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Bapuji R, Eagles D, Ferreira N, Hecht N, Zhang Y, Woo MY, Cheung WJ, Ly V, Pageau P. Comparison of peer-assisted learning with expert-led learning in medical school ultrasound education: a systematic review and meta-analysis. CAN J EMERG MED 2024; 26:188-197. [PMID: 38363447 DOI: 10.1007/s43678-024-00663-x] [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: 05/05/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Teaching point-of-care ultrasonography (PoCUS) to medical students is resource intensive. Peer-assisted learning, where the teacher can be a medical student, may be a feasible alternative to expert-led learning. The objective of this systematic review and meta-analysis was to compare the PoCUS performance assessments of medical students receiving peer-assisted vs expert-led learning. METHODS This study was submitted to PROSPERO (CRD42023383915) and reported with PRISMA guidelines. MEDLINE, Embase, ERIC, Education Source, Scopus, and Web of Science were searched from inception to November 2022. Inclusion criteria were studies comparing peer-assisted vs expert-led PoCUS teaching for undergraduate medical students. The primary outcome was performance assessment of PoCUS skills. Two reviewers independently screened citations and extracted data. The Cochrane risk-of-bias tool for randomized trials was used to assess study quality. Studies were included in the meta-analysis if mean performance assessment scores with standard deviations and sample sizes were available. A random-effects meta-analysis was conducted to estimate the accuracy score of practical knowledge test for each group. A meta-regression evaluated difference in mean scores. RESULTS The search yielded 2890 citations; 1417 unique citations remained after removing duplicates. Nine randomized-controlled studies conducted in Germany, USA, and Israel, with 593 participants, were included in the meta-analysis. The included studies assessed teaching of abdominal, cardiac, thoracic, musculoskeletal, and ocular PoCUS skills. Most studies had some risk-of-bias concerns. The estimate accuracy score after weighting is 0.56 (95% CI [0.47, 0.65]) for peer-assisted learning and 0.59 (95% CI [0.49, 0.69]) for expert-led learning. The regression coefficient estimate is 0.0281 (95% CI [- 0.1121, 0.1683]); P value is 0.69. CONCLUSION This meta-analysis found that peer-assisted learning was a reasonable alternative to expert-led learning for teaching PoCUS skills to medical students.
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Affiliation(s)
- Raj Bapuji
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nathan Ferreira
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Hecht
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
| | - Yuxin Zhang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada.
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Bintaro S, Dietrich CF, Potthoff A. Principles for teaching sonography - current status. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1628-1634. [PMID: 37142236 DOI: 10.1055/a-2059-4425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Since many young medical residents require sonographic skills early on during training, increased attention has been paid to including sonography classes in undergraduate medical education, among both professional societies and medical educators responsible for medical licensing exams. Medical schools worldwide have developed and implemented a variety of ultrasound teaching formats.This article addresses evidence-based solutions to crucial challenges in planning and implementing undergraduate sonography education. In order to achieve a sustainable increase in practical sonographic competence, we suggest small-group classes with sufficient individual hands-on scanning time for each student. We recommend concentrating on a circumscribed topic and teaching it thoroughly and practically rather than superficially outlining a broad subject area. Provided that peer teachers undergo adequate training, student peer teachers are not inferior to physicians as teachers, as far as student satisfaction, theoretical knowledge and practical skills acquisition are concerned. The assessment of acquired practical skills should consist of practical examinations, such as an objective structured clinical examination (OSCE) or a direct observation of procedural skills (DOPS). In contrast to using healthy volunteers as training models, simulation trainers allow the demonstration of pathological findings in authentic sonographic images, with the disadvantages of unrealistically easy image acquisition, as well as the lack of interaction with the patient.
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Affiliation(s)
- Sabine Bintaro
- Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Andrej Potthoff
- Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
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Rollmann I, Lauter J, Kuner C, Herrmann-Werner A, Bugaj TJ, Friederich HC, Nikendei C. Tutors´ and Students' Agreement on Social and Cognitive Congruence in a Sonography Peer-assisted-learning Scenario. MEDICAL SCIENCE EDUCATOR 2023; 33:903-911. [PMID: 37546194 PMCID: PMC10403448 DOI: 10.1007/s40670-023-01814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/08/2023]
Abstract
Purpose Peer-assisted learning has become an integral part within medical education and has been proven to be effective in teaching medical skills. Cognitive and social congruence are important factors that explain the effectiveness of peer-assisted learning. However, although theory suggests this, there is no study to date that demonstrates that students and tutors agree upon the level of cognitive and social congruence. Thus, we compared tutors' and students' perception of cognitive and social congruence and their agreement on the causes of congruence. Methods 36 students and 9 tutors from 9 courses were asked to answer questionnaires for their perception of cognitive and social congruence in a peer-assisted learning sonography scenario. Results Students and tutors experienced cognitive congruence (t = 0.8277, df = 8, p = .4318, 95% CI = [-0.232; 0.491]) and social congruence (t = 0.962, df = 8, p = .364, 95% CI = [-0.145; 0.354]) similarly. In contrast, students and tutors disagreed on causes of cognitive congruence (agreement = 53.90%) and social congruence (agreement = 58.49%). Tutors rated their empathy and interest toward students as the main cause. Students rated the helpfulness, effectiveness, and approachableness of the tutor as the main cause. Conclusions Our study filled the gap in previous research on cognitive and social congruence. Consistent with theoretical considerations, it was shown that students and tutors do indeed experience cognitive and social congruence similarly. Nevertheless, differences also emerged that may carry more or less weight depending on the research question. Future studies should therefore carefully examine whether the assessment of cognitive and social congruence of students and tutors is necessary.
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Affiliation(s)
- Ivo Rollmann
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Jan Lauter
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Charlotte Kuner
- Clinical Ultrasound Course at Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Anne Herrmann-Werner
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Medical Faculty Tübingen, Tübingen Institute for Medical Education, Tübingen, Germany
| | - Till J. Bugaj
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
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Weimer J, Rolef P, Müller L, Bellhäuser H, Göbel S, Buggenhagen H, Weimer A, Waezsada E, Kirchhoff F, Weinmann-Menke J. FoCUS cardiac ultrasound training for undergraduates based on current national guidelines: a prospective, controlled, single-center study on transferability. BMC MEDICAL EDUCATION 2023; 23:80. [PMID: 36726093 PMCID: PMC9893662 DOI: 10.1186/s12909-023-04062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION In emergency and critical-care medicine, focused cardiac ultrasound (FoCUS) is indispensable for assessing a patient's cardiac status. The aim of this study was to establish and validate a peer-to-peer-supported ultrasound course for learning FoCUS-specific skills during undergraduate studies at a German university. METHODS A 1-day, 12 teaching units training course was developed for students in the clinical section of medical college, with content based on the current national guidelines. A total of 217 students participated in the study (97 in the course group and 120 in the control group). The course and the participants' subjective assessment of improved skills were evaluated using a questionnaire (7-point Likert scale; 7 = complete agreement and 1 = no agreement at all). Objective learning gains were assessed by tests before and after the course. These consisted of a test of figural intelligence (eight items) and a test of technical knowledge (13 items). RESULTS The course participants experienced significant improvement (P < 0.001) from before to after the course, with a large effect size of η2part = 0.26. In addition, the course group had significantly better results (P < 0.001) than the control group in the post-test, with a medium to large effect size of η2part = 0.14. No significant differences (P = 0.27) were detected in the test section on figural intelligence. The evaluations showed that the participants had a high degree of satisfaction with the course approach, teaching materials, and tutors. There was also a positive increase in their subjective assessment of their own skills, including areas such as technical knowledge, ultrasound anatomy, and performance of the examination. CONCLUSION The results of both the objective learning assessment and the subjective evaluations suggest that a FoCUS course originally intended for qualified physicians is equally suitable for students. With the development and provision of modern digital teaching media, even more students will be able to benefit from this approach in the future.
