Creating an Ultrasound Scholarly Concentration Program for Medical Students

The Effectiveness of Student-Led Musculoskeletal and Vascular Ultrasound Workshops at a Single Institution: A Retrospective Survey Analysis

Introduction Point-of-care ultrasound (POCUS) is a rapidly evolving field of diagnostic medicine as its low cost, portability, and versatility have made handheld ultrasound (US) probes an invaluable tool for many modern physicians. Despite US's benefits as a bedside evaluative tool, many medical schools have not integrated POCUS into their pre-clerkship medical education due to a lack of equipment and faculty. The first objective of our study was to determine whether student tutors (STs) would be effective resources to teach musculoskeletal (MSK) and vascular US to preclinical medical students. The second objective of our study was to determine whether students who previously attended ST-run MSK US workshops perform better in vascular US than those who did not. Methods Six POCUS workshops were led by STs after approval from experienced US faculty. These included US workshops on gastrointestinal structures, forearm structures, joint structures, basic echocardiography, and US-guided IV access. We collected data from two of our six workshops. We developed surveys to gauge the confidence and ability of students to perform US after an MSK workshop and US-guided IV access workshop led by STs. We also measured students' US abilities and collected student feedback after our US-guided IV access workshop. We evaluated students' US competency in US-guided IV access via their ability to correctly position the US probe, angle the needle of insertion, move the probe with the needle, and access the vein based on the accuracy of the movements. We divided student results into two groups: students who previously attended the MSK workshop before attending the US-guided IV access workshop and students who did not attend the MSK workshop before attending the US-guided IV access workshop. We used averages, frequencies, and two-tailed t-tests to analyze the survey responses and US-guided IV access skill assessments. Results Fifty percent of first- and second-year surveyed students "agreed," and 32.4% "strongly agreed" that they felt confident using US after an ST-run MSK workshop. About 29.4% of surveyed students "agreed" and 41.2% "strongly agreed" that they felt comfortable explaining basic US concepts, such as proper probe positioning and echogenicity. The group of students who attended the MSK workshop prior to the peripheral IV workshop scored similarly to the students who did not attend the MSK workshop (14.33±1.03 versus 14.20±0.84 points). Both groups of students had an average of over 94% accuracy in technique, positioning, angling, moving the US probe, and achieving US-guided venous access after being taught by STs. Qualitative surveying noted positive student feedback, such as "Teacher was great at guiding us through the procedure." Survey responses also included suggestions on adding and diversifying equipment, such as "[It would be useful to have a] different type of needle to see the difference on ultrasound." Conclusion Based on the high percentages of accuracy and confidence, we found that STs were effective resources to teach MSK and vascular POCUS and that students who attended previous MSK ST-run US workshops had stronger vascular US ability over time compared to those who did not. Our data support the use of STs as US educational resources, especially in institutions without an existing pre-clerkship US curriculum and limited US resources.

Commentary on Ultrasound Instruction in Undergraduate Medical Education: Perspective from Two Students

BACKGROUND

Ultrasound integration in undergraduate medical education (UME) has been a focused endeavor in recent years. According to the American Institute of Ultrasound in Medicine, more than a third of all US medical schools have adopted a focused ultrasound training program for medical students. Medical student perspectives on best practices in ultrasound education are lacking in the literature.

CURRICULA EXPERIENCES

Two students' reflections are presented regarding two different didactic approaches, flipped classroom and self-study learning models, to teaching ultrasound in the pre-clinical medical education curriculum. Students present reflections on these didactic approaches to facilitate further improvement in ultrasound education curricula.

DISCUSSION

The self-directed learning model enabled students to learn foundational ultrasound exam techniques efficiently in a low-stress environment and subsequently optimized the efficiency of later faculty-led learning events. However, we noted that in both the flipped classroom and self-study learning models of education, the training on basic physical properties of ultrasound, tissue characteristics, and probe manipulation was limited.

CONCLUSION

A self-study learning model ultrasound curricula improves perceived learning efficiency and student confidence, especially when followed by faculty-guided didactics and scanning opportunities. We suggest a framework for ultrasound education curricula that includes components of both formats of ultrasound education alongside faculty-led sessions as an ideal model of ultrasound education. Further, we propose the added benefit of inanimate object scanning to optimize students' knowledge of waveform physics (image acquisition and physical properties of materials) early in the ultrasound education process.

