODS Internal medicine intern physicians (N = 149) at a single academic institution from 2016 to 2018 participated in the study. The 2017 interns (n = 47) were randomized 1:1 to receive personal HUDs (n = 24) for patient care vs no-HUDs (n = 23). All 2017 interns received a repeated lecture series regarding cardiac, thoracic, and abdominal POCUS. Interns were assessed on their ability to interpret POCUS images of normal/abnormal findings. The primary outcome was the difference in end-of-the-year assessment scores between interns randomized to receive HUDs vs not. Secondary outcomes included trainee scores after repeating lectures and confidence with POCUS. Intern scores were also compared with historical (2016, N = 50) and contemporaneous (2018, N = 52) controls who received no lectures. RESULTS Interns randomized to HUDs did not have significantly higher image interpretation scores (median HUD score: 0.84 vs no-HUD score: 0.84; P = .86). However, HUD interns felt more confident in their abilities. The 2017 cohort had higher scores (median 0.84), compared with the 2016 historical control (median 0.71; P = .001) and 2018 contemporaneous control (median 0.48; P < .001). Assessment scores improved after first-time exposure to the lecture series, while repeated lectures did not improve scores. CONCLUSIONS Despite feeling more confident, personalized HUDs did not improve interns' POCUS-related knowledge or interpretive ability. Repeated lecture exposure without further opportunities for deliberate practice may not be beneficial for mastering POCUS.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yingjie Weng
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Libo Wang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jason Bentley
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Marta Almli
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald Witteles
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Neera Ahuja
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - John Kugler
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Mohammad SH, Evans KD, Bahner D, Sommerich CM. An Interprofessional Approach to Targeted Sonography Training Using Computer-Based Simulation in Medical Students’ Clinical Training: A Case Series. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319897891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Document a feasibility study of an interprofessional approach to targeted sonography training (TST) for medical students, incorporating computer-based simulation (CBS). Procedure: Three participants received TST on the abdominal aorta from credentialed sonographers using CBS. Training included didactic instruction, skill demonstration, debrief, and feedback. An assessment template was developed to assess students’ skills and provide structured feedback. Students completed a feedback survey on the learning process that followed the training. Results: Students’ template scores were similar, despite varying prior exposure to CBS. The importance of deliberate practice, direct feedback when a student is struggling, and a debrief session following skill demonstration was evident in this study. Students agreed that this targeted instructional process provided a low-pressure environment where they could learn from mistakes and improve their confidence. Conclusion: This case series demonstrated how readily a TST session can be accomplished using computer-based simulation and the value of structured feedback.
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Affiliation(s)
- Sundus H. Mohammad
- School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Kevin D. Evans
- Radiologic Sciences/Respiratory Therapy Division, The Ohio State University, Columbus, OH, USA
| | - David Bahner
- Emergency Medicine, The Ohio State University, Columbus, OH, USA
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Celebi N, Griewatz J, Ilg M, Zipfel S, Riessen R, Hoffmann T, Malek NP, Pauluschke-Fröhlich J, Debove I, Muller R, Fröhlich E. Three different ways of training ultrasound student-tutors yield significant gains in tutee's scanning-skills. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc77. [PMID: 31844649 PMCID: PMC6905374 DOI: 10.3205/zma001285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/26/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Aim: Many medical universities rely these days on trained student tutors to enable faculty-wide undergraduate ultrasound training. However, there is neither consensus on an optimal method nor any developed and agreed standard in the training of these student tutors. Usually internships and courses are employed which have both a specific set of advantages and disadvantages. We conducted a prospective quasi-randomized study of assess the effects of three types of tutor training on the resulting improvement in scanning skills of their tutees. Methods: Three batches of student tutors were trained by a course only (C-group), by an internship only (I-group) or by a course and an internship (CI-group). The respective gains in ultrasound scanning skills of the tutees were measured prospectively. A total 75 of the 124 5th year medical students (60.5%) who attended the mandatory ultrasound course completed both pre- and post-exams on a voluntary basis. Within a limit of eight minutes and three images, they were asked to depict and label a maximum of 14 anatomical structures. Two blinded raters independently awarded two points for each label with an identifiable structure and one point for each label with a possibly identifiable structure. Results: In all three groups, the tutees improved significantly by more than doubling their pre-score results and comparably (Gains: C-group 9.19±5.73 points, p<.0001, I-group 9.77±4.81 points, p<.0001, CI-group 8.97±5.49 points, p<.0001). Conclusion: Student tutors, who were trained with a course or an internship or a course and an internship could teach scanning skills to 5th year medical students very effectively and with similar success.