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Affiliation(s)
- Johannes Weimer
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Peter Rolef
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University of Mainz, Mainz, Germany
| | - Henrik Bellhäuser
- Institute of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Sebastian Göbel
- Department of Medicine II, Cardiology Center, Department of Medicine, University of Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Andreas Weimer
- Center for Orthopedics, Emergency Surgery, and Paraplegics, Department of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Elias Waezsada
- Department of Cardiology, Kerckhoff Hospital, Bad Nauheim, Germany
| | - Friederike Kirchhoff
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Medicine I, Nephrology Center, Department of Medicine, University of Mainz, Mainz, Germany
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Zhang H, Liao AWX, Goh SH, Wu XV, Yoong SQ. Effectiveness of peer teaching in health professions education: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2022; 118:105499. [PMID: 35961134 DOI: 10.1016/j.nedt.2022.105499] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/26/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The reform in health professions education requires the focus to shift from fact memorization to exploring, analyzing, assimilating, and synthesizing information to promote active and collaborative learning. Peer teaching is one of the educational strategies. AIMS This review aimed to explore and synthesize quantitative evidence to determine the overall effect of peer teaching in enhancing students' theoretical knowledge and practical skills (e.g., procedural skills and resuscitation) in health professions education. METHODS PubMed, ScienceDirect, CINAHL, ERIC, ProQuest, reference lists of relevant studies, and reviews were searched till November 2021. Results were pooled using random-effects meta-analysis or narrative synthesis. RESULTS A total of 44 RCTs were included. This review showed a significant effect of peer teaching on procedural skills improvement and a comparable effect on theoretical knowledge and resuscitation skills acquisition compared to the conventional teaching method. Near-peer teaching seemed to be the most effective method for skill improvement. Subgroup analysis showed no significant differences between peer teaching and conventional teaching groups (e.g., expert/faculty teaching, self-study or lectures). CONCLUSIONS Peer teaching seems to be a promising teaching and learning strategy in health professions education, positively affecting theoretical knowledge and procedural skills. Future research should explore the effect of peer teaching in developing countries to provide a comprehensive picture of peer teaching.
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Affiliation(s)
- Hui Zhang
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Sam Hongli Goh
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Xi Vivien Wu
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Si Qi Yoong
- Alice Lee Centre of Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Zhang Y, Maconochie M. A meta-analysis of peer-assisted learning on examination performance in clinical knowledge and skills education. BMC MEDICAL EDUCATION 2022; 22:147. [PMID: 35248051 PMCID: PMC8897892 DOI: 10.1186/s12909-022-03183-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 02/14/2022] [Indexed: 05/24/2023]
Abstract
BACKGROUND Peer-assisted learning is a method of active learning that is gaining traction throughout higher education. In the medical curriculum, peer-assisted learning has been the subject of independent studies collecting various types of data. However, an overall analysis of those studies providing objective measurements of the influence of peer-assisted learning could be particularly useful for teachers and students alike in a knowledge-heavy curriculum such as medicine. In this study we set out to analyse the efficacy of peer-assisted learning on medical students' learning of clinical knowledge and skills that is assessed through some objective examination, and thereby define whether such approaches have a reproducible benefit for inclusion in the medical curriculum. METHODS Databases including Pubmed, Embase and Science Direct were searched for relevant studies containing randomized controlled trials (RCTs) of peer-assisted learning published before July 29th ,2020. A meta-analysis was performed by using RevMan 5.3 software. RESULTS Thirteen studies involving 2,003 medical students were analyzed for clinical knowledge and skills gains that included some objective measurement of learning. The results of this meta-analysis indicated that considering all these studies together, peer-assisted learning leads to improvements in clinical knowledge and skills learning for medical students compared with traditional teacher-led passive learning. One study was found likely to be a source of significant heterogeneity, and when this was removed from the meta-analysis, the pooled effect was no longer statistically significant. CONCLUSIONS Peer-assisted learning can be an effective method of learning applied to medical student education. Active learning through peer-assisted learning should be seen as complementary to teacher-led approaches. Two of the individual studies on peer-assisted learning show a statistically significant benefit on examination performance compared to the other studies considered, that either show negligible benefits or at worst no detriment in learning. This highlights the need for more high-quality and focused randomized control trials to identify those critical parameters that lead to improved student learning using such approaches.
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Affiliation(s)
- Yanrui Zhang
- Nanchang University Queen Mary School, Nanchang University, Room 215 Admin Building No. 1299 Xuefu Street, 330031, Nanchang, China
| | - Mark Maconochie
- School of Biological and Chemical Sciences, Queen Mary University of London, Mile End Road, E1 4NS, London, UK.
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Kloth C, Schmidt SA, Graeter T, Nikolaou K, Kaufmann S, Beer M, Thaiss WM. Evaluation of an elective ultrasound course for medical students. Clin Anat 2022; 35:354-358. [PMID: 35128729 DOI: 10.1002/ca.23838] [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: 08/21/2021] [Revised: 12/23/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023]
Abstract
To evaluate the educational benefits of teaching ultrasound in an elective radiological course for medical students. We conducted a single-center retrospective analysis of a one-week elective ultrasound course in which 39 medical students (25 female; median age 25.8 ± 2.8 years, range 21-35, 4th and 5th years of undergraduate medical education) participated as part of their radiological training. The students completed a pre- and post-course questionnaire using a five-point Likert scale for self-assessment of technical knowledge, confidence in the procedure regarding different organs, motivation for performing ultrasound, and the importance of ultrasound in medical education. The students also assessed the value of ultrasound teaching in the context of their general medical degree. Pre-test and post-test scores showed significantly improved radiology knowledge (p ≤ 0.001) concerning all abdominal organs (liver, spleen, gallbladder, kidney, urinary bladder, aorta and retroperitoneum). A significant improvement was registered in performing ultrasound of peripheral arteries and venous structures (each p = 0.001), and also of the thyroid gland (p = 0.006). General surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments. Systematic training in ultrasound markedly improved the students' skills. This was especially pronounced for solid organ structures, while students requested more education regarding the retroperitoneum and vascular structures. Teaching ultrasound in an elective hands-on training course improves anatomical understanding and practical skills associated with increased motivation. The results affirm the necessity and clinical relevance of the course during the radiological training of medical students.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Stefan Andreas Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany.,Department of Neuroradiology, Vascular and Interventional Radiology, LKH University Clinic, Auenbruggerplatz, 1, 8036 Graz, Austria
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany
| | - Sascha Kaufmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany.,Clinic of Urology, Siloah St. Trudpert Klinikum, Pforzheim, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany.,Department of Nuclear Medicine, Ulm University Medical Center, Ulm, Germany
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Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University. J Med Ultrason (2001) 2022; 49:217-230. [PMID: 35034230 PMCID: PMC8761092 DOI: 10.1007/s10396-021-01178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022]
Abstract
The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.
