Using Ultrasound to Enhance Medical Students' Femoral Vascular Physical Examination Skills

Physician Assistant Students' Perspective on Ultrasound as an Educational Technology

INTRODUCTION

The use of ultrasound as an educational technology in medical education to teach basic sciences, including anatomy and physical examination techniques, has become common. Multiple studies have demonstrated the benefits of using ultrasound to teach anatomy and physical examination skills; however, this has not been studied in physician assistant (PA) students.

METHODS

This qualitative phenomenological research used 5 semi-structured interviews of first semester PA students to obtain a deeper understanding of students' perspectives. Dominant coding categories were identified through open coding, and thematic analysis was completed to identify emerging themes of participants' perspectives.

RESULTS

Overall, the students positively perceived this use of ultrasound. Four themes emerged regarding PA students' perspectives of ultrasound as an educational technology within their Clinical Anatomy and History and Physical Examination classes: solidifying the curriculum, desiring more, looking ahead, and burden of curriculum.

DISCUSSION

This study supports the use of ultrasound as an educational technology to solidify prior learning; however, steps to ensure student commitment to the technology should be taken. Careful consideration for curricular sequencing and allocation of time should be utilized by programs attempting to integrate ultrasound in this manner. Hands-on experiences, rather than faculty demonstrations, and clinical correlation should be utilized whenever possible.

International consensus conference recommendations on ultrasound education for undergraduate medical students

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.

Medical school curriculum in the digital age: perspectives of clinical educators and teachers

BACKGROUND

There is a need to reexamine Singapore's medical school curricula in light of the increasing digitalization of healthcare. Notwithstanding Singapore's digital competitiveness, there is a perceived gap in preparing its medical students for the digital age. Furthermore, limited research has evaluated the extent to which skills in using digital technologies should be taught to medical students in Asian medical schools to prepare them for future clinical practice- a gap that is filled by this study. Using Singapore as a case study, it explores the views of some local clinical educators and teachers towards the need to impart skills in digital technologies to medical students. It also offers recommendations on ways to balance the clinicians' concerns about these technologies with the digital competencies needed for clinical practice.

METHODS

Findings were drawn from individual interviews with 33 clinical educators and teachers from Singapore's public and private healthcare sectors. They were recruited using purposive sampling. Data were interpreted using qualitative thematic analysis.

RESULTS

Participants included vice deans of education from all three local medical schools and senior consultants from a wide variety of disciplines. Overall, they acknowledged two benefits of equipping students with skills in digital technologies including promoting the culture of innovation and improving work efficiency. However, they also highlighted four main concerns of imparting these skills: (i) erosion of basic clinical skills, (ii) neglect of a generalist approach to healthcare characterized by holistic management of patients, inter-professional collaboration, and commitment to breadth of practice within each specialty, (iii) rapid pace of technological advances, and (iv) de-personalisation by technology.

CONCLUSIONS

The findings show that medical students in Singapore would benefit from a curriculum that teaches them to use digital technologies alongside core clinical skills.

Beyond the Classroom: Inspiring Medical and Health Science Students to Learn Surface Anatomy

This qualitative and quantitative study offered students the opportunity to participate in engaging and inspiring activities "outside the classroom", to extend their experience and knowledge of surface anatomy. Medical and health science students benefit from studying surface anatomy as it is relevant to their future professions that deal with patients and clients. Surface anatomy is an essential part of the learning process that allows students an opportunity to identify anatomical structures on living people and to develop their palpation and tactile skills for physical examinations of patients. Body painting is a student-centred, engaging, and motivating approach to learn surface anatomy in anatomy practical classes. In this study, anatomy learning was extended "beyond the classroom" through extra-curricular body painting projects. These projects were run by student teams consisting of a student model, student artists (4-5), and a student photographer, under the direction of the chief investigator. A total of sixteen body painting projects were carried out from 2010 to show the skeletal system, the muscular system, pregnancy, respiratory and gastrointestinal systems, and the neurovascular systems of the entire body. A SurveyMonkey of 31/41 active participants suggested that participants enjoyed the projects (94-100%), found them relevant to their future profession (80-87%), and considered them to assist with deeper understanding (94%) and long-term memory (93%) of anatomy. Learning anatomy outside the classroom through extra-curricular body painting projects was a successful way to engage, motivate, and inspire participants and first year anatomy students to study surface anatomy and to develop their physical examination skills.

