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Dietrich CF, Sirli RL, Barth G, Blaivas M, Daum N, Dong Y, Essig M, Gschmack AM, Goudie A, Hofmann T, Hoffmann B, Jenssen C, Kallenbach M, Karlas T, Krutz A, Löwe A, Lucius C, Möller K, Neubauer R, Nurnberg D, Prats M, Prosch H, Recker F, Ruppert JP, Sänger SL, Wangenheim F, Weimer JM, Westerway SC, Zervides C. Student ultrasound education - current views and controversies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:389-394. [PMID: 38484782 DOI: 10.1055/a-2265-1070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
As an extension of the clinical examination and as a diagnostic and problem-solving tool, ultrasound has become an established technique for clinicians. A prerequisite for high-quality clinical ultrasound practice is adequate student ultrasound training. In light of the considerable heterogeneity of ultrasound curricula in medical studies worldwide, this review presents basic principles of modern medical student ultrasound education and advocates for the establishment of an ultrasound core curriculum embedded both horizontally and vertically in medical studies.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Hirslanden Klinik Beau-Site, Bern, Switzerland
| | - Roxana Lucia Sirli
- Department of Internal Medicine II - Gastroenterology and Hepatology, Center of Advanced Research in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Timisoara, Romania
| | - Gregor Barth
- Department of Hematology, Oncology and Palliative Care, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine, Columbia, United States
| | - Nils Daum
- Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | | | - Adrian Goudie
- Emergency, Fiona Stanley Hospital, Murdoch, Australia
| | - Tino Hofmann
- Medicine, Witten/Herdecke University, Witten, Germany
| | - Beatrice Hoffmann
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, United States
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
| | - Michael Kallenbach
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Universitätsklinikum Düsseldorf, Dusseldorf, Germany
| | - Thomas Karlas
- Department of Internal Medicine, Division of Gastroenterology, Leipzig University Medical Center, Leipzig, Germany
| | - Alexander Krutz
- Medicine, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Axel Löwe
- Department of Internal Medicine, Hirslanden Hospital Group, Bern, Switzerland
| | - Claudia Lucius
- Outpatient Department of Gastroenterology, IBD center, Policlinic Helios Klinikum Buch, Berlin, Germany
| | - Kathleen Möller
- Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Ricarda Neubauer
- Clinic of Internal Medicine III Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Dieter Nurnberg
- Department of Internal Medicine and Gastroenterology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Prats
- Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, United States
| | - Helmut Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Wien, Austria
| | - Florian Recker
- Department of Obstetrics and Gynecology, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | | | - Johannes M Weimer
- Rudolf-Frey Teaching Department, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Susan Campbell Westerway
- School of Dentistry & Health Sciences, Charles Sturt University Australia, Wagga Wagga, Australia
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Parker M, Johnson L, Paquette R, Sakaguchi A, Kar R. The prevalence of ultrasound curricula in a sampling of U.S. physician assistant programs and recommendations for common ultrasound objectives: A national survey. ANATOMICAL SCIENCES EDUCATION 2024; 17:855-863. [PMID: 38197498 DOI: 10.1002/ase.2375] [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: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.
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Affiliation(s)
- Morgan Parker
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Laura Johnson
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Roland Paquette
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alan Sakaguchi
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Rekha Kar
- Department of Cell Systems and Anatomy, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Weimer JM, Rink M, Vieth T, Lauff J, Weimer A, Müller L, Stäuber M, Reder SR, Buggenhagen H, Bellhäuser H, Kloeckner R, Künzel J, Hoffmann EM, Würde A. Development and evaluation of a point-of-care ocular ultrasound curriculum for medical students - a proof-of-concept study. BMC MEDICAL EDUCATION 2023; 23:723. [PMID: 37789302 PMCID: PMC10548604 DOI: 10.1186/s12909-023-04723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Point-of-care Ocular Ultrasound (POCOUS) has gained importance in emergency medicine and intensive care in recent years. This work aimed to establish and evaluate a dedicated ultrasound education program for learning POCOUS-specific skills during medical studies at a university hospital. METHODS The blended learning-based program (6 teaching units) based on recent scientific publications and recommendations was developed for students in the clinical part of their medical studies. Experts and trainers consisted of physicians from the Ear-Nose-Throat, radiology, ophthalmology and neurology specialties as well as university educational specialists. Lecture notes containing digital video links for preparation was produced as teaching material. In total, 33 students participated in the study. The education program, including the teaching materials, motivation and subjective gain in competency, was evaluated with the aid of a questionnaire (7-point Likert response format). Objective learning success was assessed on the basis of pre- and post-tests. These covered the skill areas: "anatomical basics", "ultrasound basics", "understanding of cross-sectional images", "normal findings" and "pathology recognition". RESULTS In the objective assessment of image interpretation, the participants improved significantly (p < 0.001) from pre- to post-test with a large effect size (Cohen's d = 1.78, effect size r = 0.66). The evaluations revealed a high level of satisfaction with the course concept, teaching materials and the tutors. In addition, a high level of motivation was recorded in relation to continuing to study "ultrasound diagnostics" and "ophthalmologic diseases". A significant (p < 0.01) positive gain was also achieved in terms of the subjective assessment of competency. This covers areas such as expertise, sonographic anatomy and performing a POCOUS examination as well as recognizing retinal detachment, globe perforation and increased optic nerve sheath diameter. CONCLUSION The results of this feasibility study show that medical students accept and support a POCOUS-specific education program and are able to develop a higher objective and subjective level of competency. Future transfer to other sites and larger groups of participants seems feasible.
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Affiliation(s)
- Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Vieth
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jonas Lauff
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marie Stäuber
- Department of Anesthesia, Intensive Care Medicine, Emergency medicine, Pain medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sebastian R Reder
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Henrik Bellhäuser
- Institute of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein - Campus Lübeck, Lübeck, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
| | - Anna Würde
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg- University Mainz, Mainz, Germany
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Schroeder AN, Amin I, Bowen BJ, Callender SS, Ferderber M, Kerr HA, Phillips SF, Romero JM, Rudolph L, Vidlock K, Waterbrook AL, Kruse RC. Implementing a Sports Ultrasound Curriculum in Undergraduate Medical Education. Curr Sports Med Rep 2023; 22:328-335. [PMID: 37678352 DOI: 10.1249/jsr.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
ABSTRACT The utilization of sports ultrasound in the clinical practice of sports medicine physicians is growing rapidly. Simultaneously, ultrasound is being increasingly implemented as a teaching tool in undergraduate medical education. However, a sports ultrasound curriculum for medical students has not been previously described. In this article, we describe methods as well as barriers to implementing a sports ultrasound curriculum at the medical school level. Recommended content for the curriculum also is discussed. While educational goals and resources will vary among institutions, this article may serve as a general roadmap for the creation of a successful curriculum.
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Affiliation(s)
| | - Idris Amin
- Department of Neurology and Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Brady J Bowen
- Department of Medicine, Albany Medical College, Albany, NY
| | | | - Megan Ferderber
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC
| | - Hamish A Kerr
- Department Medicine, Albany Medical College, Albany, NY
| | - Shawn F Phillips
- Family and Community Medicine and Orthopedics and Rehabilitation, Penn State College of Medicine, Hershey, PA
| | - Joshua M Romero
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | | | - Kathryn Vidlock
- Family Medicine and Ultrasound, Rocky Vista University, Parker, CO
| | - Anna L Waterbrook
- Sports and Emergency Medicine, The University of Arizona, Tucson, AZ
| | - Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, IA
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Weimer J, Dionysopoulou A, Strelow KU, Buggenhagen H, Weinmann-Menke J, Dirks K, Weimer A, Künzel J, Börner N, Ludwig M, Yang Y, Lorenz L, Ille C, Müller L. Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards. BMC MEDICAL EDUCATION 2023; 23:513. [PMID: 37461025 DOI: 10.1186/s12909-023-04511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills. METHODS Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed. RESULTS A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor's didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05). CONCLUSION These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.
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Affiliation(s)
- Johannes Weimer
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Anna Dionysopoulou
- Department of obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kai-Uwe Strelow
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Klaus Dirks
- Department of General Internal Medicine and Geriatrics, Rems-Murr-Klinikum, Winnenden, Germany
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Börner
- Gastroenterological Medical Group Offices, MED Specialist Center Mainz, Mainz, Germany
| | - Michael Ludwig
- Department of Internal Medicine I, Hospital of the German Armed Forces Berlin, Berlin, Germany
| | - Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Liv Lorenz
- Department of Radiation Oncology and Radiotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Carlotta Ille
- Rudolf Frey Learning Clinic, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Weimer JM, Widmer N, Strelow KU, Hopf P, Buggenhagen H, Dirks K, Künzel J, Börner N, Weimer AM, Lorenz LA, Rink M, Bellhäuser H, Schiestl LJ, Kloeckner R, Müller L, Weinmann-Menke J. Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School-A Prospective Study. Tomography 2023; 9:1315-1328. [PMID: 37489472 PMCID: PMC10366829 DOI: 10.3390/tomography9040104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses. METHODS From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum". RESULTS Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills. CONCLUSIONS Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.