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Recker F, Barth G, Lo H, Haverkamp N, Nürnberg D, Kravchenko D, Raupach T, Schäfer VS. Students' Perspectives on Curricular Ultrasound Education at German Medical Schools. Front Med (Lausanne) 2021; 8:758255. [PMID: 34901071 PMCID: PMC8655332 DOI: 10.3389/fmed.2021.758255] [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: 08/13/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Despite ultrasound being an inherent part of medical education, only a few German medical schools have established a comprehensive ultrasound curriculum. This study aimed to explore medical students' perspectives on ultrasound in medical education (USMed). Results: Between January 1st, 2019 und June 30th, 2019, an online survey was conducted among German medical students via the students' associations and their respective teaching facilities. The survey consisted of 17 items regarding USMed. Statements were rated on a 4-point Likert scale for agreement. In total, 1040 students from 31 German medical faculties participated. The majority (1021, 98.2%) reported a very high to high interest in curricular USMed. Students agreed (n = 945, 90.9%) that USMed would be helpful along their entire course of medical studies. Considering the best starting time for USMed, the opinions of German medical students diverged: students studying in a model curriculum preferred to start in the second year (40.7%) while 49% of the students studying in a traditional curriculum preferred to start in the third year (p ≤ 0.001). An insufficient allotment of time for USMed in the planned curriculum (675, 65%) and a lack of courses run by medical faculty (305, 29.4%) were listed as perceived significant barriers to the participation in USMed. Peer teaching was regarded as an effective method in realizing USMed by 731 (70.3%) students. Conclusion: German medical students are very interested and willing to participate in USMed. There appears to be a high demand for US courses offered by medical schools.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Gregor Barth
- Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Medical School (Theodor Fontane), Neuruppin, Germany
| | - Hendra Lo
- Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Medical School (Theodor Fontane), Neuruppin, Germany
| | | | - Dieter Nürnberg
- Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Medical School (Theodor Fontane), Neuruppin, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Tobias Raupach
- Institute for Medical Education, University Hospital Bonn, Bonn, Germany
| | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
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Eimer C, Duschek M, Jung AE, Zick G, Caliebe A, Lindner M, Weiler N, Elke G. Video-based, student tutor- versus faculty staff-led ultrasound course for medical students - a prospective randomized study. BMC MEDICAL EDUCATION 2020; 20:512. [PMID: 33327947 PMCID: PMC7741871 DOI: 10.1186/s12909-020-02431-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/07/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ultrasound education is propagated already during medical school due to its diagnostic importance. Courses are usually supervised by experienced faculty staff (FS) with patient bedside examinations or students among each other but often overbooked due to limited FS availability. To overcome this barrier, use of teaching videos may be advantageous. Likewise, peer teaching concepts solely with trained student tutors have shown to be feasible and effective. The aim was to evaluate 1) objective learning outcomes of a combined video-based, student-tutor (ViST) as compared to a FS-led course without media support, 2) acceptance and subjective learning success of the videos. METHODS Two ultrasound teaching videos for basic and advanced abdominal ultrasound (AU) and transthoracic echocardiography (TTE) were produced and six students trained as tutors. Fourth-year medical students (N = 96) were randomized to either the ViST- or FS course (6 students per tutor). Learning objectives were defined equally for both courses. Acquired practical basic and advanced ultrasound skills were tested in an objective structured clinical examination (OSCE) using modified validated scoring sheets with a maximum total score of 40 points. Acceptance and subjective learning success of both videos were evaluated by questionnaires based on Kirkpatrick's evaluation model with scale-rated closed and open questions. RESULTS 79 of 96 medical students completed the OSCE and 77 could be finally analyzed. There was no significant difference in the mean total point score of 31.3 in the ViST (N = 42) and 32.7 in the FS course (N = 35, P = 0.31) or in any of the examined basic or advanced ultrasound skill subtasks. Of the 42 ViST participants, 29 completed the AU and 27 the TTE video questionnaire. Acceptance and subjective learning success of both videos was rated positively in 14-52% and 48-88% of the rated responses to each category, respectively. Attendance of either the student or faculty tutor was deemed necessary in addition to the videos. CONCLUSIONS A ViST versus FS teaching concept was able to effectively teach undergraduate students in AU and TTE, albeit acceptance of the teaching videos alone was limited. However, the ViST concept has the potential to increase course availability and FS resource allocation.
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Affiliation(s)
- Christine Eimer
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Max Duschek
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Andreas Emanuel Jung
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Günther Zick
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Amke Caliebe
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, University Medical Center Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Matthias Lindner
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Norbert Weiler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus R3, 24105, Kiel, Germany.
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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: 10] [Impact Index Per Article: 2.5] [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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12
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Hari R, Kälin K, Harris M, Walter R, Serra A. Comparing Blended Learning with Faculty-Led Ultrasound Training: Protocol for a Randomised Controlled Trial (The SIGNATURE Trial). PRAXIS 2020; 109:636-640. [PMID: 32517596 DOI: 10.1024/1661-8157/a003497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Ultrasound is increasingly used in clinical practice as a bedside tool. As medical graduates first encounter the technique in early residency, ultrasound training needs to be integrated into the undergraduate curriculum. In Switzerland, abdominal ultrasound skills have been taught by a faculty-led, 21-hour course. However, this course does not have sufficient capacity to meet the increasing demand, and there have been doubts about its effectiveness as a teaching method. We therefore developed a 21-hour blended-learning course, comprising five hours of e-learning and 16 hours of near-peer tutoring. This study investigates whether this new teaching format is as good as, or superior to, the faculty-led method. Methods: The SIGNATURE study is an investigator-initiated, two-arm, randomised controlled trial, enrolling 152 medical students at the Universities of Bern, Fribourg and Zurich. Stratified by study site, students are 1:1 randomised to either the blended-learning course or the faculty-led 2.5-day ultrasound course. Students undergo a six-station objective structured clinical examination (OSCE) and complete an online questionnaire immediately after the course and 6 months later. Discussion: If demonstrated to be effective, the blended-learning course would allow an increase in the number of undergraduate medical students that can acquire ultrasound skills before starting their residencies.