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Affiliation(s)
| | - Jan Griewatz
- Competence Centre for University Teaching in Medicine, Baden-Württemberg, Tübingen, Germany
| | - Madeleine Ilg
- Eberhard-Karls University, Medical faculty, Tübingen, Germany
| | - Stephan Zipfel
- University Hospital Tübingen, Department of Internal Medicine VI, Tübingen, Germany
| | - Reimer Riessen
- University Hospital Tübingen, Department of Internal Medicine VIII, Tübingen, Germany
| | - Tatjana Hoffmann
- University Hospital Tübingen, Department of Internal Medicine I, Tübingen, Germany
| | - Nisar Peter Malek
- University Hospital Tübingen, Department of Internal Medicine I, Tübingen, Germany
| | | | - Ines Debove
- University Hospital Bern, Department of Neurology, Bern, Switzerland
| | | | - Eckhart Fröhlich
- University Hospital Tübingen, Department of Internal Medicine I, Tübingen, Germany
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Hendriksz T, Markman Z, Pera A. An Education in Osteopathic Ultrasonography (AEIOU) Program: One Institution's Approach to Advancing an Ultrasonography Curriculum. J Osteopath Med 2019; 118:746-752. [PMID: 30398572 DOI: 10.7556/jaoa.2018.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Advances in ultrasonography (US) have allowed this technology to play an increasingly important role in numerous fields of medicine. It is important that medical schools incorporate this broadly applicable tool into their curricula. Touro University College of Osteopathic Medicine-CA has implemented a progressive US curriculum that is intended to complement osteopathic education, keep pace with medical advances, and arm future physicians with the most advanced skills and tools to practice medicine. In this article, the authors highlight the importance of US training in medical education and demonstrate the relative ease, cost-effectiveness, and direct benefit to students of implementing such a curriculum. The authors discuss the specifics of the US curriculum in osteopathic undergraduate medical education and describe how a staged rollout helped the college address the need for funding, faculty, and facilities. Plans for continued expansion, the successful and effective use of peer educators, the outcomes measured from this project, and avenues for further study are also discussed.
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Wolf R, Geuthel N, Gnatzy F, Rotzoll D. Undergraduate ultrasound education at German-speaking medical faculties: a survey. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc34. [PMID: 31544134 PMCID: PMC6737263 DOI: 10.3205/zma001242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 03/24/2019] [Accepted: 04/15/2019] [Indexed: 05/21/2023]
Abstract
Background: The purpose of this study was twofold: to assess the status of undergraduate medical ultrasound (US) education in the German-speaking area and to suggest a possible framework for a longitudinal undergraduate medical US curriculum based on the study results and a literature review. Methods: The survey included 44 medical faculties in the German-speaking area: 37 in Germany, four in Austria and three in German-speaking Switzerland. A standardized questionnaire focused on the following aspects of undergraduate medical US education: general information, organization, resources, assessment methods and evaluation. Results: Data from 28 medical faculties were analysed. 26 out of 28 medical faculties offered US courses, 21 offered compulsory as well as elective courses, four offered compulsory and one elective courses only. 27 medical faculties supported US skills implementation. Abdominal US (n=25) was most common in teaching basic US skills. A learning objective catalogue was provided at 15 medical faculties. At 22 medical faculties, medical specialists were involved in undergraduate medical US education. 24 out of 26 medical faculties thought that peer-teaching is important to convey US skills. Medical faculties used the following methods to assess US skills: objective structured clinical examination (OSCE, n=7), non-standardized practical exams (n=4), non-standardized combined oral-practical exams (n=2) or direct observation of procedural skills (DOPS, n=1). 25 out of 26 medical faculties evaluated their US courses and 19 made suggestions for improvements in undergraduate medical US education. Conclusion: Medical faculty members in the German-speaking area have recognized the relevance of undergraduate medical US education. So far, courses are offered heterogeneously with rather short hands-on scanning time and high student-instructor ratio. Based on the results of this study and a literature review we suggest a possible framework and milestones on the way to a longitudinal undergraduate medical US curriculum.