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Affiliation(s)
- Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Nina Widmer
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Kai-Uwe Strelow
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Paula Hopf
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Klaus Dirks
- Department of General Internal Medicine and Geriatrics, Rems-Murr-Klinikum, 71364 Winnenden, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 95053 Regensburg, Germany
| | - Norbert Börner
- Gastroenterological Medical Group Offices at the MED Specialist Centre Mainz, 55131 Mainz, Germany
| | - Andreas Michael Weimer
- Centre of Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Liv Annebritt Lorenz
- Department of Radiation Oncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 95053 Regensburg, Germany
| | - Henrik Bellhäuser
- Institute of Psychology, Johannes Gutenberg University of Mainz, 55112 Mainz, Germany
| | - Lina Judit Schiestl
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes-Gutenberg University Mainz, 55131 Mainz, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, 23583 Lübeck, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, University Medical Centre of the Johannes Gutenberg University-Mainz, 55131 Mainz, Germany
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Teichgräber U, Ingwersen M, Ehlers C, Mentzel HJ, Redies C, Stallmach A, Behringer W, Guntinas-Lichius O. Integration of ultrasonography training into undergraduate medical education: catch up with professional needs. Insights Imaging 2022; 13:150. [PMID: 36153444 PMCID: PMC9509508 DOI: 10.1186/s13244-022-01296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
Ultrasonography (US) has become the first-line imaging modality even for physicians who are not imaging specialists. The progress has not yet been sufficiently considered in medical education. The aim was to develop a curriculum that integrates US as a compulsory part into medical education directly from the start, to build up professional competencies toward residency.
Methods
Development was based on Kern’s six-step approach to identify problems, specify needs, define goals, outline strategies, and propose methods.
Results
The proposed curriculum follows a spiral course within which students should pass through four levels of training with increasing complexity. Students will be asked to independently prepare for courses by using learning videos. On the first training level, US should be closely linked to anatomy and physiology courses. Competency-centered courses should be held in small groups. On the second level, in the third year of education, students will apply point-of-care ultrasonography concerning multiple medical disciplines. On the third level, they will select a compulsory course in a specialty of their choice, held at five consecutive dates. From then on, US will be conducted in patients. Finally, during the final year, students are expected to use US under pro-active supervision with a large degree of independence and confidence. Throughout the curriculum, the discipline of radiology combines vertically with foundational sciences and horizontally with other medical specialties.
Conclusion
The conceptual proposal for a longitudinal US curriculum presented here has been developed by radiologists to equip students with competencies needed for contemporary patient care.
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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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Kameda T, Koibuchi H, Konno K, Taniguchi N. Self-learning followed by telepresence instruction of focused cardiac ultrasound with a handheld device for medical students: a preliminary study. J Med Ultrason (2001) 2022; 49:415-423. [PMID: 35739371 PMCID: PMC9223254 DOI: 10.1007/s10396-022-01233-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
Purpose This study aimed to assess the feasibility and efficiency of self-learning with or without self-training (subjects performed scans on themselves) and telepresence instruction in focused cardiac ultrasound (FOCUS) education for medical students. Methods This study included 24 medical students. The participants initially completed a written pre-test and were randomized into a video lecture (participants watched a video lecture) or self-training (participants watched a video lecture and self-performed FOCUS) group. After finishing self-learning, they completed a written post-test. Then they undertook a skill pre-test and a first perception survey. Telepresence instruction was then provided. Finally, they undertook a skill post-test and a second perception survey. Results The written post-test total scores were significantly higher than the pre-test total scores (P < 0.001). In the skill pre-test, the scores for the video lecture and self-training groups were not significantly different (P = 0.542). The skill post-test total scores were significantly higher than the skill pre-test total scores (P = 0.008). Forty-two percent of the video lecture group participants agreed that the video lecture was effective preparation for the skill pre-test, while all participants in the same group agreed that the combination of the video lecture and telepresence instruction was effective preparation for the skill post-test. Conclusion This study demonstrated the feasibility and efficiency of self-learning followed by telepresence instruction on FOCUS for medical students.
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Affiliation(s)
- Toru Kameda
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Harumi Koibuchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kei Konno
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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10
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Peterman NJ, Yeo E, Kaptur B, Smith EJ, Christensen A, Huang E, Rasheed M. Analysis of Rural Disparities in Ultrasound Access. Cureus 2022; 14:e25425. [PMID: 35774712 PMCID: PMC9236672 DOI: 10.7759/cureus.25425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This work aims to conduct a geospatial analysis of recent ultrasound access and usage within the United States, with a particular focus on disparities between rural and urban areas. Methods/Materials Multiple public datasets were merged on a county level, including US Department of Agriculture economic metrics and Centers for Medicare Services data using the most recent years available (2015-2019). From these databases, 39 total variables encompassing the socioeconomic, health, and ultrasound characteristics of each county were obtained. Current Procedural Terminology (CPT) codes incorporated included ultrasound-guided procedures and diagnostic exams. Three thousand eleven counties were included. The combined dataset was then exported to GeoDa for network-based analysis and to produce map visualizations. To identify statistically significant (p < 0.05) hotspots and coldspots in point-of-care ultrasound (POCUS) prevalence, Moran’s I was used. Choropleth maps were created for visualization. ANOVA was run across the four Moran’s I groups for each of 39 variables of interest. Results A total of 30,135,085 ultrasound-related CPT codes were billed to Medicare over 2015-2019, with 26.55% of codes being ultrasound-guided procedures and 73.45% being diagnostic exams. 38.84% of rural counties had access to POC ultrasound compared to 88.56% of metropolitan counties and 74.19% of counties overall. Hotspots of POCUS were in Southern California and the Eastern US (average of 1,441 per 10,000 Medicare members per year). Coldspot areas were seen in the Great Plains and Midwest (average of 7.43 per 10k Medicare members per year). Hotspot clusters, when compared to coldspot clusters, were significantly (p < 0.001) more dense (703.6 to 14.9 people per square mile), more urbanized (3.5 to 7.1 Rural-Urban Continuum (RUC)), more college-educated (25.1% to 20.0%), more likely to have an Emergency Department (ED) visit (725.8 to 616.9 visits per 1,000 Medicare members), more likely to be obese (19.0% to 12.9%), less likely to be uninsured (10.1% to 13.0%), had more Black representation (8.5% to 3.4%), and less Hispanic representation (2.6% to 5.5%). Conclusions Ultrasound access and usage demonstrate significant geospatial trends across the United States. Hotspot and coldspot counties differ on several key sociodemographic and economic variables.
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11
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Meggitt A, Way DP, Iyer MS, Mahan JD, Gold D. Residents' Perspective on Need for Point-of-Care Ultrasound Education During Pediatric Residency. Hosp Pediatr 2022; 12:607-617. [PMID: 35510494 DOI: 10.1542/hpeds.2021-006444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many medical disciplines incorporate point-of-care ultrasound (POCUS) into their practice. Despite well-defined applications, POCUS has not been widely adopted in pediatrics and is not commonly taught during residency. Our objective was to profile the current state of POCUS education in pediatric residency training from the resident perspective. METHODS We surveyed pediatric trainees about their POCUS education, general opinions about POCUS, and perceived barriers to POCUS training in residency. We distributed the survey to a random sample of Ohio pediatric residents, stratified by program size and training level. Descriptive statistics were used to characterize responses. RESULTS We sampled 66.4% of the population (371 of 559) of Ohio pediatric residents and achieved a response rate of 59.3%. Only 15% of respondents received POCUS training during residency, with 85% having never performed a POCUS scan. Most (86%) desired POCUS education and 67% believed it should be required during residency. Residents felt that POCUS would be useful for procedural guidance (95%), clinical diagnosis (94%), and patient safety (74%). Most residents (61%) believed POCUS education would benefit their careers, particularly those planning on subspecialization. Barriers to POCUS education included lack of an established curriculum (75%), competing educational priorities (58%), and a shortage of qualified instructors (52%). CONCLUSIONS Although Ohio pediatric residents do not receive formal POCUS education in residency, they desire such training and believe it would benefit their future practice. Consensus on scope of practice, development of a standardized curriculum, and increased faculty training in POCUS may help address this educational gap.
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Affiliation(s)
- Austin Meggitt
- University of Colorado, Anschutz Medical Campus, Denver, Colorado
| | - David P Way
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Maya S Iyer
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Delia Gold
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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12
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Olivares-Perez ME, Graglia S, Harmon DJ, Klein BA. Virtual anatomy and point-of-care ultrasonography integration pilot for medical students. ANATOMICAL SCIENCES EDUCATION 2022; 15:464-475. [PMID: 34748279 DOI: 10.1002/ase.2151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
Despite its significant clinical use, there is no standardized point-of-care ultrasonography (POCUS) curriculum in undergraduate medical education. As Covid-19 abruptly mandated the use of virtual education, instructors were challenged to incorporate and improve POCUS education within these new constraints. It was hypothesized that integrating POCUS into anatomy via brief video lessons and a subsequent interactive virtual lesson would lead to an objective understanding of POCUS concepts, improved understanding of the corresponding anatomy, and subjective improvement of student confidence with POCUS. A cross-sectional descriptive study assessed first-year medical students' perspectives and performance before and after the interventions (n = 161). The intervention was split into two parts: (1) three optional 10-minute POCUS videos that reinforced anatomy concepts taught in the laboratory sessions, and (2) a subsequent two-hour interactive virtual session reviewing POCUS and anatomy concepts. Students completed a knowledge and confidence assessment tool before and after the interactive session. Survey responses (n = 51) indicated that 94% of students felt the optional videos improved their understanding of POCUS and were educationally valuable. One half of medical students (50%) indicated that the demonstrations improved their anatomy understanding. Initial self-reported confidence was low after the optional video lessons, despite an average score of 58% on the knowledge assessment (n = 130). However, confidence increased significantly along with an increase in score performance to 80% after the interactive session (n = 39, P < 0.01). Results suggest that the virtual integration pilot enhanced student learning of both anatomy and POCUS.