An Integrated Point-of-Care Ultrasound Curriculum: An Evidence-Based Approach

ABSTRACT

Point-of-care ultrasound (POCUS) has been demonstrated to improve students' medical knowledge and clinical exam skills and advances patient care through numerous diagnostic and therapeutic applications. Despite the growing use of ultrasound in medical education and clinical practice, few physician assistant (PA) programs have successfully integrated POCUS education into their curricula. This manuscript describes an evidence-based approach for integrating POCUS education throughout a 2-year PA curriculum, with the goal of serving as a useful guidepost for other PA programs as they strive to incorporate this valuable skill into their curricula.

Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University

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.

Medical Student Ultrasound Education: The Radiology Chair Weighs In

ABSTRACT

To assess the radiology department chairs' opinions concerning current status and plans for teaching ultrasound to medical students, the American College Taskforce on Radiology Ultrasound Education, commissioned by the American College of Radiology, distributed a survey to 142 radiology chairs and a medical school dean subgroup.The response rate was 30% (42/142), and 76% indicated ultrasound was currently part of the medical student curriculum. In preclinical years, radiology involvement was only 6.4%. During clinical years, radiology led ultrasound education with 51.7% in general and 82.9% in elective rotations. Regarding actual content, top 4 results were evenly distributed between learning hands-on scanning (81.1%), diagnostic use of ultrasound (75.7%), anatomy/pathology (75.7%), and ultrasound guidance for procedures (54.0%). Educational leaders in preclinical courses were emergency medicine (72.7%) followed by radiology (45.4%) physicians. During clinical years, leaders were radiology (52.6%) and emergency medicine (47.4%) physicians. Most chairs stated that knowledge of diagnostic ultrasound should be mandatory (76.2%), stressing the importance of teaching the diagnostic capabilities and uses of ultrasound as the primary goal (78.8%). Perceived barriers to implementation were evenly distributed between lack of space in the curriculum (55.6%), lack of faculty (48.2%), lack of resources (44.4%), and lack of institutional support (40.7%). The American College Taskforce on Radiology Ultrasound Education survey shows that radiology's role in ultrasound undergraduate education occurs almost exclusively during clinical years, and the chairs voice a desire to improve upon this role. Barriers include both intradepartmental (faculty and resources) and institutional (curricular) factors.

Integration of ultrasound in medical School: Effects on Physical Examination Skills of Undergraduates

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.

Beyond Bones: Assessing Whether Ultrasound-Aided Instruction and Practice Improve Unassisted Soft Tissue Palpation Skills of First-Year Medical Students

OBJECTIVES

Our purpose was to determine whether ultrasound (US)-aided instruction and practice on musculoskeletal anatomy would improve first-year medical students' ability to locate and identify specific soft tissue structures by unaided palpation in the upper and lower extremities of healthy human models.

METHODS

This study was a randomized crossover design with 49 first-year medical students randomly assigned to 1 of 2 groups. Each group was provided expert instruction and hands-on practice using US to scan and study soft tissue structures. During session 1, group A learned the anatomy of the upper extremities, whereas group B learned the lower. Students were then tested on their proficiency in locating 4 soft tissue structures (2 upper and 2 lower extremities) through palpation of a human model. During session 2, group A learned lower extremities, and group B learned upper. At the end of session 2, students repeated the assessment.

RESULTS

After the first instructional session, neither group performed significantly better on identifying and locating the soft tissue landmarks they learned aided by US. After the second instructional session, however, scores for both groups increased approximately 20 percentage points, indicating that both groups performed significantly better on palpating and identifying both the upper and lower extremity soft tissue landmarks (Cohen d = 0.89 and 0.82, respectively).

CONCLUSIONS

Time and practice viewing soft tissue structures with US assistance seems to have a "palpation-with-eyes" effect that improves students' abilities to correctly locate, palpate, and identify limb-specific soft tissue structures once the US assistance is removed.

The POCUS pulse check: A randomized controlled crossover study comparing pulse detection by palpation versus by point-of-care ultrasound

BACKGROUND

Manual pulse checks (MP) are an unreliable skill even in the hands of healthcare providers (HCPs). In the context of cardiac arrest, this may translate into inappropriate chest compressions when a pulse is present, or conversely omitting chest compressions when one is absent. To date, no study has assessed the use of B-mode ultrasound (US) for the detection of a carotid pulse. The primary objective of this study was to assess the time required to detect a carotid pulse in live subjects using US compared to the traditional palpation method.