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Affiliation(s)
- Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Kaspar Kälin
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Michael Harris
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
- College of Medicine & Health, University of Exeter, UK
| | - Robin Walter
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Andreas Serra
- Clinic of General Internal Medicine and Nephrology, Klinik Hirslanden Zurich, Switzerland
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13
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Jeker L, Birrenbach T, Walter R, Hari R. [Peer Teaching in Ultrasound Education - A Narrative Review]. PRAXIS 2020; 109:631-635. [PMID: 32517595 DOI: 10.1024/1661-8157/a003498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Peer Teaching in Ultrasound Education - A Narrative Review Abstract. Learning about ultrasound is becoming an increasingly important component of the undergraduate medical curriculum. However, teaching about this is very time-consuming, which is why many universities use peer teaching in ultrasound training. Peer teaching has various advantages that go beyond reducing specialists' teaching time: students may learn more from their peers because their cognitive schemata are more congruent and they are more likely to be open about their learning deficits. In addition, the process of teaching leads to increased learning and motivation in the peer teachers themselves. Most studies that compare peer teaching with teaching from medically qualified tutors show comparable learning effects, with different advantages for the two settings.
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Affiliation(s)
- Lia Jeker
- Berner Institut für Hausarztmedizin, Universität Bern, Bern
| | - Tanja Birrenbach
- Universitäres Notfallzentrum, Inselspital, Universitätsspital, Universität Bern, Bern
| | - Robin Walter
- Berner Institut für Hausarztmedizin, Universität Bern, Bern
| | - Roman Hari
- Berner Institut für Hausarztmedizin, Universität Bern, Bern
- Department of Educational Development and Research, Maastricht University, Maastricht, Niederlande
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14
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Radiography students' perceptions of Peer assisted learning. Radiography (Lond) 2019; 26:e109-e113. [PMID: 32052761 DOI: 10.1016/j.radi.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Peer Assisted Learning (PAL) is collaborative learning in which students from the same or different academic levels learn from each other. It is meant to support the regular teaching and learning process. Learning in PAL can be explained by constructive social learning theories and has many advantages such as, students' perception of it and the ease of discussion between peers. This study aims to measure students' perception of PAL in the context of radiography education. METHODS A PAL programme was implemented in one module taught to second year radiography students. A questionnaire was then distributed to the participating students (n = 28) to measure their perception of PAL; the questionnaire consisted of 13 questions with a Likert scale of 5 (1 = strongly disagree to 5 = strongly agree). The results were analysed using SPSS to calculate the percentages, means, standard deviations, and factorial analysis. RESULTS Twenty-six students responded to the questionnaire (92.8%). The range of agreement in all questionnaire items ranged from 79.9% to 92.3%. The factor analysis revealed two main factors affecting students' acceptability. PAL enriched students' learning experience and helped them in preparation for exams. CONCLUSION The use of PAL is highly acceptable by students in context of radiography education. IMPLICATIONS FOR PRACTICE More studies are necessary to confirm the best methods of using PAL. These may involve both students and educators, and pre- and post-methods.
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15
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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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16
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Stephen VS, Wells M. Technically Adequate Images for Preparticipation Screening Echocardiography Can Be Obtained by Novices After a Single Day of Training. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3015-3023. [PMID: 30985021 DOI: 10.1002/jum.15009] [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: 10/16/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Echocardiography-naïve physicians were trained in a 1-day course to determine whether they could obtain images adequate for preparticipation screening in athletes. METHODS Twenty-six physicians with no previous experience in echocardiography were trained to perform preparticipation screening echocardiography during a 6-hour course. Each image was rated for its technical quality on a diagnostic adequacy score. The time taken to perform the images was also evaluated. RESULTS The images obtained a median score of 3 (interquartile range, 2-4), which was considered adequate for preparticipation screening. Video clips achieved a higher rating than the still images, with a median score of 4 (interquartile range, 3-4). The best-performing 50% of the participants obtained adequate images for screening 95% of the time after the initial training. Considering the group overall, 79.2% of all video clips were adequate. The median time to perform the scans was 39 seconds. The correlation between the time and adequacy score showed that the quickest novices were also able to obtain the best images. CONCLUSIONS It is feasible to use novice sonographers to perform preparticipation screening echocardiography provided that the skill of the candidates is assessed after training, and competent individuals are selected. Video images should be used rather than still images.
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Affiliation(s)
- Victoria Sarah Stephen
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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17
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Hüppe T, Groesdonk HV, Volk T, Wagenpfeil S, Wallrich B. Image quality to estimate ventricular ejection fraction by last year medical students improves after short courses of training. BMC MEDICAL EDUCATION 2019; 19:385. [PMID: 31640642 PMCID: PMC6805468 DOI: 10.1186/s12909-019-1809-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transthoracic echocardiography is the primary imaging modality for diagnosing cardiac conditions but medical education in this field is limited. We tested the hypothesis that a structured theoretical and supervised practical course of training in focused echocardiography in last year medical students results in a more accurate assessment and more precise calculation of left ventricular ejection fraction after ten patient examinations. METHODS After a theoretical introduction course 25 last year medical students performed ten transthoracic echocardiographic examination blocks in postsurgical patients. Left ventricular function was evaluated both with an eye-balling method and with the calculated ejection fraction using diameter and area of left ventricles. Each examination block was controlled by a certified and blinded tutor. Bias and precision of measurements were assessed with Bland and Altman method. RESULTS Using the eye-balling method students agreed with the tutor's findings both at the beginning (88%) but more at the end of the course (95.7%). The variation between student and tutor for calculation of area, diameter and ejection fraction, respectively, was significantly lower in examination block 10 than in examination block 1 (each p < 0.001). Students underestimated both the length and the area of the left ventricle at the outset, as complete imaging of the left heart in the ultrasound sector was initially unsuccessful. CONCLUSIONS A structured theoretical and practical transthoracic echocardiography course of training for last year medical students provides a clear and measurable learning experience in assessing and measuring left ventricular function. At least 14 examination blocks are necessary to achieve 90% agreement of correct determination of the ejection fraction.