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Affiliation(s)
- Marcus E Olivares-Perez
- Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California, USA
| | - Sally Graglia
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Derek J Harmon
- Department of Anatomy, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Barbie A Klein
- Department of Anatomy, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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13
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Russell FM, Zakeri B, Herbert A, Ferre RM, Leiser A, Wallach PM. The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:723-727. [PMID: 34789665 DOI: 10.1097/acm.0000000000004512] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the current state of point-of-care ultrasound (POCUS) integration in undergraduate medical education (UME) at MD-granting medical schools in the United States. METHOD In 2020, 154 clinical ultrasound directors and curricular deans at MD-granting medical schools were surveyed. The 25-question survey collected data about school characteristics, barriers to POCUS training implementation, and POCUS curriculum details. Descriptive analysis was conducted using frequency and percentage distributions. RESULTS One hundred twenty-two (79%) of 154 schools responded to the survey, of which 36 were multicampus. Sixty-nine (57%) schools had an approved POCUS curriculum, with 10 (8%) offering a longitudinal 4-year curriculum. For a majority of schools, POCUS instruction was required during the first year (86%) and second year (68%). Forty-two (61%) schools were teaching fundamentals, diagnostic, and procedural ultrasound. One hundred fifteen (94%) schools identified barriers to implementing POCUS training in UME, which included lack of trained faculty (63%), lack of time in current curricula (54%), and lack of equipment (44%). Seven (6%) schools identified no barriers. CONCLUSIONS Over half of the responding medical schools in the United States had integrated POCUS instruction into their UME curricula. Despite this, a very small portion had a longitudinal curriculum and multiple barriers existed for implementation, with the most common being lack of trained faculty. The data from this study can be used by schools planning to add or expand POCUS instruction within their current curricula.
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Affiliation(s)
- Frances M Russell
- F.M. Russell is ultrasound research director and co-director of ultrasound education, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bita Zakeri
- B. Zakeri is director of continuing medical education, Division of Continuing Medical Education, Indiana University School of Medicine, Indianapolis, Indiana; ORCID: https://orcid.org/0000-0002-9654-1156
| | - Audrey Herbert
- A. Herbert is co-director of ultrasound education, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robinson M Ferre
- R.M. Ferre is director of ultrasound and co-director of ultrasound education, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Abraham Leiser
- A. Leiser is a medical student, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul M Wallach
- P.M. Wallach is executive associate dean, Educational Affairs and Institutional Improvement, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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14
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Nussbaum RP, Chu SK. Introductory Resident-Led Physical Medicine and Rehabilitation Case-Based Ultrasound Workshop for Medical Students. Am J Phys Med Rehabil 2022; 101:e57-e61. [PMID: 34864769 DOI: 10.1097/phm.0000000000001939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The core clinical ultrasound milestones for medical students in the United States do not cover the majority of clinical topics pertinent to the specialty of physical medicine and rehabilitation. In addition, one of the major barriers to teaching physical medicine and rehabilitation residents ultrasound is a lack of instructors with sufficient experience. A solution to both of these problems is the establishment of a resident-led case-based ultrasound workshop for medical students that introduces them to the field of physical medicine and rehabilitation. This novel workshop involved 30 medical students and 9 resident instructors. The students participated in five hands-on interactive physical medicine and rehabilitation clinical cases where each student had 5 mins per case to scan. A program evaluation survey showed that the workshop achieved the objectives of increasing medical student confidence in describing the role of a physical medicine and rehabilitation physician and physical medicine and rehabilitation patient populations as well as confidence using ultrasound for evaluating the peripheral nervous system and musculoskeletal system. Resident instructors endorsed that the workshop was beneficial for improving their physical medicine and rehabilitation ultrasound teaching skills and also increased their interest for contributing to future workshops. The intention of this project is to reproduce similar initiatives in physical medicine and rehabilitation residency training programs across the United States.
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Affiliation(s)
- Ryan P Nussbaum
- From the Department of Physical Medicine and Rehabilitation/Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, Illinois (RPN, SKC); and Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (RPN)
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15
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Smith CJ, Barron K, Shope RJ, Beam E, Piro K. Motivations, barriers, and professional engagement: a multisite qualitative study of internal medicine faculty's experiences learning and teaching point-of-care ultrasound. BMC MEDICAL EDUCATION 2022; 22:171. [PMID: 35279153 PMCID: PMC8918294 DOI: 10.1186/s12909-022-03225-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) graduate medical education is expanding across many specialties, but a lack of trained faculty is a common barrier. Even well-designed faculty development programs struggle with retention, yet little is known about the experiences of practicing physicians learning POCUS. Our objective is to explore the experiences of clinician-educators as they integrate POCUS into their clinical and teaching practices to help inform curriculum design. METHODS Qualitative study using instrumental case study design to analyze interview data from 18 internal medicine clinician-educators at 3 academic health centers. Interviewees were recruited by program directors at each site to include participants with a range of POCUS use patterns. Interviews took place from July-August 2019. RESULTS Analysis yielded 6 themes: teaching performance, patient care, curriculum needs, workflow and access, administrative support, and professional engagement. Participants felt POCUS enhanced their teaching skills, clinical decision making, and engagement with patients. The themes highlighted the importance of longitudinal supervision and feedback, streamlined integration of POCUS into clinical workflow, and administrative support of time and resources. Interviewees reported learning and teaching POCUS helped combat burn-out and enhance their sense of professional engagement. CONCLUSIONS Learning POCUS as a practicing clinician-educator is a complicated endeavor that must take into account mastery of psychomotor skills, existing practice habits, and local institutional concerns. Based upon the themes generated from this study, we make recommendations to help guide POCUS faculty development curriculum design. Although this study focused on internists, the findings are likely generalizable to other specialties with growing interest in POCUS education.
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Affiliation(s)
- Christopher J Smith
- Department of Internal Medicine, Division of Hospital Medicine, University of Nebraska Medical Center, 986430 Nebraska Medical Center, Omaha, NE, USA.
| | - Keith Barron
- Prisma Health Midlands - University of South Carolina School of Medicine, Department of Internal Medicine, Division of General Internal Medicine, 14 Richland Medical Park Drive, Suite, Columbia, SC, 320, USA
| | - Ronald J Shope
- Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Beam
- Interprofessional Academy of Educators, University of Nebraska Medical Center, 987115 Nebraska Medical Center, Omaha, NE, USA
| | - Kevin Piro
- Department of Internal Medicine, Division of Hospital Medicine, Oregon Health & Science University, 3270 SW Pavilion Loop Suite, Portland, OR, 350, USA
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16
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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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17
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Bacon DR, Cowles K, Thapa D, White A, Allen AJ, Doughton J, Beck Dallaghan G, Jordan SG. Creating an Ultrasound Scholarly Concentration Program for Medical Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1103-1110. [PMID: 34594147 PMCID: PMC8478088 DOI: 10.2147/amep.s330771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Daniel R Bacon
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Keri Cowles
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Diwash Thapa
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alexander White
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Austin J Allen
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - John Doughton
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Gary Beck Dallaghan
- Office of Medical Education, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sheryl G Jordan
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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18
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Toledo GC, Schreider A, Camilo GB, Basile Colugnati FA, da Silva Fernandes NM, Bastos MG. Abdominal ultrasound augments the medical students' ability to identify free intraabdominal fluid. ACTA ACUST UNITED AC 2021; 67:195-199. [PMID: 34231766 DOI: 10.1590/1806-9282.67.02.20200507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Free intra-abdominal fluid describes an accumulation of free fluid in the peritoneal cavity. It has different etiologies, but it frequently constitutes a meaningful clinical sign. In this study, the authors interrogate whether abdominal ultrasound augments the medical students' ability to identify free intra-abdominal fluid. METHODS Thirty-one medical students without any previous formal ultrasound training were subjected to cognitive assessment before and after four and a half-hour of theoretical lecture and hands-on course about the diagnosis of free intra-abdominal fluid by physical examination and abdominal ultrasound. The hands-on sessions were done in healthy volunteers with a simulated peritoneal catheter and in patients treated with peritoneal dialysis with different amounts of dialysate in their cavity. RESULTS The cognitive assessment before and after the course increased from 6.7±2.3 to 11.6±1.1 points (p<0.0001). The sensitivity, specificity, and accuracy in the diagnosis of free intra-abdominal fluid were higher when students used abdominal ultrasound. The students agree with the inclusion of abdominal ultrasound in the diagnose of free intra-abdominal fluid in the undergraduate curriculum. CONCLUSIONS This study demonstrates that incorporating abdominal ultrasound is feasible and improves medical students' short-time competency in performing and interpreting the findings diagnostic of free intra-abdominal fluid.