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Affiliation(s)
- Robert Wolf
- University of Leipzig, Faculty of Medicine, Skills and Simulation Centre LernKlinik Leipzig, Leipzig, Germany
| | - Nicole Geuthel
- University Hospital Leipzig, Department of Paediatrics, Clinic for Paediatric Surgery, Leipzig, Germany
| | - Franziska Gnatzy
- St. Elisabeth Hospital Leipzig, Clinic for Internal Medicine II, Leipzig, Germany
| | - Daisy Rotzoll
- University of Leipzig, Faculty of Medicine, Skills and Simulation Centre LernKlinik Leipzig, Leipzig, Germany
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Royer DF. Seeing with Sound: How Ultrasound Is Changing the Way We Look at Anatomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1138:47-56. [PMID: 31313257 DOI: 10.1007/978-3-030-14227-8_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ultrasound uses high frequency sound waves and their rebounding echoes to capture live images of the structures beneath the skin. Thanks to recent technological advances, contemporary ultrasound machines offer excellent image resolution packaged in smaller, highly portable devices, which has allowed ultrasound to expand into new areas, both within the hospital as well as across non-traditional settings. Ultrasound is an incredibly powerful visualization tool in medicine, allowing physicians to safely see and interrogate the most relevant parts of their patient's internal anatomy instantly. Point-of-care ultrasound, a focused ultrasound evaluation performed at the patient's bedside, is now common across medical specialties, encompassing a vast array of diagnostic, procedural and screening applications. The impressive expansion of point-of-care ultrasound has resulted in an increased demand for ultrasound training earlier during medical school. As a non-invasive and non-destructive way to see inside the living body, ultrasound is an ideal tool to teach anatomy. It allows both medical and non-medical students the ability to improve their understanding and retention of anatomical form and function. The widespread and still expanding use of ultrasound in healthcare today, as well as its adoption into the anatomy classroom, is a testament to the power of ultrasound for achieving real-time visualization of the hidden aspects of our bodies.
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Affiliation(s)
- Danielle F Royer
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, USA.
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Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, Edvardsen T, Galderisi M, Sicari R, Donal E, Stefanidis A, Delgado V, Zamorano J, Popescu BA. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
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Affiliation(s)
- Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal.,Faculdade Ciências Médicas da Universidade nova de Lisboa, Campo Mártires da Pátria 130, Lisbon, Portugal
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Alexsandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, VIa S. Pansini 5, Napples, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, Pisa, Italy
| | - Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jose Zamorano
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9, 100, Madrid, Spain.,CIBERV, Madrid, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Institute of cardiovascular diseases "Prof. Dr. C C Iliescu, Bucharest, Romania
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Abstract
Sonography is increasingly being used by nephrologists and the field of dialysis access is no exception. Advances in technology have allowed the addition of this universally available, portable, non-invasive tool to the nephrologist's armamentarium, which provides information on both morphology and physiology without the need for contrast or radiation. Ultrasound may be used across the spectrum of dialysis access, including central venous catheter placements, vascular mapping, regional anesthesia, creation, maintenance and assessment of hemodialysis access as well as assessment of the abdominal wall and peritoneal dialysis catheter placements. However, the lack of exposure in most training programs limits incorporation of routine use of ultrasounds in nephrology practice. As our specialty embarks on the ultrasound revolution, a two-pronged approach is essential to provide ample training opportunities while ensuring establishment of basic standards for training and competency.