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Affiliation(s)
- Tobias Hüppe
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University, Medical Center, Kirrberger Straße 100, 66421, Homburg, Saar, Germany.
| | | | - Thomas Volk
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University, Medical Center, Kirrberger Straße 100, 66421, Homburg, Saar, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Saar, Germany
| | - Benedict Wallrich
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University, Medical Center, Kirrberger Straße 100, 66421, Homburg, Saar, Germany
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18
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Garofalo E, Bruni A, Pelaia C, Landoni G, Zangrillo A, Antonelli M, Conti G, Biasucci DG, Mercurio G, Cortegiani A, Giarratano A, Vetrugno L, Bove T, Forfori F, Corradi F, Vaschetto R, Cammarota G, Astuto M, Murabito P, Bellini V, Zambon M, Longhini F, Navalesi P, Bignami E. Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study. Ultrasound J 2019; 11:21. [PMID: 31578700 PMCID: PMC6775177 DOI: 10.1186/s13089-019-0137-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/31/2019] [Indexed: 01/07/2023] Open
Abstract
Background This study aims to ascertain whether (1) an educational program is sufficient to achieve adequate Diaphragm Ultrasound (DUS) assessments on healthy volunteers and (2) combining a video tutorial with a practical session is more effective in making learners capable to obtain accurate DUS measurements, as opposed to sole video tutorial. Results We enrolledstep 1: 172 volunteers naïve to ultrasound. After watching a video tutorial, a questionnaire was administered and considered to be passed when at least 70% of the questions were correctly answered. Course participants who passed the theoretical test were randomized to either intervention or control group. Learners randomized to the interventional group underwent to a practical training, tutored by an expert, before accessing DUS examination. Participants randomized to the control group directly accessed DUS examination, without any practical training. DUS measurements by learners and tutors were recorded and checked for accuracy, according to predefined criteria. Detection of both acoustic windows and accurate DUS assessment was achieved by 83.7% learners of the intervention group while 3.5% only among controls (p < 0.0001). The subcostal view of the diaphragm was correctly identified by 92% and 65% learners in the intervention and control groups, respectively (p < 0.0001) while the apposition zone by 86% and 71% learners, respectively (p = 0.026). An accurate diaphragm displacement (DD) measurement was obtained by 91% and 45% learners in the intervention and control groups, respectively (p < 0.0001) while an accurate thickening fraction (TF) measurement by 99% and 21%, respectively (p < 0.0001). DD measurements by both groups of learners were significantly correlated with those assessed by expert tutors; however, a significant improvement of measurement accuracy was found in learners randomized to receive also the practical training, compared to controls. Conclusions A combined approach consisting of a theoretical module followed by a practical training is more effective in managing acoustic windows and performing accurate measurements when compared to an exclusively theoretical course. Trial registration prospectively registered on clinicaltrials.gov (Identifier: NCT03704129; release date 17th October 2018).
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Affiliation(s)
- Eugenio Garofalo
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Viale Europa-Loc, Germaneto, 88100, Catanzaro, Italy
| | - Andrea Bruni
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Viale Europa-Loc, Germaneto, 88100, Catanzaro, Italy
| | - Corrado Pelaia
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Viale Europa-Loc, Germaneto, 88100, Catanzaro, Italy
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Conti
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Mercurio
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Luigi Vetrugno
- Department of Anaesthesia and Intensive Care, University of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anaesthesia and Intensive Care, University of Udine, Udine, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Rosanna Vaschetto
- Translational Medicine Department, Eastern Piedmont University, Novara, Italy.,Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Marinella Astuto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Federico Longhini
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Viale Europa-Loc, Germaneto, 88100, Catanzaro, Italy
| | - Paolo Navalesi
- Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Viale Europa-Loc, Germaneto, 88100, Catanzaro, Italy.
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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19
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Bugaj TJ, Blohm M, Schmid C, Koehl N, Huber J, Huhn D, Herzog W, Krautter M, Nikendei C. Peer-assisted learning (PAL): skills lab tutors' experiences and motivation. BMC MEDICAL EDUCATION 2019; 19:353. [PMID: 31521146 PMCID: PMC6744669 DOI: 10.1186/s12909-019-1760-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences. METHODS We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring. RESULTS In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors. CONCLUSIONS With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.
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Affiliation(s)
- T. J. Bugaj
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - M. Blohm
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Esslingen, Esslingen, Germany
| | - C. Schmid
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - N. Koehl
- Practice Drs./NL Albertus Arends, Heidelberg, Germany
| | - J. Huber
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - D. Huhn
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - W. Herzog
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - M. Krautter
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
- Clinic for Kidney, Hypertension and Autoimmune Diseases, Klinikum Stuttgart, Stuttgart, Germany
| | - C. Nikendei
- Department of General Internal and Psychosomatic Medicine, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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20
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Dietrich CF, Hoffmann B, Cantisani V, Dong Y, Hari R, Nisenbaum H, Nicholls D, Nolsøe CP, Radzina M, Recker F, Serra A, Sweet L, Westerway S, Blaivas M. Medical Student Ultrasound Education, a WFUMB Position Paper, Part I, response to the letter to the Editor. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1857-1859. [PMID: 30981532 DOI: 10.1016/j.ultrasmedbio.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vito Cantisani
- Department of Imaging Diagnostics, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Roman Hari
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern, Bern, Switzerland
| | - Harvey Nisenbaum
- Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Delwyn Nicholls
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Christian Pállson Nolsøe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital Copenhagen Academy for Medical Education and Simulation Ultrasound Section, University of Copenhagen, Copenhagen, Denmark
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, And Radiology Research Laboratory, Riga Stradins University University of Latvia, Riga, Latvia
| | - Florian Recker
- Department of Obstetrics and Gynecology And Sono Education Academy, University Hospital Bonn, Bonn, Germany
| | - Andreas Serra
- Department of Internal Medicine and Nephrology, EFSUMB Learning Center, Klinik Hirslanden, Zürich, Switzerland
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sue Westerway
- School of Dentistry & Health Science, Charles Sturt University, New South Wales, Australia
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, 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: 22] [Impact Index Per Article: 4.4] [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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Ben-Sasson A, Lior Y, Krispel J, Rucham M, Liel-Cohen N, Fuchs L, Kobal SL. Peer-teaching cardiac ultrasound among medical students: A real option. PLoS One 2019; 14:e0212794. [PMID: 30917143 PMCID: PMC6436682 DOI: 10.1371/journal.pone.0212794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/08/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Teaching cardiac ultrasound (CU) image acquisition requires hands-on practice under qualified instructors supervision. We assessed the efficacy of teaching medical students by their previously trained classmates (teaching assistants [TAs]) compared to teaching by expert trainers (cardiologists or diagnostic medical sonographers. METHODS Sixty-six students received 8-hour CU training: 4-hour lectures on ultrasound anatomy and imaging techniques of 6 main CU views (parasternal long [PLAV] and short axis [PSAV]; apical 4-chamber [4ch], 2-chamber [2ch], and 3-chamber [3ch]; and sub costal [SC]) followed by 4 hours of hands-on exercise in groups of ≤5 students under direct supervision of a TA (group A: 44 students) or a qualified trainer (group B: 22 students). Students' proficiency was evaluated on a 6-minute test in which they were required to demonstrate 32 predetermined anatomic landmarks spread across the 6 views and ranked on a 0-100 scale according to a predetermined key. RESULTS The 6-minute test final grade displayed superiority of group A over group B (54±17 vs. 39±21, respectively [p = 0.001]). This trend was continuous across all 6 main views: PLAV (69±18 vs. 54±23, respectively), PSAV (65±33 vs. 41±32, respectively), 4ch (57±19 vs. 43±26, respectively), 2ch (37±29 vs. 33±27, respectively), 3ch (48±23 vs. 35±25, respectively), and SC (36±27 vs. 24±28, respectively). CONCLUSIONS Teaching medical students CU imaging acquisition by qualified classmates is feasible. Moreover, students instructors were superior to senior instructors when comparing their students' capabilities in a practical test. Replacing experienced instructors with TAs could help medical schools teach ultrasound techniques with minimal dependence on highly qualified trainers.