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Affiliation(s)
- Gabriela Cumani Toledo
- Universidade Federal de Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Programa de Pós-graduação em Saúde - Juiz de Fora (MG), Brasil
| | - Alyne Schreider
- Universidade Federal de Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Programa de Pós-graduação em Saúde - Juiz de Fora (MG), Brasil
| | - Gustavo Bittencourt Camilo
- Universidade Federal de Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Programa de Pós-graduação em Saúde - Juiz de Fora (MG), Brasil
| | - Fernando Antonio Basile Colugnati
- Universidade Federal de Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Programa de Pós-graduação em Saúde - Juiz de Fora (MG), Brasil
| | - Natalia Maria da Silva Fernandes
- Universidade Federal de Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Programa de Pós-graduação em Saúde - Juiz de Fora (MG), Brasil
| | - Marcus Gomes Bastos
- Universidade Federal de Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Programa de Pós-graduação em Saúde - Juiz de Fora (MG), Brasil.,Centro Universitário Governador Ozanam Coelho, Faculdade de Medicina - Ubá (MG), Brasil.,Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia - Juiz de Fora (MG), Brasil
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Sena A, Alerhand S, Lamba S. Milestone Approach to Designing a Point-of-Care Ultrasound Curriculum for Transition-to-Residency Programs in the United States. TEACHING AND LEARNING IN MEDICINE 2021; 33:270-281. [PMID: 33085534 DOI: 10.1080/10401334.2020.1814296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Point-of-care ultrasound is fast becoming standard clinical bedside practice for diverse specialties. Medical schools are responding by adding ultrasound education, though the majority use it to supplement the learning of basic sciences. Point-of-care ultrasound practice-based clinical skills education is rare. There also is a lack of standardization across curricula, leading to much variability in the ultrasound skills that medical students from different schools bring to residency. To best inform a point-of-care ultrasound curriculum for our Transition-to Residency program, we investigated literature on 1) how medical students are being prepared for use of point-of-care ultrasound in clinical practice, 2) what skills are being taught, 3) what point-of-care ultrasound skills residency programs expect from incoming residents. Approach: We reviewed literature to identify curricula in U.S. medical schools that teach the concepts, knowledge, and skills related to point-of-care ultrasound. We also mapped point-of-care ultrasound expectations set forth by the Entrustable Professional Activities for undergraduate medical education to the specialty-specific milestones identified by the Accreditation Council for Graduate Medical Education. Additionally, we reviewed specialty-specific professional organizations for position statements and guidelines describing the point-of-care ultrasound skills expected for practicing physicians in their respective specialties. The goal was to identify any needs and gaps in education regarding point-of-care ultrasound across the undergraduate to graduate medical education continuum to practice. Findings: We found seven published point-of-care ultrasound curricula for medical students. There was wide variability in these curricula regarding what point-of-care ultrasound content is being taught, as well as when and how this skill is taught. No Entrustable Professional Activity listed point-of-care ultrasound as a skill requirement for graduating medical students. For graduate medical education, there was wide variability across specialties in residency milestones related to point-of-care ultrasound; some (e.g., emergency medicine) listed extensive milestones while others (e.g., internal medicine) listed none. However, we found that many specialty-specific professional organizations do list detailed point-of-care ultrasound expectations for their practicing physicians. Insights: As point-of-care ultrasound is fast becoming common practice across many specialties, standardization of education and related competencies-similar to other clinical skills training-is necessary across medical schools. Mapping point-of-care ultrasound expectations to current teaching across the continuum from undergraduate to graduate medical education may allow schools to tailor point-of-care ultrasound training for Transition-to-Residency programs. We provide a sample pilot point-of-care ultrasound curriculum that we designed for our Transition-to-Residency course.
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Affiliation(s)
- Ariel Sena
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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20
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Lum M, Sheehy L, Lai J, Tillman D, Damewood S, Schmidt J. Integration of Lung Point-of-care Ultrasound into Clinical Decision Making for Medical Students in Simulated Cases. West J Emerg Med 2020; 22:124-129. [PMID: 33439818 PMCID: PMC7806326 DOI: 10.5811/westjem.2020.12.48717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) has an emerging presence in medical student education; however, there is limited evidence that this translates into appropriate clinical care. We aimed to evaluate the ability of medical students to integrate newly obtained POCUS knowledge into simulated clinical cases. Methods We conducted an observational study of medical students participating in a mandatory rotation during their clinical years. Students in small groups underwent formalized lung POCUS lectures and hands-on training. Students participated in simulated “dyspnea” cases focused on either congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). They were observed for critical actions including elements related to medical decision-making and ultrasound use and interpretation. Ultrasound-specific written knowledge was gauged with a short assessment after the first lecture and at week 4. Results A total of 62 students participated and were observed during simulations. All groups correctly identified and treated CHF in the simulated case. Most groups (7 out of 9) attempted to use ultrasound in the CHF case; five groups correctly recognized B-lines; and four groups correctly interpreted B-lines as pulmonary edema. No groups used ultrasound in the COPD case. Conclusion Most students attempted to use ultrasound during simulated CHF cases after a brief didactic intervention; however, many students struggled with clinical application. Interestingly, no students recognized the need to apply ultrasound for diagnosis and management of COPD. Future studies are needed to better understand how to optimize teaching for medical students to improve translation into POCUS skills and improved clinical practice.
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Affiliation(s)
- Michelle Lum
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Lauren Sheehy
- Tucson Medical Center, Department of Emergency Medicine, Tucson, Arizona
| | - Jason Lai
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - David Tillman
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Sara Damewood
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
| | - Jessica Schmidt
- University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin
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21
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Gel Rounds: Integrating Bedside Ultrasound Training for Third-Year Medical Students Into the Internal Medicine Clerkship. Ultrasound Q 2020; 36:333-338. [PMID: 33136932 DOI: 10.1097/ruq.0000000000000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite formal ultrasound training becoming prevalent in preclinical medical student education, significant barriers remain to the continuation of this training during clinical years. We sought to develop a program for third-year medical students to continue ultrasound training after an already robust preclinical ultrasound curriculum and evaluate their scanning confidence after participation. We developed a program to facilitate bedside ultrasound scanning of patients being cared for by third-year students. Students identified appropriate patients to be scanned, obtained consent for scanning, and determined which scans were most appropriate given the patient's clinical problems. Trained facilitators met with students at the bedside in 1-hour sessions called Gel Rounds to observe and direct the students' scans of their patients. Fifty-one students were surveyed after completing Gel Rounds. Students were significantly more likely to feel comfortable with independently acquiring and interpreting images after Gel Rounds than before completing the activity. Approximately 67% of students felt that ultrasound had utility in assisting bedside clinical reasoning, and this proportion did not change significantly after completing Gel Rounds. Gel Rounds was a positive continuation of the ultrasound curriculum into the third-year clerkship environment. A minority of students reported prior ultrasound exposure in their third year, reflecting difficulty with developing a longitudinal curriculum. The activity helped students to independently acquire and interpret images in patients. Because Gel Rounds can be performed at the discretion of students and faculty, it fits naturally in a variety of existing longitudinal curricula.
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22
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Nausheen F, Young C, Brazil J, Dunagan T, Bhupathy R, Elango S, Crowley J. Confidence Level and Ability of Medical Students to Identify Abdominal Structures After Integrated Ultrasound Sessions. Ultrasound Int Open 2020; 6:E7-E13. [PMID: 32728657 PMCID: PMC7383059 DOI: 10.1055/a-1199-1578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/10/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose Determine the confidence level and ability of first year medical
students to identify abdominal structures using a wireless portable ultrasound
scanner. Methods The students were assessed for their confidence and ability to
perform abdominal ultrasound. The 5-point Likert survey included questions on
their perception about ultrasound as a resource for learning anatomy, physical
examination skills, and the quality of the pre-session instructions. Data was
also recorded by the faculty about the students’ ultrasound skills and
confidence. Goodman and Kruskal's gamma was used to demonstrate an
association between the students’ ability to identify the structures and
the self-reported student confidence level. Results Most of the students had confidence and were able to identify the
liver, kidney, and urinary bladder, while almost half of them needed faculty
help them to identify the inferior vena cava and aorta. The spleen and gall
bladder were the most difficult to locate even for the very confident students.
The perception of supervising faculty was that the confidence level was low in
most of the students and only 13–20% of students felt
“very confident” about performing ultrasound. Almost 37%
needed encouragement and support and almost 10% of the students were not
willing to try to locate difficult organs. Some students started locating the
ureteric jet and portal vein. Most of the students agreed that ultrasound is an
excellent resource for learning anatomy and physical examination skills. All
students suggested having more ultrasound sessions. Conclusion Most of the students feel confident about performing
ultrasound and they perceive that ultrasound can enhance their basic sciences
and physical examination skills.
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Affiliation(s)
- Fauzia Nausheen
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Corey Young
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - John Brazil
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Timothy Dunagan
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Renu Bhupathy
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Sambandam Elango
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Jason Crowley
- Medical Education, California University of Science and Medicine, San Bernardino, United States
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23
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Ma IWY, Steinmetz P, Weerdenburg K, Woo MY, Olszynski P, Heslop CL, Miller S, Sheppard G, Daniels V, Desy J, Valois M, Devine L, Curtis H, Romano MJ, Martel P, Jelic T, Topping C, Thompson D, Power B, Profetto J, Tonseth P. The Canadian Medical Student Ultrasound Curriculum: A Statement From the Canadian Ultrasound Consensus for Undergraduate Medical Education Group. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1279-1287. [PMID: 31943311 PMCID: PMC7317450 DOI: 10.1002/jum.15218] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study sought to establish by expert review a consensus-based, focused ultrasound curriculum, consisting of a foundational set of focused ultrasound skills that all Canadian medical students would be expected to attain at the end of the medical school program. METHODS An expert panel of 21 point-of-care ultrasound and educational leaders representing 15 of 17 (88%) Canadian medical schools was formed and participated in a modified Delphi consensus method. Experts anonymously rated 195 curricular elements on their appropriateness to include in a medical school curriculum using a 5-point Likert scale. The group defined consensus as 70% or more experts agreeing to include or exclude an element. We determined a priori that no more than 3 rounds of voting would be performed. RESULTS Of the 195 curricular elements considered in the first round of voting, the group reached consensus to include 78 and exclude 24. In the second round, consensus was reached to include 4 and exclude 63 elements. In our final round, with 1 additional item added to the survey, the group reached consensus to include an additional 3 and exclude 8 elements. A total of 85 curricular elements reached consensus to be included, with 95 to be excluded. Sixteen elements did not reach consensus to be included or excluded. CONCLUSIONS By expert opinion-based consensus, the Canadian Ultrasound Consensus for Undergraduate Medical Education Group recommends that 85 curricular elements be considered for inclusion for teaching in the Canadian medical school focused ultrasound curricula.