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Affiliation(s)
- Vandana Dua Niyyar
- Division of Nephrology, Department of Medicine, Emory University, Atlanta, GA, USA
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Kumar A, Kugler J, Jensen T. Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments. J Gen Intern Med 2019; 34:1025-1031. [PMID: 30924088 PMCID: PMC6544692 DOI: 10.1007/s11606-019-04945-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicine. However, a key question remains: how does one define "competency" with this emerging technology? As our trainees become more acquainted with POCUS, it is vital to develop validated methodology for defining and measuring competency amongst inexperienced users. As a framework, the assessment of competency should include evaluations that assess the acquisition and application of POCUS-related knowledge, demonstration of technical skill (e.g., proper probe selection, positioning, and image optimization), and effective integration into routine clinical practice. These assessments can be performed across a variety of settings, including web-based applications, simulators, standardized patients, and real clinical encounters. Several validated assessments regarding POCUS competency have recently been developed, including the Rapid Assessment of Competency in Echocardiography (RACE) or the Assessment of Competency in Thoracic Sonography (ACTS). However, these assessments focus mainly on technical skill and do not expand upon other areas of this framework, which represents a growing need. In this review, we explore the different methodologies for evaluating competency with POCUS as well as discuss current progress in the field of measuring trainee knowledge and technical skill.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA.
| | - John Kugler
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA
| | - Trevor Jensen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Celebi N, Griewatz J, Malek NP, Krieg S, Kuehnl T, Muller R, Pauluschke-Fröhlich J, Debove I, Riessen R, Zipfel S, Fröhlich E. Development and implementation of a comprehensive ultrasound curriculum for undergraduate medical students - a feasibility study. BMC MEDICAL EDUCATION 2019; 19:170. [PMID: 31138197 PMCID: PMC6537195 DOI: 10.1186/s12909-019-1611-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/17/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Ultrasound is one of the most important imaging techniques in clinical medicine with unique advantages. Skills in ultrasound imaging are very usefull for physicians including novices and thus also mandated by the Task Force "National Competence-Based Learning Objectives for Undergraduate Medical Education" (NKLM) in Germany and as well as by the German Ultrasound Society (Deutsche Gesellschaft für Ultraschall in der Medizin, DEGUM). Since ultrasound is best learned hands-on in very small supervised groups, we developed and implemented a comprehensive ultrasound-curriculum for all undergraduate medical students of our faculty using a peer-teaching concept. METHODS We used Kern's six-step model of curricular development comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational stategies, (5) implementation, and (6) evaluation and feedback. RESULTS The developed curriculum covers basic ultrasound of the abdomen and the throat, eFAST (Extended Focused Assessment with Sonography for Trauma), lung-ultrasound, FEEL (Focused Echocardiography in Emergency Life Support) and compression duplex sonography of the thigh deep vein system. All 5th year medical students receive a 90 min lecture on ultrasound basics by a faculty member and then a 12.5 h hands-on course divided into three sessions with one student tutor for every 4 students. The students are provided with a script (PDF-File) that covers all the learning goals, including example images of pathologies. The student tutors are trained during a 1 week ultrasound course and a 21-day rotation through seven different ultrasound laboratories. In addition, they undergo a standardized 1.5 day didactical training. Prior to the implementation for all students, the overall course was tested on 27 volunteer students. These students rated (on a 6-point Likert scale from 1 = excellent to 6 = very poor) the satisfaction with the student tutors and the faculty members as 1.4 ± .9 (mean ± stddev) and 1.3 ± .5 respectively. CONCLUSION A comprehensive ultrasound curriculum for all undergraduate medical students using a peer-teaching concept is feasible. Further studies are needed to evaluate in detail the learning outcomes for students and student tutors.