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Affiliation(s)
- Alon Ben-Sasson
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yotam Lior
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Soroka Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- * E-mail:
| | - Jonathan Krispel
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moshe Rucham
- Joyce and Irwing Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergio L. Kobal
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
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Davis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in Undergraduate Medical Education: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2667-2679. [PMID: 29708268 DOI: 10.1002/jum.14628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/18/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students. METHODS A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full-text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors. RESULTS Ninety-five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US-related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non-US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed. CONCLUSIONS There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.
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Affiliation(s)
- Joshua J Davis
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Jacqueline Potts
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Charles A Pohl
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Matthew Fields
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
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Krause C, Krause R, Krause R, Gomez N, Jafry Z, Dinh VA. Effectiveness of a 1-Hour Extended Focused Assessment With Sonography in Trauma Session in the Medical Student Surgery Clerkship. JOURNAL OF SURGICAL EDUCATION 2017; 74:968-974. [PMID: 28479071 DOI: 10.1016/j.jsurg.2017.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/15/2017] [Accepted: 03/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended focused assessment with sonography in trauma (eFAST) into the year-3 medical student surgical clerkship. DESIGN A prospective cohort study where participants served as self-controls. One hour of instruction in the eFAST examination, along with 3 required observed examinations, was incorporated into the year-3 surgery clerkship. Effectiveness of the training was evaluated by a preliminary and posttraining assessment. An online survey was used assessing comfort based on a 5-point Likert scale. An online quiz was used assessing knowledge, and a 2-part objective structured clinical examination (OSCE) was used assessing skill and speed. Participants also logged 3 eFAST examinations during the 10-week clerkship where they reported their comfort in performing and interpreting the eFAST on a 5-point Likert scale. Postassessment was held during the last week of the clerkship and included the same online quiz, survey, and 2-part OSCE. SETTING The study was performed at Loma Linda University and affiliated hospitals where surgical clerkship students rotate. PARTICIPANTS A total of 148 year-3 medical students completed the study. RESULTS All testing modalities showed improvement. The mean average of the OSCE improved from 46% ± 27% to 81% ± 18%. The percentage of participants able to perform the examination in less than 6 minutes increased from 18% ± 27% to 84% ± 36%. Participants' comfort level in recognizing eFAST pathology increased from a mean of 2.40 ± 0.94 to 3.55 ± 0.87 out of 5. Comfort in performing the eFAST examination improved from 2.81 ± 0.79 to 3.77 ± 0.68. Comfort in interpreting the eFAST examination improved from 2.88 ± 0.87 to 3.65 ± 0.72. CONCLUSIONS This study demonstrates that incorporating 1 hour of eFAST training into the general surgery clerkship is feasible and may lead to improved competency in performing and interpreting the eFAST examination.
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Affiliation(s)
- Cassandra Krause
- Department of Surgery, Loma Linda University, Loma Linda School of Medicine, Loma Linda, California.
| | - Reed Krause
- Department of Surgery, Loma Linda University, Loma Linda School of Medicine, Loma Linda, California
| | - Raymond Krause
- Department of Surgery, Loma Linda University, Loma Linda School of Medicine, Loma Linda, California
| | - Nephtali Gomez
- Department of Surgery, Loma Linda University, Loma Linda, California
| | - Zan Jafry
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California
| | - Vi Am Dinh
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California; Department of Medicine, Loma Linda University, Loma Linda, California
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Gradl-Dietsch G, Menon AK, Gürsel A, Götzenich A, Hatam N, Aljalloud A, Schrading S, Hölzl F, Knobe M. Basic echocardiography for undergraduate students: a comparison of different peer-teaching approaches. Eur J Trauma Emerg Surg 2017; 44:143-152. [PMID: 28717985 DOI: 10.1007/s00068-017-0819-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/11/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of different teaching interventions in a peer-teaching environment on basic echocardiography skills and to examine the influence of gender on learning outcomes. METHODS We randomly assigned 79 s year medical students (55 women, 24 men) to one of four groups: peer teaching (PT), peer teaching using Peyton's four-step approach (PPT), team based learning (TBL) and video-based learning (VBL). All groups received theoretical and practical hands-on training according to the different approaches. Using a pre-post-design we assessed differences in theoretical knowledge [multiple choice (MC) exam], practical skills (Objective Structured Practical Examination, OSPE) and evaluation results with respect to gender. RESULTS There was a significant gain in theoretical knowledge for all students. There were no relevant differences between the four groups regarding the MC exam and OSPE results. The majority of students achieved good or very good results. Acceptance of the peer-teaching concept was moderate and all students preferred medical experts to peer tutors even though the overall rating of the instructors was fairly good. Students in the Video group would have preferred a different training method. There was no significant effect of gender on evaluation results. CONCLUSIONS Using different peer-teaching concepts proved to be effective in teaching basic echocardiography. Gender does not seem to have an impact on effectiveness of the instructional approach. Qualitative analysis revealed limited acceptance of peer teaching and especially of video-based instruction.
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Affiliation(s)
- G Gradl-Dietsch
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR Clinic, University of Essen, 21 Wickenburgstreet, 45147, Essen, Germany
| | - A K Menon
- Department Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - A Gürsel
- Department Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - A Götzenich
- Department Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - N Hatam
- Department Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - A Aljalloud
- Department Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - S Schrading
- Department of Radiology, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany
| | - F Hölzl
- Department of Interdisciplinary Emergency Medical Care, Medical Center Marienhöhe, 25 Mauerfeldchen, 52146, Würselen, Germany
| | - M Knobe
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, 52074, Aachen, Germany.
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Henwood PC, Mackenzie DC, Liteplo AS, Rempell JS, Murray AF, Leo MM, Dukundane D, Dean AJ, Rulisa S, Noble VE. Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1189-1194. [PMID: 28258591 DOI: 10.7863/ultra.16.05073] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies. METHODS We conducted point-of-care ultrasound training for physicians from Rwandan hospitals. Physicians then used point-of-care ultrasound and recorded their findings, interpretation, and effects on patient management. Data were collected for 6 months. Trainee studies were reviewed for image quality and accuracy. RESULTS Fifteen participants documented 1158 ultrasounds; 590 studies (50.9%) had matched images and interpretations for review. Abdominal ultrasound for free fluid was the most frequently performed application. The mean image quality score was 2.36 (95% confidence interval, 2.28-2.44). Overall sensitivity and specificity for trainee-performed examinations was 94 and 98%. Point-of-care ultrasound use most commonly changed medications administered (42.4%) and disposition (30%). CONCLUSIONS A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.
