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Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, Abuhamad A, Noble V, Hussain A, Prosen G, Villen T, Via G, Nogue R, Goodmurphy C, Bastos M, Nace GS, Volpicelli G, Wakefield RJ, Wilson S, Bhagra A, Kim J, Bahner D, Fox C, Riley R, Steinmetz P, Nelson BP, Pellerito J, Nazarian LN, Wilson LB, Ma IWY, Amponsah D, Barron KR, Dversdal RK, Wagner M, Dean AJ, Tierney D, Tsung JW, Nocera P, Pazeli J, Liu R, Price S, Neri L, Piccirillo B, Osman A, Lee V, Naqvi N, Petrovic T, Bornemann P, Valois M, Lanctot JF, Haddad R, Govil D, Hurtado LA, Dinh VA, DePhilip RM, Hoffmann B, Lewiss RE, Parange NA, Nishisaki A, Doniger SJ, Dallas P, Bergman K, Barahona JO, Wortsman X, Smith RS, Sisson CA, Palma J, Mallin M, Ahmed L, Mustafa H. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14:31. [PMID: 35895165 PMCID: PMC9329507 DOI: 10.1186/s13089-022-00279-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
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Affiliation(s)
- Richard A. Hoppmann
- Internal Medicine, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Bldg 3, Room 306, Columbia, SC 29209 USA
| | - Jeanette Mladenovic
- Foundation for the Advancement of International Medical Education and Research, Philadelphia, USA
| | - Lawrence Melniker
- Quality Emergency Department, NewYork-Presbyterian Health System, New York, USA
| | - Radu Badea
- Internal Medicine and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Blaivas
- Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Miguel Montorfano
- Ultrasound and Doppler Department, Hospital de Emergencias “Dr. Clemente Alvarez”, Rosario, Argentina
| | | | - Vicki Noble
- Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Arif Hussain
- Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gregor Prosen
- Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Tomás Villen
- Francisco de Vitoria University School of Medicine, Madrid, Spain
| | - Gabriele Via
- Department of Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ramon Nogue
- Emergency Medicine, University of Lleida School of Medicine, Lleida, Spain
| | - Craig Goodmurphy
- Ultrasound Education, Penn State College of Medicine, Hershey, USA
| | - Marcus Bastos
- Ultrasound Point of Care, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, Brazil
| | - G. Stephen Nace
- Medical Education and Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Giovanni Volpicelli
- Internal Medicine, Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Steve Wilson
- University of South Carolina School of Medicine, Columbia, USA
| | | | - Jongyeol Kim
- Neurology, School of Medicine Texas Tech University Health Sciences Center, Lubbock, USA
| | - David Bahner
- Department of Emergency Medicine, The Ohio State University, Columbus, USA
| | - Chris Fox
- Department Emergency Medicine, University of California Irvine, Irvine, USA
| | - Ruth Riley
- Library Services, University of South Carolina School of Medicine, Columbia, USA
| | | | - Bret P. Nelson
- Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Pellerito
- Radiology and Science Education, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Levon N. Nazarian
- Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - L. Britt Wilson
- Physiology, University of South Carolina School of Medicine, Columbia, USA
| | - Irene W. Y. Ma
- Medicine, Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - David Amponsah
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, USA
| | - Keith R. Barron
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Renee K. Dversdal
- Internal Medicine, Oregon Health & Science University, Portland, USA
| | - Mike Wagner
- Medicine, University of South Carolina School of Medicine-Greenville, Greenville, USA
| | - Anthony J. Dean
- Emeritus Department of Emergency Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David Tierney
- Internal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
| | - James W. Tsung
- Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paula Nocera
- Anesthesiologist, Hospital Sírio Libanês, São Paulo, Brazil
| | - José Pazeli
- Nephology and Critical Care, Barbacena’s School of Medicine, Barbacena, Brazil
| | - Rachel Liu
- Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Susanna Price
- Cardiology and Intensive Care, Royal Brompton Hospital, London, England
| | - Luca Neri
- Emergency and Intensive Care Medicine, King Fahad Specialist Hospital Dammam, Ad Dammām, Saudi Arabia
| | | | - Adi Osman
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri, Ipoh, Perak Malaysia
| | - Vaughan Lee
- Medical Education, University of South Alabama College of Medicine, Mobile, USA
| | - Nitha Naqvi
- Royal Brompton Hospital Part of Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Paul Bornemann
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Maxime Valois
- Medicine, McGill and Sherbrooke Universities, Montreal, Canada
| | | | - Robert Haddad
- Ultrasound Education - Ultrasound Institute, University of South Carolina School of Medicine, Columbia, USA
| | - Deepak Govil
- Critical Care Medicine, Medanta - The Medicity, Gurgaon, India
| | | | - Vi Am Dinh
- Emergency Medicine and Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Robert M. DePhilip
- Emeritus Biomedical Education and Anatomy, The Ohio State University, Columbus, USA
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Harvard Medical School, Boston, USA
| | - Resa E. Lewiss
- Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, USA
| | - Nayana A. Parange
- Medical Sonography, University of South Australia Allied Health and Human Performance, Adelaide, Australia
| | - Akira Nishisaki
- Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Stephanie J. Doniger
- Pediatric Emergency Medicine, Children’s Hospital in Orange California, Orange, USA
| | - Paul Dallas
- Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kevin Bergman
- Family and Community Medicine, University of California - San Francisco, Martinez, USA
| | - J. Oscar Barahona
- Greenwich Ultrasound Services, Greenwich Ultrasound Associates, PC, Greenwich, USA
| | - Ximena Wortsman
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. Stephen Smith
- Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Craig A. Sisson
- Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James Palma
- Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Liju Ahmed
- King Faisal Specialist Hospital and Research Center, Madinah, Kingdom of Saudi Arabia
| | - Hassan Mustafa
- Internal Medicine, University of Manitoba, Manitoba, Canada
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Khoury M, Fotsing S, Jalali A, Chagnon N, Malherbe S, Youssef N. Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943615. [PMID: 32754649 PMCID: PMC7378712 DOI: 10.1177/2382120520943615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. METHODS Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. RESULTS For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. CONCLUSION The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.