Comparing the Effectiveness and Image Quality of Musculoskeletal Ultrasound of First-Year Medical Students After Training by Student Tutors Versus Ultrasound Instructors: A Pilot Study

Background

Ultrasound is a vital part in many medical schools’ curriculum. Although there is strong support for the use of student tutors (STs), there is a lack in gauging their effectiveness with more difficult organ systems such as the musculoskeletal (MSK) system. We aim to determine the effectiveness of using STs versus expert ultrasound instructors (UIs) when teaching MSK ultrasound.

Methodology

Medical students were recruited to participate in an MSK workshop to identify superficial volar arm structures (radial nerve, radial artery, median nerve, ulnar artery, ulnar nerve) using Butterfly iQ. In total, 14 participants were taught by STs and 10 participants were taught by UIs. Participants imaged the five structures and answered surveys gauging their confidence via five-point Likert scales.

Results

There was no significant difference in confidence or identification accuracy for all five structures between the two groups. However, there was a significant difference in confidence in the understanding of basic ultrasound concepts in favor of the UI group (p < 0.05). A greater number of students were more confident in identifying all five structures when taught by STs, but more students correctly identified the structures when taught by UIs.

Conclusions

The results on confidence could be due to positive peer perception. Both groups scored relatively high in their identification accuracies, promoting the successful use of STs. The successful use of STs in teaching MSK ultrasound opens the possibility to developing peer-led ultrasound curriculum on more complex ultrasound topics in the future.

Continuous multidimensional assessment system of medical residents in teaching hospitals

Background and aims

Evaluation of learners is considered as one of the most important principles in education, especially in the clinical fields. Continuous assessment can be used to provide appropriate feedback to students about their strengths and weaknesses. In this regard, this study is aimed to design a system of continuous assessment of medical residents (SCMARs).

Methods

This study was performed using a combination of qualitative methods, including focus group discussion, expert panel, and Delphi technique. The study population consisted of all the stakeholders involved in the evaluation process of medical residents in Imam Reza Hospital Complex (IRHC) in Iran. This study was conducted in three phases, including identification of subthemes and indicators, production of a primary framework for the SCMAR, and agreement on the subthemes of the SCMAR. The nominal group technique was used for generating priority information. Data analysis was performed during the agreement review stage with the Excel software version 2016.

Results

The finalized SCMAR consisted of 10 main themes and 38 subthemes. The themes included objectives, evaluators, areas, and indicators of evaluation, evaluation periods, evaluation requirements, data collection, data sources, point assignment and data analysis methods, reporting, and feedback dissemination methods. Five areas of evaluation and 11 indicators of evaluation were proposed.

Conclusion

A comprehensive assessment system that continuously evaluates the performance of Medical Residents can be used as a stimulus to improve the quality of educational processes. The present study was aimed to address this need by designing a framework for such a system.

Creating an Ultrasound Scholarly Concentration Program for Medical Students

INTRODUCTION

Point of care ultrasound (POCUS) is increasingly prevalent and standardized in undergraduate medical education (UME); however, roughly 25% of United States medical schools lack an ultrasound curriculum. One of the commonly cited barriers to ultrasound training in UME is faculty time resources. Here, we describe an ultrasound scholarly concentration program (SCP) designed to provide medical students with ultrasound opportunities in clinical and scholarly domains, while reducing the need for extensive faculty resources.

METHODS

SCPs at the University of North Carolina School of Medicine have 3 requirements: an elective course, a longitudinal portfolio, and a final scholarly project. Thus, the ultrasound SCP was designed to comprise an introductory clinical elective to ultrasound, development of a longitudinal scan portfolio, and a final scholarly project in ultrasound related research or educational innovation. A review of the literature and search of the top 50 US medical schools by US News & World Report was performed to assess the novelty of the ultrasound SCP.

RESULTS

To the best of our knowledge, the ultrasound SCP is the first scholarly concentration, track or pathway offered to medical students in the United States. It is the first description of a student designed and student led curriculum focused on providing meaningful ultrasound opportunities to students without necessitating unavailable faculty resources and educational infrastructure.

CONCLUSION

A novel ultrasound SCP is described which has clinical aims to expose students to clinical ultrasound as well as scholarly aims to facilitate ultrasound related research and educational innovation. It is designed to enable students to make ultrasound a defining characteristic of their medical school experience. The SCP relies on motivated student involvement and near-peer teaching in a way that is self-sustaining and self-improving.