METHODS

We conducted a prospective randomized controlled crossover non-inferiority trial. HCPs attended a 15 minute focused US workshop on identification of the carotid pulse. Both pulse check methods were timed for each participant on two different subjects in random order. The primary outcome was time to carotid pulse detection in seconds (s). Secondary outcomes included confidence levels of pulse detection measured on a 100 mm visual analog scale (VAS) and rates of prolonged pulse checks (> 5 s or >10 s). The study was powered to determine whether US pulse checks were not slower than MP by greater than two seconds. The results are presented as the difference in means with a 90% two-sided confidence interval (CI).

RESULTS

111 participants completed the study. Mean pulse detection times were 4.22 s (SD 3.26) by US compared to 4.71 s (SD 6.45) by MP with a mean difference in times of -0.49 s (90% CI: -1.77 to 0.39). There were no significant differences between US and MP in the rates of prolonged pulse checks of greater than 5 s (23% vs 19%, p = 0.45) or 10 s (9% vs 8%, p = 0.81). First attempt at detection of pulse checks was more successful in the US group (99.1% vs 85.6%, p = 0.0001). Prior to training, participants reported higher confidence using MP compared to US; 68 (IQR 48-83) vs 15 (IQR 8-42) mm (p < 0.001). Following the study, participants reported higher confidence levels using US than MP; 91 (IQR 82-97) vs 83 (IQR 72-94) mm (p < 0.001).

CONCLUSIONS

Carotid pulse detection in live subjects was not slower using US as compared to palpation, and demonstrated higher first attempt success rate and less variability in measurement times. A brief teaching session was sufficient to improve confidence of carotid pulse identification even in those with no previous US training. The preliminary results from this study provide the groundwork for larger studies to evaluate this pulse check method for patients in cardiac arrest.

Point-of-Care Ultrasound: Does it Affect Scores on Standardized Assessment Tests Used Within the Preclinical Curriculum?

OBJECTIVES

An increasing number of medical schools are incorporating point-of-care ultrasound (POCUS) into preclinical and clinical curricula. The ultimate effect of this teaching is unclear, and there has been no distinct link between ultrasound (US) learning and existing standardized student assessments. Additionally, neither optimal timing nor methods of POCUS integration have been established. We aimed to demonstrate the effect of US teaching on standardized objective assessments that already exist within the curriculum and, in doing so, discern a route for POCUS curricular integration.

METHODS

A longitudinal POCUS pilot curriculum was started in 2013, with the class of 2017. We collected basic science course results, standardized objective structured clinical examination scores, and United States Medical Licensing Examination step 1 scores from both the pilot group (n = 34) and matched control participants (n = 34) from the classes of 2017 and 2018. Scores between POCUS students and controls were analyzed by Student t tests.

RESULTS

Students participating in the longitudinal POCUS program scored significantly higher on the physical examination portion of their clinical skill objective structured clinical examination assessment than the control group (mean score, 89.2 versus 85.7; P < .05). This parameter was the only area with a statistically significant difference.

CONCLUSIONS

Point-of-care US program implementation may improve students' overall physical examination understanding and performance, even when US performance itself is not being tested. Introducing a POCUS curriculum may work best when designed in conjunction with the physical examination thread of a medical school curriculum.

Tips and tricks for facilitating teaching of Doppler waveforms and ankle-brachial index in undergraduate level: A practical guide

Although the measurement of ankle-brachial index (ABI) is considered a fundamental skill in assessment and diagnosis of peripheral arterial disease and a predictive tool for cardiovascular events, real-world practice shows that the experience of many health professionals is far from ideal. Not only teaching and practice of ABI measurement in undergraduate medical curricula are limited but various mistakes in the process of calculation, estimation, and interpretation of ABI results in the postgraduate practice have also been documented. Because vascular surgery is a core subject in our medical school, we deal with the difficulties and challenges that undergraduate medical students and nurses face to measure and comprehend ABI. We came up with useful tips and maneuvers to overcome these difficulties. Accordingly, this article provides twelve easy-to-follow useful tips to enhance and facilitate the teaching and comprehension of ABI. Moreover, it favors the simultaneous teaching of Doppler arterial waveform examination as a means to facilitate accurate interpretation and validation of ABI results.

Methodological characteristics of randomized controlled trials of ultrasonography in emergency medicine

INTRODUCTION

Interest in ultrasonography in emergency medicine has increased in recent years, as reflected by a marked increase in publications on the topic. The aim of this study was to 1) describe and evaluate methodological characteristics of randomized controlled trials (RCTs) evaluating an ultrasound intervention in emergency department and 2) estimate whether the reports adequately described the intervention to allow replication.