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Affiliation(s)
- Patricia C Henwood
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David C Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua S Rempell
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alice F Murray
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Megan M Leo
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Damas Dukundane
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Anthony J Dean
- Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Rulisa
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Vicki E Noble
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Kobal SL, Lior Y, Ben-Sasson A, Liel-Cohen N, Galante O, Fuchs L. The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum. BMC MEDICAL EDUCATION 2017; 17:94. [PMID: 28558692 PMCID: PMC5450418 DOI: 10.1186/s12909-017-0928-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a pocket ultrasound device (PUD) in a short, specially designed course. METHODS Thirty-one medical students in their first clinical year participated in the study. All were novices in the use of cardiac ultrasound. The training consisted of 4 hours of frontal lectures and 4 hours of hands-on training. Students were encouraged to use PUD for individual practice. Finally, the students' proficiency in the acquisition of ultrasound images and their ability to recognize normal and pathological states were evaluated. RESULTS Sixteen of 27 (59%) students were able to demonstrate all main ultrasound views (parasternal, apical, and subcostal views) in a six-minute test. The most obtainable view was the parasternal long-axis view (89%) and the least obtainable was the subcostal view (58%). Ninety-seven percent of students correctly differentiated normal from severely reduced left ventricular function, 100% correctly differentiated a normal right ventricle from a severely hypokinetic one, 100% correctly differentiated a normal mitral valve from a rheumatic one, and 88% correctly differentiated a normal aortic valve from a calcified one, while 95% of them correctly identified the presence of pericardial effusion. CONCLUSIONS Training of medical students in cardiac ultrasound during the first clinical year using a short, focused course is feasible and enables students with modest ability to acquire the main transthoracic ultrasound views and gain proficiency in the diagnosis of a limited number of cardiac pathologies.
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Affiliation(s)
- Sergio L Kobal
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Yotam Lior
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alon Ben-Sasson
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Herrmann-Werner A, Gramer R, Erschens R, Nikendei C, Wosnik A, Griewatz J, Zipfel S, Junne F. Peer-assisted learning (PAL) in undergraduate medical education: An overview. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 121:74-81. [PMID: 28545616 DOI: 10.1016/j.zefq.2017.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 11/26/2022]
Abstract
Peer-assisted learning (PAL) has a long tradition and is nowadays implemented in the curricula of most medical faculties. Besides traditional areas of application like problem-based learning, anatomy, or CPR, more and more departments and institutes have established PAL as part of their everyday teaching. This narrative review provides some background information and basic definitions of PAL. It offers an overview on features and determinants as well as underlying learning theories and developments in PAL. In addition, motives for implementation are highlighted followed by a comparison of advantages and disadvantages. After outlining aspects of quality management including the training of tutors and the evaluation and acceptance of PAL formats, this review concludes with an outlook on how PAL can proceed into the future and where further research is necessary.
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Affiliation(s)
- Anne Herrmann-Werner
- University Hospital Tuebingen, Department of Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany; Medical Faculty Tuebingen, Interdisciplinary Training and Simulation Centre DocLab, Tuebingen, Germany.
| | - Regina Gramer
- Medical Faculty Tuebingen, Interdisciplinary Training and Simulation Centre DocLab, Tuebingen, Germany
| | - Rebecca Erschens
- University Hospital Tuebingen, Department of Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
| | - Christoph Nikendei
- University of Heidelberg, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Annette Wosnik
- Medical Faculty Tuebingen, Dean's Office for student affairs, Tuebingen, Germany
| | - Jan Griewatz
- University of Tuebingen, Competence Centre for University Teaching in Medicine Baden-Wuerttemberg, Tuebingen, Germany
| | - Stephan Zipfel
- University Hospital Tuebingen, Department of Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany; Medical Faculty Tuebingen, Dean's Office for student affairs, Tuebingen, Germany
| | - Florian Junne
- University Hospital Tuebingen, Department of Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany
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Dreyhaupt J, Mayer B, Keis O, Öchsner W, Muche R. Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc26. [PMID: 28584874 PMCID: PMC5450430 DOI: 10.3205/zma001103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/17/2016] [Accepted: 12/29/2016] [Indexed: 05/11/2023]
Abstract
An increasing number of studies are being performed in educational research to evaluate new teaching methods and approaches. These studies could be performed more efficiently and deliver more convincing results if they more strictly applied and complied with recognized standards of scientific studies. Such an approach could substantially increase the quality in particular of prospective, two-arm (intervention) studies that aim to compare two different teaching methods. A key standard in such studies is randomization, which can minimize systematic bias in study findings; such bias may result if the two study arms are not structurally equivalent. If possible, educational research studies should also achieve this standard, although this is not yet generally the case. Some difficulties and concerns exist, particularly regarding organizational and methodological aspects. An important point to consider in educational research studies is that usually individuals cannot be randomized, because of the teaching situation, and instead whole groups have to be randomized (so-called "cluster randomization"). Compared with studies with individual randomization, studies with cluster randomization normally require (significantly) larger sample sizes and more complex methods for calculating sample size. Furthermore, cluster-randomized studies require more complex methods for statistical analysis. The consequence of the above is that a competent expert with respective special knowledge needs to be involved in all phases of cluster-randomized studies. Studies to evaluate new teaching methods need to make greater use of randomization in order to achieve scientifically convincing results. Therefore, in this article we describe the general principles of cluster randomization and how to implement these principles, and we also outline practical aspects of using cluster randomization in prospective, two-arm comparative educational research studies.