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Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Peter Steinmetz
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Kirstin Weerdenburg
- Department of Pediatric Emergency MedicineIWK Health Center and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Michael Y. Woo
- Department of Emergency MedicineUniversity of Ottawa and Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Paul Olszynski
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Claire L. Heslop
- Division of Emergency Medicine, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Stephen Miller
- Department of Emergency Medicine, Skilled Clinician Program, Undergraduate Medical EducationDalhousie UniversityHalifaxNova ScotiaCanada
| | - Gillian Sheppard
- Department of Emergency MedicineMemorial University of NewfoundlandSt John'sNewfoundlandCanada
| | - Vijay Daniels
- Division of General Internal MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Janeve Desy
- Division of General Internal MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Maxime Valois
- Department of Emergency MedicineMcGill UniversityMontrealQuebecCanada
- Department of Emergency MedicineSherbrooke UniversitySherbrookeQuebecCanada
| | - Luke Devine
- Division of General Internal MedicineUniversity of TorontoTorontoOntarioCanada
| | - Heather Curtis
- Department of Diagnostic ImagingDalhousie UniversityHalifaxNova ScotiaCanada
| | - Michael J. Romano
- Division of Emergency Medicine, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Patrick Martel
- Department of Emergency Medicine, Thunder Bay Regional Health Sciences CenterNorth Ontario School of MedicineThunder BayOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Claude Topping
- Departments of Family Medicine and Emergency MedicineLaval University, QuebecQuebecCanada
| | - Drew Thompson
- Department of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Barbara Power
- Department of Medicine, EducationUniversity of OttawaOttawaOntarioCanada
| | - Jason Profetto
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Pete Tonseth
- Department of RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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24
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Prosch H, Radzina M, Dietrich CF, Nielsen MB, Baumann S, Ewertsen C, Jenssen C, Kabaalioğlu A, Kosiak W, Kratzer W, Lim A, Popescu A, Mitkov V, Schiavone C, Wohlin M, Wüstner M, Cantisani V. Ultrasound Curricula of Student Education in Europe: Summary of the Experience. Ultrasound Int Open 2020; 6:E25-E33. [PMID: 32885138 PMCID: PMC7458842 DOI: 10.1055/a-1183-3009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Despite the increasing role of ultrasound, structured ultrasound teaching is only slowly being integrated into the curricula of medical schools and universities all over Europe. Aim To survey the current situation at European universities regarding the integration of ultrasound in student medical education and to report on models of student ultrasound training from selected European universities. Methods A questionnaire survey focusing on the implementation of curricular ultrasound education was sent out to the 28 presidents of the national ultrasound societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the questionnaires to the medical universities of their countries. Results Overall, 53 questionnaires were returned from 46 universities in 17 European countries. In most of the universities (40/46 universities, 87%), the theoretical background of ultrasound is taught. However, in only a minority of universities is ultrasound integrated in anatomy courses (8/46 universities, 17%) or basic science courses (16/46 universities, 35%). Practical skills in ultrasound are taught in 56% of the universities (26/46 universities) and tested in a practical exam in seven of the responding universities (15%). The number of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The respondents reported that lack of time and limited faculty funding were major hurdles. Conclusion According to our survey, only a minority of European universities has integrated ultrasound into the preclinical curriculum thus far. Future EFSUMB initiatives will continue to promote the introduction of ultrasound as an integrative part of the core curriculum of student medical education, and the preparation of proper teaching material.
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Affiliation(s)
- Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical
University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Maija Radzina
- Riga Stradins University, Radiology department, Riga,
Latvia
- University of Latvia, Medical Faculty, Paula Stradina clinical
university hospital, Diagnostic Radiology Institute Riga, Latvia
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site,
Salem und Permanence, Bern, Switzerland
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen,
Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen,
Denmark
| | - Sven Baumann
- Department of Internal Medicine I, Ulm University Hospital, Ulm,
Germany
| | | | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland,
Strausberg, and Brandenburg Institute for Clinical Ultrasound, Neuruppin,
Germany
| | | | - Wojciech Kosiak
- Department of Paediatrics, Haematology and Oncology, Medical University
of Gdansk, Poland
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Ulm,
Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare Trust,
UK
| | - Alina Popescu
- Department of Gastroenterology, "Victor Babeș"
University of Medicine and Pharmacy Timișoara, Timișoara, Romania
| | - Vladimir Mitkov
- Diagnostic Ultrasound Department, Russian Medical Academy of Continuous
Professional Education, Moscow, Russian Federation)
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of
Aging, „G. d’Annunzio“ University, Chieti,
Italy
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala Universitet, Uppsala,
Sweden
| | - Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen
Brüder Trier, Germany
| | - Vito Cantisani
- Department of Radiological, Oncologic and Anatomo-pathologic Sciences,
University of Rome La Sapienza, Roma, Italy
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25
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Torralba KD, Cannella AC, Kissin EY, Bolster MB, Salto LM, Higgs J, Samuels J, Nishio MJ, Kaeley GS, Evangelisto A, De Marco P, Kohler MJ. Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs. Arthritis Care Res (Hoboken) 2020; 72:859-870. [PMID: 28777891 DOI: 10.1002/acr.23336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasound (MSUS) in rheumatology in the US has advanced by way of promotion of certifications and standards of use and inclusion of core fellowship curriculum. In order to inform endeavors for curricular integration, the objectives of the present study were to assess current program needs for curricular incorporation and the teaching methods that are being employed. METHODS A needs-assessment survey (S1) was sent to 113 rheumatology fellowship program directors. For programs that taught MSUS, a curriculum survey (S2) was sent to lead faculty. Programs were stratified according to program size and use of a formal written curriculum. RESULTS S1 (108 of 113 respondents; response rate 96%) revealed that 94% of programs taught MSUS, with 41% having a curriculum. Curricular implementation was unaffected by program size. Formal curricular adoption of MSUS was favored by 103 directors (95.3%), with 65.7% preferring such adoption to be optional. S2 (74 of 101 respondents; response rate 73%) showed that 41% of programs utilized a formal curriculum. Multiple teaching strategies were used, with content that was generally similar. Use of external courses, including the Ultrasound School of North American Rheumatologists course, was prevalent. Fewer barriers were noted compared to past surveys, but inadequate time, funding, and number of trained faculty still remained. Lack of divisional interest (P = 0.046) and interest of fellows (P = 0.012) were noted among programs without a formal curriculum. CONCLUSION MSUS is taught by a significantly larger number of rheumatology fellowship programs today. Multiple teaching strategies are used with common content, and barriers still remain for some programs. Most program directors favor inclusion of a standardized MSUS curriculum, with many favoring inclusion to be optional.
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Affiliation(s)
| | | | | | - Marcy B Bolster
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jay Higgs
- San Antonio Uniformed Services, San Antonio, Texas
| | | | | | | | - Amy Evangelisto
- Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey
| | - Paul De Marco
- Georgetown University School of Medicine, Washington, DC
| | - Minna J Kohler
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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26
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Linehan V, Ramlackhansingh J, Hartery A, Gullipalli R. The Use of a Student Radiology Interest Group to Promote Ultrasound Education-A Single Center Experience. Acad Radiol 2020; 27:724-736. [PMID: 31492525 DOI: 10.1016/j.acra.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
RATIONAL AND OBJECTIVES Despite the increasing use of point of care ultrasound (POCUS) across many specialities, ultrasound training in Canadian medical schools is limited. At our center, the student Radiology Interest Group (RIG) has addressed this learning need by hosting an annual workshop for diagnostic ultrasound to improve student competency in POCUS. MATERIALS AND METHODS The Ultrasound Workshop is a voluntary event offered to second-year medical students by the RIG. Feedback from each session is collected to continually improve the workshop and inform on teaching strategies. This year, we also provided an online survey to all second-year medical students that compared the competency and confidence of students who did or did not attend the workshop. RESULTS Student feedback from the Ultrasound Workshop was extremely positive. Students believed it was a valuable training experience and should be incorporated into the curriculum. The Ultrasound Workshop increased student's basic understanding of ultrasound but did not affect their confidence in using POCUS compared to students who did not attend. Finally, results from the online survey demonstrated that students believe learning POCUS is necessary for their future career, but there is not enough training in the current curriculum. CONCLUSION The Ultrasound Workshop is a useful training exercise to increase student understanding of ultrasound, but more training may be required to increase student confidence and competency. Overall, extracurricular Ultrasound Workshops coordinated by student-led RIGs can serve as successful adjuncts to the curriculum.