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Affiliation(s)
- Nora Celebi
- PHV Dialysis Center Waiblingen, Beinsteiner Straße 8/3, 71334 Waiblingen, Germany
| | - Jan Griewatz
- Eberhard-Karls University, Competence Centre for University Teaching in Medicine, Baden-Wuerttemberg, Elfriede-Aulhorn-Str. 10, D-72076 Tuebingen, Germany
| | - Nisar P. Malek
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Sarah Krieg
- Medical Faculty, Eberhard-Karls University, Geissweg 5/3, 72076 Tübingen, Germany
| | - Toni Kuehnl
- Medical Faculty, Eberhard-Karls University, Geissweg 5/3, 72076 Tübingen, Germany
| | - Reinhold Muller
- Professorial Research Fellow AITHM, James Cook University, 1/14-88 McGregor Rd, Smithfield, QLD 4878 Australia
| | - Jan Pauluschke-Fröhlich
- Department of Gynecology, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Ines Debove
- Department of Neurology, Inselspital, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Reimer Riessen
- Department of Internal Medicine, Intensive Care Unit, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Stephan Zipfel
- Department of Internal Medicine VI (Psychosomatic medicine), University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Eckhart Fröhlich
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
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Celebi N, Griewatz J, Malek NP, Hoffmann T, Walter C, Muller R, Riessen R, Pauluschke-Fröhlich J, Debove I, Zipfel S, Fröhlich E. Outcomes of three different ways to train medical students as ultrasound tutors. BMC MEDICAL EDUCATION 2019; 19:125. [PMID: 31046757 PMCID: PMC6498570 DOI: 10.1186/s12909-019-1556-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND In order to provide faculty-wide undergraduate ultrasound training in times of scarce resources, many medical faculties employ trained peer-student tutors to oversee the hands-on training. However, data to guide the training of ultrasound peer-student tutors are scarce. We conducted a prospective quasi-randomized study to assess the gain in theoretical knowledge and practical scanning skills of peer-student tutors who were trained with a course only, an internship only, or the combination of a course and an internship. METHODS A total of 44 peer-student tutors were trained by a one-week course only (C-Group, n = 21), by an internship only (I-Group, n = 10) or by a course and an internship (CI-Group, n = 13). Prior to and after the completion of the training the peer-student tutors completed an MC-test (theoretical knowledge) and an OSCE (practical scanning skills). RESULTS With all three education concepts, the peer-student tutors had significant and comparable gains in theoretical knowledge (C-group + 90%, I-group + 61.5%, CI-group + 114.0%) and practical scanning skills (C-group + 112.0%, I-group + 155.0% and CI-group + 123.5%), all p < 0.001. CONCLUSION Peer-student tutors, who were trained with a course or an internship or a course and internship improved their theoretical knowledge and their practical scanning skills significantly and to a comparable degree.