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Affiliation(s)
- Jens Dreyhaupt
- Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany
- *To whom correspondence should be addressed: Jens Dreyhaupt, Ulm University, Institute of Epidemiology and Medical Biometry, Schwabstr. 13, 89075 Ulm, Germany, Phone: +49(0)731/50-26895, Fax: +49(0)731/50-26902, E-mail:
| | - Benjamin Mayer
- Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany
| | - Oliver Keis
- Ulm University, Office of the Dean of Studies for Medicine, Ulm, Germany
| | - Wolfgang Öchsner
- Ulm University, Office of the Dean of Studies for Medicine, Ulm, Germany
- University Hospital Ulm, Department of Cardiac Anesthesiology, Ulm, Germany
| | - Rainer Muche
- Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany
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Williamson JM. Is geographical location a barrier for echo training? An observational account of 10 student cardiac sonographers' pursuit to achieve accreditation. SONOGRAPHY 2016. [DOI: 10.1002/sono.12091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tai J, Molloy E, Haines T, Canny B. Same-level peer-assisted learning in medical clinical placements: a narrative systematic review. MEDICAL EDUCATION 2016; 50:469-84. [PMID: 26995485 DOI: 10.1111/medu.12898] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 05/08/2023]
Abstract
BACKGROUND Peer-assisted learning (PAL) is increasingly used in medical education, and the benefits of this approach have been reported. Previous reviews have focused on the benefits of peer tutoring of junior students by senior students. Forms of PAL such as discussion groups and role-playing have been neglected, as have alternative teacher-learner configurations (e.g. same-level PAL) and the effects on other stakeholders, including clinician educators and patients. This review examines the benefits of same-level PAL for students, clinician educators and patients in pre-registration clinical medical education. METHODS Medline, PsycINFO, CINAHL and ERIC were searched in March 2014. A total of 1228 abstracts were retrieved for review; 64 full-text papers were assessed. Data were extracted from empirical studies describing a same-level PAL initiative in a clinical setting, focusing on effects beyond academic performance and student satisfaction. Qualitative thematic analysis was employed to identify types of PAL and to cluster the reported PAL effects. RESULTS Forty-three studies were included in the review. PAL activities were categorised into role-play, discussion, teaching and assessment. Only 50% of studies reported information beyond self-report and satisfaction with the PAL intervention. Benefits for students (including development of communication and professional skills) and clinician educators (developing less-used facilitation skills) were reported. Direct patient outcomes were not identified. Caveats to the use of PAL emerged, and guidelines for the use of PAL were perceived as useful. CONCLUSION Many student-related benefits of PAL were identified. PAL contributes to the development of crucial skills required for a doctor in the workplace. Vertical integration of learning and teaching skills across the curriculum and tools such as feedback checklists may be required for successful PAL in the clinical environment. Benefits for patients and educators were poorly characterised within the included studies. Future work should evaluate the use of PAL with regards to student, clinician educator and patient outcomes.
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Affiliation(s)
- Joanna Tai
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Elizabeth Molloy
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Terry Haines
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Benedict Canny
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Fu JY, Krause C, Krause R, Mccoy J, Schindler A, Udrea DS, Villarreal LA, Jafry Z, Am Dinh V. Integration of Point-of-Care Ultrasound Training into Undergraduate Medical Curricula--A Perspective from Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2016; 3:10.4137_JMECD.S38240. [PMID: 29349317 PMCID: PMC5736279 DOI: 10.4137/jmecd.s38240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 05/16/2023]
Abstract
The utility of point of care ultrasound training during medical school is becoming more and more evident. At the Loma Linda University School of Medicine, we have formally integrated ultrasound education into the curriculum of all four years. Exposure begins in the first few months of Year 1 and takes form in a variety of educational mediums through Year 4. Whether students receive training through mandatory sessions during physical diagnosis courses or extracurricular workshops provided through the Ultrasound Interest Group--the experience equips learners of at all different skill levels with the confidence to apply what they have learned to patient care. The successful integration of ultrasound training into the medical curriculum can be attributed to progressive administration, devoted faculty and eager students. The perspective of medical students during the integration process is described in this paper.
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Affiliation(s)
- Jasmine Y. Fu
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Cassie Krause
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Reed Krause
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Josh Mccoy
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - April Schindler
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Daniel S. Udrea
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | | | - Zan Jafry
- Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Vi Am Dinh
- Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA
- Department of Medicine, Division of Pulmonary and Critical Care, Loma Linda University, Loma Linda, CA, USA
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Chang CM, Wu WH, Kuo BIT, Lee TY, Liu CY, Chang HH. Using a questionnaire among patient, resident doctor and senior supervisor: Are their answers the same? Complement Ther Med 2014; 22:296-303. [PMID: 24731901 DOI: 10.1016/j.ctim.2014.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/30/2014] [Accepted: 02/23/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aims to contribute to the development of objective diagnostic standards in Traditional Chinese Medicine (TCM), in order to improve the training of physicians. METHODS We devised a questionnaire study to evaluate the accuracy of resident doctors' diagnostic skills by comparing their assessment of patients with those of their senior supervising physician and the patients themselves. We selected 39 patients with systemic lupus erythematosus (SLE) at Chang Gung Memorial Hospital, Taiwan, between November 1, 2008 and June 30, 2012, and had the resident doctors (R), their senior supervisor (S) and their patients (P) fill out questionnaires before treatment (V1), immediately after treatment (V5) and two months after treatment (V6), in order to record their assessments on the patients' condition. The R and S questionnaires covered subjective symptoms, tongue, and pulse, while the P questionnaires only included general symptoms. We then compared the assessment records to determine the level of agreement between them. RESULTS The agreements of inquiry during the study for P and S were 0.78 (V1) to 0.84 (V6) and 0.87 (V1) to 0.94 (V6) for R and S, respectively, the agreements between R and S for tongue diagnosis and pulse diagnosis were 0.87 (V1) to 0.90 (V6) and 0.91 (V1) to 0.95 (V6), respectively. All the above agreements improved with time from V1 to V6. CONCLUSIONS The results show that the patient input was feasible and effective and that the questionnaire method provided an objective assessment standard to determine how successfully the resident doctor was trained. Furthermore, it facilitated a training process that could help resident doctors improve their skills.
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Affiliation(s)
- Ching-Mao Chang
- Graduate Institute of Clinical Medicine, and Graduate Institute of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33378, Taiwan.
| | - Wen-Hsiang Wu
- Department of Healthcare Management, Yuanpei University, Hsinchu 30015, Taiwan.
| | - Benjamin Ing-Tiau Kuo
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Tzung-Yan Lee
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33378, Taiwan.
| | - Chia-Yu Liu
- Department of Chinese Medicine, Linsen Chinese Medicine Branch, Taipei City Hospital, Taipei 10453, Taiwan.
| | - Hen-Hong Chang
- Graduate Institute of Clinical Medicine, and Graduate Institute of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33378, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33378, Taiwan; Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan.
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Gaspar HA, Morhy SS, Lianza AC, de Carvalho WB, Andrade JL, do Prado RR, Schvartsman C, Delgado AF. Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians. BMC MEDICAL EDUCATION 2014; 14:25. [PMID: 24502581 PMCID: PMC3926333 DOI: 10.1186/1472-6920-14-25] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/03/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. METHODS Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations. RESULTS The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training. CONCLUSIONS The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.
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Affiliation(s)
- Heloisa A Gaspar
- Pediatric Intensive Care - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, Rua do Carreiro de Pedra 111 apto 152C, Jd. Caravelas, CEP 04728-020 São Paulo, Brazil
| | - Samira S Morhy
- Radiology Department - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Alessandro C Lianza
- Radiology Department - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Werther B de Carvalho
- Pediatric Intensive Care - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, Rua do Carreiro de Pedra 111 apto 152C, Jd. Caravelas, CEP 04728-020 São Paulo, Brazil
| | - Jose L Andrade
- Radiology Department - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Rogério R do Prado
- Department of Statistics, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Cláudio Schvartsman
- Emergency Medicine Department, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, São Paulo, Brazil
| | - Artur F Delgado
- Pediatric Intensive Care - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina, São Paulo University, Rua do Carreiro de Pedra 111 apto 152C, Jd. Caravelas, CEP 04728-020 São Paulo, Brazil
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