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Affiliation(s)
- V Linehan
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, Newfoundland A1B 3V6, Canada.
| | - J Ramlackhansingh
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, Newfoundland A1B 3V6, Canada
| | - A Hartery
- Discipline of Radiology, St. Clare's Mercy Hospital, Newfoundland, Canada
| | - R Gullipalli
- Discipline of Radiology, St. Clare's Mercy Hospital, Newfoundland, Canada
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27
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Oteri V, Occhipinti F, Gribaudo G, Marastoni F, Chisari E. Integration of ultrasound in medical School: Effects on Physical Examination Skills of Undergraduates. MEDICAL SCIENCE EDUCATOR 2020; 30:417-427. [PMID: 34457685 PMCID: PMC8368431 DOI: 10.1007/s40670-020-00921-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Ultrasound (US) imaging has rapidly increased its application in almost every medical field. Many universities worldwide provide teaching of US for undergraduates in their curricula. Emerging evidence is supporting the use of ultrasonography to improve also non-US skills and knowledge of medical students. OBJECTIVES The purpose of this review is to understand if the integration of US lessons into medical students' curriculum improves their learning of physical examination and enhances their skills when performing it. METHODS We performed a systematic review of literature by searching three electronic medical databases. We included studies of any level of evidence published in peer-reviewed journals. Evaluated data were extracted using the PICO framework and critically analyzed. PRISMA guidelines were applied; we excluded all the articles evaluated with serious risk of bias and/or low methodological quality. RESULTS We included 15 articles, accounting for more than 1643 medical students involved from five different countries and 14 various academical institutions. Eight out of nine studies (88.9%) reported an improvement of practical physical examination scores by students exposed to ultrasound lectures. Eleven out of eleven studies (100%), which administered self-assessment questionnaires, reported strong agreement among students that ultrasound lectures helped them learning and understanding the physical exam and improved their confidence and skills. CONCLUSIONS Increasing evidence shows that incorporating ultrasound in medical students' curriculum might improve their ability and confidence when learning and performing a physical exam. This significant tendency needs to be corroborated at a deeper level by further studies.
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Affiliation(s)
- Vittorio Oteri
- Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy
| | | | | | | | - Emanuele Chisari
- Department of General Surgery and Medical Specialties, University of Catania, Catania, Italy
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28
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Loder CM, Minadeo L, Jimenez L, Luna Z, Ross L, Rosenbloom N, Stalburg CM, Harris LH. Bridging the Expertise of Advocates and Academics to Identify Reproductive Justice Learning Outcomes. TEACHING AND LEARNING IN MEDICINE 2020; 32:11-22. [PMID: 31293184 DOI: 10.1080/10401334.2019.1631168] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Reproductive justice (RJ) is defined by women of color advocates as the right to have children, not have children and parent children while maintaining reproductive autonomy. In the United States, physicians have been complicit in multiple historical reproductive injustices, involving coercive sterilization of thousands of people of color, low income, and disabilities. Currently, reproductive injustices continue to occur; however, physicians have no formal RJ medical education to address injustices. The objective of this study was to engage leading advocates within the movement using a Delphi method to identify critical components for such a curriculum. Approach: In 2016, we invited 65 RJ advocates and leaders to participate in an expert panel to design RJ medical education. A 3-round Delphi survey was distributed electronically to identify content for inclusion in an RJ curriculum. In the next 2 survey rounds, experts offered feedback and revisions and rated agreement with including content recommendations in the final curriculum. We calculated descriptive statistics to analyze quantitative data. A team with educational expertise wrote learning outcomes based on expert content recommendations. Findings: Of the 65 RJ advocates and leaders invited, 41 participated on the expert panel of the Delphi survey. In the first survey, the expert panel recommended 58 RJ content areas through open-ended response. Over the next 2 rounds, there was consensus among the panel to include 52 of 58 of these areas in the curriculum. Recommended content fell into 11 broad domains: access, disparities, and structural competency; advocacy; approaches to reproductive healthcare; contemporary law and policy; cultural safety; historical injustices; lesbian, gay, bisexual, transgender, queer/questioning, and intersex health; oppression, power, and bias training; patient care; reproductive health; and RJ definitions. The 97 learning outcomes created from this process represented both unique and existing educational elements. Insights: A collaborative methodology infused with RJ values can bridge experts in advocacy and academics. New learning outcomes identified through this process can enhance medical education; however, it is just as important to consider education in RJ approaches to care as it is knowledge about that care. We must explore the pedagogic process of RJ medical education while considering that expertise in this area may exist outside of the medical community and thus there is a need to partner with RJ advocates. Finally, we expect to use innovative teaching methods to transform medical education and achieve an RJ focus.
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Affiliation(s)
- Charisse M Loder
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Leah Minadeo
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Laura Jimenez
- California Latinas for Reproductive Justice, Los Angeles, California, USA
| | - Zakiya Luna
- Department of Sociology, University of California, Santa Barbara, Santa Barbara, California, USA
| | - Loretta Ross
- Women's Studies, Hampshire College, Amherst, Massachusetts, USA
| | - Nancy Rosenbloom
- Legal Advocacy, National Advocates for Pregnant Women, New York, New York, USA
| | - Caren M Stalburg
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lisa H Harris
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Cevik AA, Cakal ED, Abu-Zidan F. Point-of-care Ultrasound Training During an Emergency Medicine Clerkship: A Prospective Study. Cureus 2019; 11:e6118. [PMID: 31723483 PMCID: PMC6844539 DOI: 10.7759/cureus.6118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim This study evaluated the effects of three-hour instructor-led training courses in the Extended Focused Assessment Sonography for Trauma (EFAST) and Rapid Ultrasound in Shock and Hypotension (RUSH) protocols on knowledge gain and retention by final-year medical students. Methods This prospective study evaluated 79 final year medical students participating in an emergency medicine (EM) clerkship during the 2017-2018 academic year. None of the included students had prior formal ultrasound training or hands-on experience. All students participated in three-hour training courses on the EFAST and RUSH protocols, with training on each protocol involving one hour of didactic training and two hours of practical training. Knowledge improvement was measured by testing before and after each course, and knowledge retention was evaluated on a final clerkship multiple choice question (MCQ) examination. Results Median scores were significantly higher after rather than before both the EFAST (15; range, 12-19 vs. 7; range, 2-18; p < 0.0001) and RUSH (16; range, 6-20 vs. 6; range, 1-13; p < 0.0001) courses. EFAST knowledge was significantly higher than RUSH knowledge before (p = 0.04) but not after (p = 0.82) taking the respective course. The RUSH score was significantly lower than the EFAST score on the final clerkship MCQ examination (p < 0.0001). Conclusions Three hours of instructor-led ultrasound training given during an EM clerkship significantly increased knowledge of both the EFAST and RUSH protocols. Knowledge retention after two weeks was higher for the EFAST than the RUSH protocol. A longer period of RUSH training may improve the retention of knowledge.
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Affiliation(s)
- Arif Alper Cevik
- Internal Medicine, Emergency Medicine Section, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, ARE
| | - Elif Dilek Cakal
- Emergency Medicine, Mersin City Education and Research Hospital, Mersin, TUR
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Hendriksz T, Markman Z, Pera A. An Education in Osteopathic Ultrasonography (AEIOU) Program: One Institution's Approach to Advancing an Ultrasonography Curriculum. J Osteopath Med 2019; 118:746-752. [PMID: 30398572 DOI: 10.7556/jaoa.2018.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Advances in ultrasonography (US) have allowed this technology to play an increasingly important role in numerous fields of medicine. It is important that medical schools incorporate this broadly applicable tool into their curricula. Touro University College of Osteopathic Medicine-CA has implemented a progressive US curriculum that is intended to complement osteopathic education, keep pace with medical advances, and arm future physicians with the most advanced skills and tools to practice medicine. In this article, the authors highlight the importance of US training in medical education and demonstrate the relative ease, cost-effectiveness, and direct benefit to students of implementing such a curriculum. The authors discuss the specifics of the US curriculum in osteopathic undergraduate medical education and describe how a staged rollout helped the college address the need for funding, faculty, and facilities. Plans for continued expansion, the successful and effective use of peer educators, the outcomes measured from this project, and avenues for further study are also discussed.
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Royer DF. Seeing with Sound: How Ultrasound Is Changing the Way We Look at Anatomy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1138:47-56. [PMID: 31313257 DOI: 10.1007/978-3-030-14227-8_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ultrasound uses high frequency sound waves and their rebounding echoes to capture live images of the structures beneath the skin. Thanks to recent technological advances, contemporary ultrasound machines offer excellent image resolution packaged in smaller, highly portable devices, which has allowed ultrasound to expand into new areas, both within the hospital as well as across non-traditional settings. Ultrasound is an incredibly powerful visualization tool in medicine, allowing physicians to safely see and interrogate the most relevant parts of their patient's internal anatomy instantly. Point-of-care ultrasound, a focused ultrasound evaluation performed at the patient's bedside, is now common across medical specialties, encompassing a vast array of diagnostic, procedural and screening applications. The impressive expansion of point-of-care ultrasound has resulted in an increased demand for ultrasound training earlier during medical school. As a non-invasive and non-destructive way to see inside the living body, ultrasound is an ideal tool to teach anatomy. It allows both medical and non-medical students the ability to improve their understanding and retention of anatomical form and function. The widespread and still expanding use of ultrasound in healthcare today, as well as its adoption into the anatomy classroom, is a testament to the power of ultrasound for achieving real-time visualization of the hidden aspects of our bodies.
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Affiliation(s)
- Danielle F Royer
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, USA.
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Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, Edvardsen T, Galderisi M, Sicari R, Donal E, Stefanidis A, Delgado V, Zamorano J, Popescu BA. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
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Affiliation(s)
- Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal.,Faculdade Ciências Médicas da Universidade nova de Lisboa, Campo Mártires da Pátria 130, Lisbon, Portugal
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Alexsandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, VIa S. Pansini 5, Napples, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, Pisa, Italy
| | - Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jose Zamorano
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9, 100, Madrid, Spain.,CIBERV, Madrid, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Institute of cardiovascular diseases "Prof. Dr. C C Iliescu, Bucharest, Romania
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Kingwill A, Barker G, Wong A. Point-of-care ultrasound: its growing application in hospital medicine. Br J Hosp Med (Lond) 2019; 78:492-496. [PMID: 28898139 DOI: 10.12968/hmed.2017.78.9.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Point-of-care ultrasound is emerging as an important adjunct to the clinical examination. Ultrasonography has long been seen as a modality for experts but this is changing and it is hoped that, with appropriate training, point-of-care ultrasound will become a modern-day diagnostic necessity.