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Affiliation(s)
- Nora Celebi
- PHV dialysis center Waiblingen, Beinsteiner Straße 8/3, 71334 Waiblingen, Germany
| | - Jan Griewatz
- Competence Centre for University Teaching in Medicine, Baden-Wuerttemberg, Elfriede-Aulhorn-Str. 10, D-72076 Tuebingen, Germany
| | - Nisar Peter Malek
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Tatjana Hoffmann
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Carina Walter
- Eberhard-Karls University, Geissweg 5/3, 72076 Tübingen, Germany
| | - Reinhold Muller
- James Cook University, 1/14-88 McGregor Rd, Smithfield, QLD 4878 Australia
| | - Reimer Riessen
- Department of Internal Medicine VIII (Intensive Care Unit), University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Jan Pauluschke-Fröhlich
- Department of Womens Health, University Hospital Tübingen, Calwerstraße 7, 72076 Tübingen, Germany
| | - Ines Debove
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, CH Switzerland
| | - Stephan Zipfel
- Department of Internal Medicine VI (Psychosomatic Medicine), University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Eckhart Fröhlich
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
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Hower K, Young CF, Wagner A, Thorsen D, Dugan J. Can Osteopathic Medical Students Accurately Measure Abdominal Aortic Dimensions Using Handheld Ultrasonography Devices in the Primary Care Setting? J Osteopath Med 2019; 119:e19-e24. [DOI: 10.7556/jaoa.2019.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
The US Preventive Services Task Force (USPSTF) recommends a 1-time ultrasonography (US) screening for abdominal aortic aneurysm (AAA) to reduce AAA-specific mortality in men aged 65 to 75 years who have ever smoked. A 2015 study concluded that less than 50% of at-risk primary care patients are screened for AAA. To increase screening rates, it would be beneficial to train other health care professionals in accurately measuring abdominal aortic dimensions.
Objective
To determine whether osteopathic medical students can use handheld US machines to measure abdominal aortic diameters as accurately as an experienced US technologist.
Methods
Three osteopathic medical students underwent 8 hours of US training with a board-certified radiologist to measure abdominal aortic dimensions using a handheld US device. After the training, students independently conducted AAA US screenings at a clinic on participants meeting USPSTF AAA screening criteria. Transverse and anteroposterior measurements were taken at 3 sites: celiac axis, inferior to the renal arteries, and superior to the iliac bifurcation. A US technologist then measured the participants’ aortic diameters in the radiology department at another facility. The measurements from both reports were then compared using a 2-sample t test.
Results
The aortic diameter was measured in 16 participants with a mean (SD) body mass index of 26.7 (3.6). The mean (SD) difference between novice and expert measurement of the abdominal aorta was −0.15 (0.23) cm. No statistically significant difference was found between the US measurements completed by students and a US technologist (t=−1.38, P=.09). None of the participants met the criteria for AAA (>3.0 cm), with the largest abdominal aorta scanned by experts measuring 2.86 cm.
Conclusion
When properly trained, osteopathic medical students can accurately measure abdominal aortic diameters using a handheld US device. Training more medical students in ultrasonography would offer increased screening opportunities and possibly reduce AAA-related mortality. Further studies are needed to assess the ability of osteopathic medical students to accurately measure AAAs, as no participants in this study met the criteria for AAA.
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Bell FE, Neuffer FH, Haddad TR, Epps JC, Kozik ME, Warren BC. Active Learning of the Floor of Mouth Anatomy with Ultrasound. ANATOMICAL SCIENCES EDUCATION 2019; 12:310-316. [PMID: 30414266 DOI: 10.1002/ase.1839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 06/08/2023]
Abstract
More emphasis is now being placed on active learning in medical education. Ultrasound is an active learning tool that can be used to supplement didactic instruction. This study describes a self-guided activity for learning floor of mouth ultrasound. Thirty-three first year medical students learned floor of mouth scan technique and ultrasound anatomy through a brief PowerPoint module. They subsequently performed the scan on a standardized patient. Each student was asked to label the floor of mouth muscles on the image he or she acquired. After the activity, the students were given a quiz on anatomic relationships of the floor of mouth. Perceptions about the activity were collected through a survey. All 33 students obtained a floor of mouth image within a three minute time limit. Twenty-four (73%) students were able to completely and accurately label the image in time. The mean score on the muscle relationships quiz was 93%. Overall perceptions were very positive with most students expressing a "high" or "very high" level of interest in incorporating similar self-guided activities within the curriculum. This study showed that it is feasible for students to learn scan technique and recognize relevant ultrasound anatomy in an independent fashion through a brief active learning module. Furthermore, the students found the activity enjoyable. The implication is that similar activities could be developed which would provide additional ways to incorporate active learning strategies.