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Affiliation(s)
- Michel Khoury
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Salomon Fotsing
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Alireza Jalali
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Nicolas Chagnon
- Department of Emergency Medicine,
Montfort Hospital, Ottawa, ON, Canada
| | | | - Nermine Youssef
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
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Mazza G, Romo CM, Torres M, Duffens A, Vyas A, Moran K, Livingston J, Gonzales S, Lahham S, Shniter I, Thompson M, Fox JC. Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama. World J Emerg Med 2019; 10:46-50. [PMID: 30598718 DOI: 10.5847/wjem.j.1920-8642.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava (IVC) to the aorta (Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama. METHODS This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration. RESULTS A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half (n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half (n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8. CONCLUSION Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.
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Affiliation(s)
- Genevieve Mazza
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | | | - Marlene Torres
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Ali Duffens
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Annasha Vyas
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Katherine Moran
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Joshua Livingston
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Savannah Gonzales
- School of Medicine, University of California Irvine, Irvine, CA 92697, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Inna Shniter
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
| | - Maxwell Thompson
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
| | - John Christian Fox
- Department of Emergency Medicine, University of California Irvine, Orange, CA 92868, USA
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Tarique U, Tang B, Singh M, Kulasegaram KM, Ailon J. Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:69-82. [PMID: 28748549 DOI: 10.1002/jum.14333] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/20/2017] [Indexed: 05/20/2023]
Abstract
The clinical applications of point-of-care ultrasound (US) have expanded rapidly over the past decade. To promote early exposure to point-of-care US, there is widespread support for the integration of US curricula within undergraduate medical education. However, despite growing evidence and enthusiasm for point-of-care US education in undergraduate medical education, the curricular design and delivery across undergraduate medical education programs remain variable without widely adopted national standards and guidelines. This article highlights the educational and teaching applications of point-of-care US with a focus on outcomes. We then review the evidence on curricular design, delivery, and integration and the assessment of competency for point-of-care US in undergraduate medical education.
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Affiliation(s)
- Usman Tarique
- Faculty of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Brandon Tang
- Faculty of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Manni Singh
- Faculty of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kulamakan Mahan Kulasegaram
- Faculty of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Wilson Center and Undergraduate Medical Education, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Ailon
- Faculty of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of General Internal Medicine and Palliative Care, Saint Michael's Hospital, Toronto, Ontario, Canada
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Lee JB, Tse C, Keown T, Louthan M, Gabriel C, Anshus A, Hasjim B, Lee K, Kim E, Yu L, Yu A, Lahham S, Bunch S, Alvarado M, Gari A, Fox JC. Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students. World J Emerg Med 2017; 8:281-286. [PMID: 29123606 DOI: 10.5847/wjem.j.1920-8642.2017.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the short-term efficacy of a 4-week ultrasound curriculum taught by American first-year medical students to general practitioners working in public health care clinics, or puskesmas, in Bandung, Indonesia. METHODS We performed a prospective, observational study of Indonesian health care practitioners from public clinics in Bandung, Indonesia. These practitioners were enrolled in a 4-week ultrasound training course taught by first-year American medical students. A total of six sessions were held comprising of 38 ultrasound milestones. A pre-course and post-course written exam and practical exam was taken by each participant. RESULTS We enrolled 41 clinicians in the course. The average pre-course exam score was 35.2% with a 2.4% pass rate, whereas the average post-course exam score was 82.0% with a 92.7% pass rate. The average practical score at the completion of the course was 83.2% (SD=0.145) with 82.9% of the class passing (score above 75.0%). CONCLUSION Our data suggests that first-year medical students can effectively teach ultrasound to physicians in Indonesia using a 4-week intensive ultrasound training course. Future studies are needed to determine the amount of training required for proficiency and to evaluate the physicians' perceptions of the student-instructors' depth of knowledge and skill in point of care ultrasound.
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Affiliation(s)
- Jonathan B Lee
- School of Medicine, University of California, Irvine, USA
| | - Christina Tse
- School of Medicine, University of California, Irvine, USA
| | - Thomas Keown
- School of Medicine, University of California, Irvine, USA
| | | | | | | | - Bima Hasjim
- School of Medicine, University of California, Irvine, USA
| | - Katrina Lee
- School of Medicine, University of California, Irvine, USA
| | - Esther Kim
- School of Medicine, University of California, Irvine, USA
| | - Luke Yu
- School of Medicine, University of California, Irvine, USA
| | - Allen Yu
- School of Medicine, University of California, Irvine, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Steven Bunch
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Maili Alvarado
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - Abdulatif Gari
- Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
| | - John C Fox
- School of Medicine, University of California, Irvine, USA.,Department of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA
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