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Affiliation(s)
- Aidan Kingwill
- Senior Clinical Fellow in Adult Intensive Care, Oxford Critical Care Ultrasound Learning and Research, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX2 9DU
| | - Graham Barker
- Consultant Intensivist and Anaesthetist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Adrian Wong
- Consultant Intensivist and Anaesthetist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
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Abstract
PURPOSE Over the past 10 years, successful ultrasound integration into medical education has resulted in 8 residencies and 52 undergraduate medical schools requiring ultrasound training for graduation. Physician assistants (PAs) are trained in the medical model, yet very little is known about the integration of ultrasound into their curricula. This study examined how ultrasound is used, if at all, in the PA education curricula. METHODS Physician assistant program directors (PDs) were sent a survey addressing ultrasound integration into their curricula. Questions focused on the use of ultrasound to teach didactic courses and on inclusion of point-of-care ultrasound (POCUS) scanning skills as an adjunct to the physical examination. The survey also asked about students' feelings toward ultrasound integration into the curricula. RESULTS Investigators contacted 201 PDs, and 107 (53.2%) PDs responded. Twenty-five of the respondents (23.4%) reported using ultrasound in the basic sciences. The top 3 reasons for not including ultrasound in preclinical courses were no ultrasound machine, expense, and no faculty trained in ultrasound. Seventy-three of the respondents (68.2%) thought that POCUS scanning skills should be included in the curriculum. More than 83% felt that faculty or adjunct faculty should teach those skills. CONCLUSION This survey demonstrated that there is great interest in integrating ultrasound into the PA curriculum but that many challenges inhibit implementation. Lack of access to ultrasound machines and to trained faculty are the biggest challenges to integrating ultrasound into the PA curriculum. Physician assistant programs face content and competency challenges similar to those that medical schools face, as well as several challenges that are unique to PA education. Future research is needed to address these issues.
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Schaefer AF, Wilson AB, Barger JB, Azim HM, Brokaw JJ, Brooks WS. What Does a Modern Anatomist Look like? Current Trends in the Training of Anatomy Educators. ANATOMICAL SCIENCES EDUCATION 2019; 12:225-235. [PMID: 30211985 DOI: 10.1002/ase.1806] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/05/2018] [Accepted: 05/06/2018] [Indexed: 06/08/2023]
Abstract
Anatomical sciences are foundational to the health professions, yet little is known about the qualifications of anatomy educators at the graduate and professional level in the United States. Moreover, there is concern that the number of qualified anatomy educators being trained may be insufficient to meet the growing demand posed by new and expanded programs in medicine and allied health specialties. The authors surveyed anatomists from across the country to (i) characterize the educational credentials of current anatomy educators and (ii) assess the perceived need for education-focused postdoctoral positions or formal mentorships to prepare anatomists for teaching-intensive faculty positions. To probe the survey responses more deeply, one-on-one interviews were conducted with eight individuals selected to represent a diverse sample of respondents in terms of institution, gender, and academic rank. Results indicate that 30-40% of educators at the graduate level and approximately 60% of those at the undergraduate level lack graduate coursework in histology, embryology, and neuroanatomy. Forty-five percent of respondents had completed a postdoctoral fellowship. Eighty-six percent replied "yes/maybe" to the question of whether an anatomy education postdoctoral fellowship would benefit doctoral graduates. The top 3 reasons for this recommendation were to (i) establish independent educational research, (ii) improve a publication record, and (iii) gain additional teaching experience. Notable weaknesses of education-focused postdoctoral training were related to finances, fear of exploitation, and undervaluing of teaching. Moving forward, postdoctoral fellowships and other forms of postgraduate training may represent a key strategy for training anatomists in the current educational climate. Anat Sci Educ 00: 000-000. © 2018 American Association of Anatomists.
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Affiliation(s)
- Audra F Schaefer
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Evansville, Indiana
| | - Adam B Wilson
- Department of Cell and Molecular Medicine, Rush University, Chicago, Illinois
| | - J Bradley Barger
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama
| | - Homaira M Azim
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - James J Brokaw
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - William S Brooks
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama
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Goodcoff A, Keane D, Bialczak A, Ziner E, Hanna JB. Point-of-Care Ultrasonography Integration in Undergraduate Medical Education: A Student-Driven Approach. THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION 2019; 119:e11-e16. [PMID: 30801119 DOI: 10.7556/jaoa.2019.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The importance of medical ultrasonography (US) is well established, but given an already dense curriculum, integration of US into preclinical training can be difficult. Although there is no clear consensus on the best practice for integrating US into medical school curricula, growing student interest in US training demands investigation of potential solutions. Objective To investigate whether US integration through peer-assisted learning (PAL) and extracurricular activities during preclinical training is perceived to be valuable by student participants. Methods First- and second-year students at the West Virginia School of Osteopathic Medicine (WVSOM) were invited via email to attend 4 monthly PAL extracurricular US sessions on the following point-of-care US topics: (1) basic lung examination to assess pleural sliding, (2) extended focused assessment with sonography for trauma, (3) right upper quadrant biliary examination, and (4) US-guided central venous catheter placement. A brief survey using Likert-style questions inquired about participants' level of agreement with whether the given session was appropriately complex, increased comfort with US, was informative and interactive, and improved confidence in identifying anatomic structures (sessions 2 and 3 only). A final question asked participants whether they would attend more extracurricular US sessions. Results Fifty-eight students (36 unique students) attended the peer-led sessions. Of the 58 students, 50 responded to the survey for a response rate of 86.2%. Responses were overwhelmingly positive. All respondents strongly agreed or agreed that these sessions improved their confidence in identifying anatomic structures using US, and 49 (98%) strongly agreed or agreed that they would attend more US sessions. Conclusion Respondents strongly endorsed the peer-led US sessions, which has facilitated the formal integration of an elective US course at WVSOM. The peer-led sessions introduced at WVSOM could provide the framework and motivation for similar courses at osteopathic medical schools across the country.
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Varsou O. The Use of Ultrasound in Educational Settings: What Should We Consider When Implementing this Technique for Visualisation of Anatomical Structures? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1156:1-11. [DOI: 10.1007/978-3-030-19385-0_1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Pazeli JM, Vieira ALS, Vicentino RS, Pazeli LJ, Lemos BC, Saliba MMR, Mello PA, Costa MD. Point-of-care ultrasound evaluation and puncture simulation of the internal jugular vein by medical students. Crit Ultrasound J 2018; 10:34. [PMID: 30564947 PMCID: PMC6298909 DOI: 10.1186/s13089-018-0115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives To show that medical students can evaluate the internal jugular vein (IJV) and its anatomical variations after rapid and focused training. We also aimed to evaluate the success rate of IJV puncture in simulation following traditional techniques (TTs) and monitored via ultrasound (US). Materials and methods Six medical students without experience with US were given 4 h of theoretical–practical training in US, and then evaluated the IJV and common carotid artery (CCA) of 105 patients. They also simulated a puncture of the IJV at a demarcated point, where a TT was theoretically performed. Results Adequate images were obtained from 95% of the patients; the IJV, on the right side, was more commonly found in the anterolateral position in relation to the CCA (38%). On the left side, the most commonly position observed was the anterior (36%). The caliber of the IJV relative to the CCA greatly varied. The success rate in the IJV puncture simulation, observed with US, by the TTs was 55%. Conclusion The training of medical students to recognize large neck vessels is a simple, quick, and feasible task and that can be integrated into the undergraduate medical curriculum.
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Affiliation(s)
- José Muniz Pazeli
- FAME - Barbacena's School of Medicina, Barbacena, Brazil. .,Federal University of Juiz de Fora, Juiz de Fora, Brazil.
| | - Ana Luisa Silveira Vieira
- FAME - Barbacena's School of Medicina, Barbacena, Brazil.,Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Luisa Jabour Pazeli
- SUPREMA - School of Medical Sciences and Health of Juiz de Fora, Juiz de Fora, Brazil
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Feilchenfeld Z, Kuper A, Whitehead C. Stethoscope of the 21st century: dominant discourses of ultrasound in medical education. MEDICAL EDUCATION 2018; 52:1271-1287. [PMID: 30334276 DOI: 10.1111/medu.13714] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/11/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education. METHODS We conducted a Foucauldian critical discourse analysis (CDA) to identify and analyse discourses that legitimise and privilege the use of POCUS in medical education. We assembled an archive of 473 texts published between 1980 and 2017. Each article in the archive was analysed to identify frequently occurring truth statements (expressing concepts whose truths are unquestioned within particular discourses) that we used to characterise the major discourses that construct representations of POCUS in medical education. RESULTS We identified three dominant discourses: (i) a visuo-centric discourse prioritising the visual information as truth over other clinical data; (ii) a utilitarian discourse emphasising improvements in patient care; and (iii) a modernist discourse highlighting the current and future needs of clinicians in our technological world. These discourses overlap and converge; the core discursive effect makes the further elevation of POCUS in medical education, and the resulting attenuation of other curricular priorities, appear inevitable. CONCLUSIONS The three dominant discourses identified in this paper engender ideal conditions for the proliferation of POCUS in medical education through curricular guidelines, surveys of adherence to these guidelines and authoritative position statements. By identifying and analysing these dominant discourses, we can ask questions that do not take for granted the assumed truths underpinning the discourses, highlight potential pitfalls of proposed curricular changes and ensure these changes truly improve medical education.