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Affiliation(s)
- Floyd E Bell
- Department of Radiology, University of South Carolina School of Medicine, Columbia, South Carolina
- Ultrasound Institute, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Francis H Neuffer
- Department of Radiology, University of South Carolina School of Medicine, Columbia, South Carolina
| | - T Robert Haddad
- Ultrasound Institute, University of South Carolina School of Medicine, Columbia, South Carolina
| | - James C Epps
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Michael E Kozik
- University of South Carolina School of Medicine, Columbia, South Carolina
| | - Brandon C Warren
- University of South Carolina School of Medicine, Columbia, South Carolina
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Byrne C, Kahl N, Knight B, Lee M, Morley S, Lahham S, Bingisser R, Thompson M, Shniter I, Valdes V, Fox JC. A Prospective Evaluation of Point of Care Ultrasound Teaching in Switzerland. J Med Ultrasound 2019; 27:92-96. [PMID: 31316219 PMCID: PMC6607874 DOI: 10.4103/jmu.jmu_57_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023] Open
Abstract
Context: As the utility of point-of-care ultrasound (POCUS) continues to expand in the medical field, there is a need for effective educational methods. In Switzerland, medical education follows the European model and lasts 6 years, focusing on preclinical training during the first 2 years. No previous studies have evaluated the optimal time for teaching ultrasound in European medical education. Aims: The aim of this study is to provide ultrasound training to medical students in Switzerland at varying times during their clinical training to determine if the level of training plays a role in their ability to comprehend and to apply basic POCUS skills. Methods: We performed an observational study utilizing a convenience sample of Swiss medical students between July 11, 2016 and August 6, 2016. They were taught a 2-day POCUS course by five American-trained 1st-year medical students. Following this course, students were evaluated with written and clinical examination. Results: 100 Swiss medical students were enrolled in the study. A total of 59 of these students were early clinical students, and 41 students were late clinical students. A two-tailed t-test was performed and demonstrated that the late clinical students performed better than the early clinical students on the written assessment; however, no difference was found in clinical skill. Conclusion: Our data suggest that Swiss medical students can learn and perform POCUS after a 2-day instructional taught by trained 1st-year American medical students. No difference was found between students in early clinical training and late clinical training for the ability to perform POCUS.
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Affiliation(s)
- Connor Byrne
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Nico Kahl
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Brian Knight
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Monica Lee
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Stephanie Morley
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | | | - Maxwell Thompson
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - Inna Shniter
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - Victoria Valdes
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - John C Fox
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
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50
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Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Ann Fam Med 2019; 17:61-69. [PMID: 30670398 PMCID: PMC6342599 DOI: 10.1370/afm.2330] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ultrasound (POCUS) by general practitioners. METHODS We followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. We searched the databases MEDLINE (via PubMed), EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials using the key words ultrasonography and general practice in combination and using thesaurus terms. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTS We included in our review a total of 51 full-text articles. POCUS was applied for a variety of purposes, with the majority of scans focused on abdominal and obstetric indications. The length of training programs varied from 2 to 320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused POCUS scans were reported to have a higher diagnostic accuracy and be associated with less harm than more comprehensive scans or screening scans. The included studies were of a low quality, however, mainly because of issues with design and reporting. CONCLUSIONS POCUS has the potential to be an important tool for the general practitioner and may possibly reduce health care costs. Future research should aim to assess the quality of ultrasound scans in broader groups of general practitioners, further explore how these clinicians should be trained, and evaluate the clinical course of patients who undergo scanning by general practitioners.
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Affiliation(s)
| | - Sinead Holden
- Center for General Practice at Aalborg University, Aalborg, Denmark.,Center for Neuroplasticity and Pain (CNAP), Aalborg East, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Jonathan Vela
- Department of Rheumatology, Aalborg University Hospital, Aalborg North, Denmark
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