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Affiliation(s)
- Zac Feilchenfeld
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- The Wilson Centre, Toronto, ON, Canada
| | - Cynthia Whitehead
- The Wilson Centre, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
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Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 45:271-281. [PMID: 30497768 DOI: 10.1016/j.ultrasmedbio.2018.09.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
The introduction of ultrasound into medical student education is well underway in many locations around the world, but is still in its infancy or has yet to begin in others. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. In this article, we discuss the state of the art of ultrasound in medical education throughout the world, as well as various methodologies utilized to improve student education and to incorporate ultrasound into every facet of training. Experiences from various educational systems and available evidence regarding the impact of ultrasound education are summarized. Representing multiple societies and specialties throughout the world, we discuss established modern as well as novel education structures and different successful approaches.
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Stolz LA, Amini R, Situ-LaCasse E, Acuña J, Irving SC, Friedman L, Fiorello AB, Stea N, Fan H, Adhikari S. Multimodular Ultrasound Orientation: Residents' Confidence and Skill in Performing Point-of-care Ultrasound. Cureus 2018; 10:e3597. [PMID: 30680258 PMCID: PMC6338403 DOI: 10.7759/cureus.3597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R2 = 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications.
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Affiliation(s)
- Lori A Stolz
- Emergency Medicine, University of Cincinnati, Cincinnati, USA
| | - Richard Amini
- Emergency Medicine, University of Arizona, Tucson, USA
| | | | - Josie Acuña
- Emergency Medicine, University of Arizona, Tucson, USA
| | | | - Lucas Friedman
- Emergency Medicine, University of California, Riverside, USA
| | | | - Nicholas Stea
- Emergency Medicine, University of Arizona, Tucson, USA
| | - Heinrich Fan
- Emergency Medicine, University of Arizona, Tucson, USA
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Dietrich CF. [Ultrasound in Student Education]. PRAXIS 2018; 107:1267-1271. [PMID: 30424694 DOI: 10.1024/1661-8157/a003115] [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: 06/09/2023]
Abstract
Ultrasound in Student Education Abstract. The subject 'Ultrasound in Medicine', already introduced during the studies increases the motivation of students by its practical character and combines basic medical knowledge (anatomy, physiology) and imaging with clinical applications in a unique way. This is done on the one hand as a point of care method (POCUS) at the point of decision-making, and on the other hand as a 'radiological' method with intervention options. POCUS is the use of ultrasound by physicians to correctly identify problems and implement solutions at the point of action. Both the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB) have published position papers on the targeted application of ultrasound technology (point of care), the status of which is reported here.
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Tuma J, Schwarzenbach HR. [Not Available]. PRAXIS 2018; 107:1241. [PMID: 30424696 DOI: 10.1024/1661-8157/a003117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
Limited research exists on PAs and use of point-of-care (POC) ultrasound. This pilot survey sought to determine current views on and use of POC ultrasound in a small group of PAs. METHODS The authors developed an anonymous voluntary survey on PA views and use of POC ultrasound. The survey was entered into Qualtrics and e-mailed three times. RESULTS Nearly 27% of the subjects use ultrasound with 62% feeling confident in their ability to use ultrasound. The top reason for not using ultrasound was lack of access to a machine (50%). Only 35.3% of those without access to a machine were interested in bringing ultrasound into their practices. Sixty-seven percent of respondents felt that PAs should have standardized ultrasound training. CONCLUSIONS Results demonstrate that more research is needed into the applicability of POC ultrasound to all PA practice areas as well as how PAs should be trained in POC ultrasound.
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Mladenovic J, O’Brien MC, Hoppman R. Shaping the Future of Point-of-Care-Ultrasound in Medical Education. South Med J 2018; 111:449-451. [DOI: 10.14423/smj.0000000000000832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wakefield RJ, Weerasinghe A, Tung P, Smith L, Pickering J, Msimanga T, Arora M, Flood K, Gupta P, Bickerdike S, McLaughlan J, Uttley A, Wilson J, Evans T, Wolstenhulme S, Roberts TE. The development of a pragmatic, clinically driven ultrasound curriculum in a UK medical school. MEDICAL TEACHER 2018; 40:600-606. [PMID: 29490531 DOI: 10.1080/0142159x.2018.1439579] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Whether ultrasound (US) should be incorporated into a medical undergraduate curriculum remains a matter of debate within the medical education arena. There are clear potential benefits to its early introduction particularly with respect to the study of living anatomy and physiology in addition to the learning of clinical skills and procedures required for the graduate clinical practice. However, this needs to be balanced against what is perceived as an added value in addition to financial and time constraints which may potentially lead to the sacrifice of other aspects of the curriculum. Several medical schools have already reported their experiences of teaching US either as a standalone course or as a fully integrated vertical curriculum. This article describes and discusses the initial experience of a UK medical school that has taken the steps to develop its own pragmatic vertical US curriculum based on clinical endpoints with the intent of using US to enhance the learning experience of students and equipping them with the skills required for the safe practice as a junior doctor.
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Affiliation(s)
- Richard J Wakefield
- a Department of Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds , Leeds , UK
| | - Asoka Weerasinghe
- b Department of Emergency Medicine , Dewsbury and District Hospital, Mid Yorkshire Hospitals NHS Trust , Wakefield , UK
| | - Patrick Tung
- b Department of Emergency Medicine , Dewsbury and District Hospital, Mid Yorkshire Hospitals NHS Trust , Wakefield , UK
| | - Laura Smith
- c Department of Clinical Skills Education, Leeds Institute of Medical Education , University of Leeds , Leeds , UK
| | - James Pickering
- d Division of Anatomy, Leeds Institute of Medical Education , University of Leeds , Leeds , UK
| | - Tendekayi Msimanga
- e Department of Acute and General Medicine , Mid Yorkshire NHS Trust, University of Leeds , Leeds , UK
| | - Mohit Arora
- f Department of Emergency Medicine , Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Karen Flood
- g Department of Vascular Interventional Radiology , Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Pawan Gupta
- h Department of Anaesthesia , Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Suzanne Bickerdike
- i Leeds Institute of Medical Education , University of Leeds , Leeds , UK
| | - James McLaughlan
- j School of Electronic and Electrical Engineering/Leeds Institute of Cancer and Pathology , University of Leeds , Leeds , UK
| | - Ashley Uttley
- k Radiology Department , Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | - Jean Wilson
- l School of Medicine , University of Leeds , Leeds , UK
| | - Tony Evans
- m Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Stephen Wolstenhulme
- k Radiology Department , Leeds Teaching Hospitals NHS Trust , Leeds , UK
- n Faculty of Health Sciences , University of Malta , Msida , Malta
| | - Trudie E Roberts
- i Leeds Institute of Medical Education , University of Leeds , Leeds , UK
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Novaes AKB, Dalamura R, Menon T, Pazeli JM, Bastos MG. Homemade ultrasound phantom for simulation of hydronephrosis. ACTA ACUST UNITED AC 2018; 40:206-208. [PMID: 29738039 PMCID: PMC6533979 DOI: 10.1590/2175-8239-jbn-3916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/24/2017] [Indexed: 02/02/2023]
Abstract
In this article, we describe the development of a simple and inexpensive
simulation phantom as a surrogate of human hydronephrosis for the identification
of urinary tract obstruction at bedside to be used in undergraduate training of
medical students.
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Affiliation(s)
| | - Ramon Dalamura
- Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia, Juiz de Fora, MG, Brasil
| | - Talita Menon
- Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia, Juiz de Fora, MG, Brasil
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Luetmer MT, Cloud BA, Youdas JW, Pawlina W, Lachman N. Simulating the multi-disciplinary care team approach: Enhancing student understanding of anatomy through an ultrasound-anchored interprofessional session. ANATOMICAL SCIENCES EDUCATION 2018; 11:94-99. [PMID: 28914990 DOI: 10.1002/ase.1731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/27/2017] [Accepted: 08/23/2017] [Indexed: 06/07/2023]
Abstract
Quality of healthcare delivery is dependent on collaboration between professional disciplines. Integrating opportunities for interprofessional learning in health science education programs prepares future clinicians to function as effective members of a multi-disciplinary care team. This study aimed to create a modified team-based learning (TBL) environment utilizing ultrasound technology during an interprofessional learning activity to enhance musculoskeletal anatomy knowledge of first year medical (MD) and physical therapy (PT) students. An ultrasound demonstration of structures of the upper limb was incorporated into the gross anatomy courses for first-year MD (n = 53) and PT (n = 28) students. Immediately before the learning experience, all students took an individual readiness assurance test (iRAT) based on clinical concepts regarding the assigned study material. Students observed while a physical medicine and rehabilitation physician demonstrated the use of ultrasound as a diagnostic and procedural tool for the shoulder and elbow. Following the demonstration, students worked within interprofessional teams (n = 14 teams, 5-6 students per team) to review the related anatomy on dissected specimens. At the end of the session, students worked within interprofessional teams to complete a collaborative clinical case-based multiple choice post-test. Team scores were compared to the mean individual score within each team with the Wilcoxon signed-rank test. Students scored higher on the collaborative post-test (95.2 ±10.2%) than on the iRAT (66.1 ± 13.9% for MD students and 76.2 ±14.2% for PT students, P < 0.0001). Results suggest that this interprofessional team activity facilitated an improved understanding and clinical application of anatomy. Anat Sci Educ 11: 94-99. © 2017 American Association of Anatomists.
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Affiliation(s)
- Marianne T Luetmer
- Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Beth A Cloud
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - James W Youdas
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Wojciech Pawlina
- Department of Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
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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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50
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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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