METHODS

We searched MEDLINE via PubMed for RCTs published in 2015 assessing an ultrasound intervention, regardless of type, that were performed in an emergency department or evaluated in an emergency situation. Two researchers independently screened titles, abstracts and full texts. Data from all included studies were independently extracted. The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias of reports, and the intervention reporting was evaluated by using the Template for Intervention Description and Replication checklist.

RESULTS

We identified 11 reports. The most frequent topic was vascular access/identification (n = 4). Random sequence generation and allocation concealment were performed correctly in 55% and 27% trials. Three quarters of reports (73%) showed improper reporting or absence of participant blinding. Risk of bias due to assessor blinding was rated low for 3 RCTs (27%), risk of attrition bias low for all reports, and risk of selective outcome reporting unclear for most reports (n = 10). Only 3 reports (27%) provided an optimal description of the intervention.

CONCLUSION

The quality of these trials raises questions. In our sample, the authors did not correctly report blinding of participants and assessors or allocation concealment.

Stethoscope of the 21st century: dominant discourses of ultrasound in medical education

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.

Ultrasonography in Undergraduate Medical Education: A Systematic Review

OBJECTIVES

The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students.

METHODS

A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full-text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors.

RESULTS

Ninety-five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US-related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non-US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed.

CONCLUSIONS

There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.

Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review

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.

Can Ultrasound Be Used to Improve the Palpation Skills of Physicians in Training? A Prospective Study

BACKGROUND

Accurate diagnosis of musculoskeletal disorders relies heavily on the physical examination, including accurate palpation of musculoskeletal structures. The literature suggests that there has been a deterioration of physical examination skills among medical students and residents, in part due to increased reliance on advanced imaging. It has been shown that knowledge of musculoskeletal anatomy and physical examination skills improve with the use of ultrasound; however, the literature is limited.

OBJECTIVE

To determine whether ultrasound can improve the ability of physicians in training (residents) to palpate the long head of the biceps tendon (LHBT) in the bicipital groove.

DESIGN

Prospective study design.

SETTING

Tertiary care center.

PARTICIPANTS

Ten physical medicine and rehabilitation residents served as subjects. Exclusion criteria included the presence of any condition that precluded their ability to palpate. Three volunteers were used as models. Model exclusion criteria included anything that distorted normal shoulder anatomy or inhibited examiner palpation. Three investigators with experience performing diagnostic musculoskeletal ultrasound were used to confirm palpation attempts.

METHODS

Subjects attempted to palpate the LHBT bilaterally in the bicipital groove of each model. Investigators assessed the accuracy of the palpation attempt using real-time ultrasonography. Subjects participated in a 30-minute ultrasound-assisted training session learning how to palpate the LHBT in the bicipital groove with ultrasound confirmation. After the ultrasound training session, subjects again attempted to palpate the LHBT in the bicipital groove of each model with investigator confirmation.

MAIN OUTCOME MEASUREMENTS

LHBT palpation accuracy rates preintervention versus postintervention.

RESULTS

Pretraining LHBT palpation accuracy was 20% (12/60 attempts). Post-ultrasound training session accuracy was 51.7% (31/60 attempts; P ≤ .001).

CONCLUSIONS

Our findings demonstrate that palpation accuracy improves after ultrasound assisted LHBT palpation training. These data suggest that the use of ultrasound may be beneficial when teaching musculoskeletal palpation skills to health care professionals.

LEVEL OF EVIDENCE

II.

Ultrasound in undergraduate medical education: a systematic and critical review

CONTEXT

The use of point-of-care ultrasound (POCUS) in clinical care is growing rapidly and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically.

OBJECTIVES

We conducted a critical and systematic review framed by the rationales enumerated in academic publications by advocates of ultrasound in UME.

METHODS

This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified from an archive of 403 academic publications using techniques from Foucauldian critical discourse analysis (CDA). We then sought empirical evidence in support of these rationales, using a critical synthesis methodology also adapted from CDA.

RESULTS

We identified four dominant discursive rationales with different levels of evidentiary support. The use of ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve the quality of patient care was difficult to evaluate.

CONCLUSIONS

Our analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimises them and may preclude further primary research. As the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

Acquisition and Long-term Retention of Bedside Ultrasound Skills in First-Year Medical Students

OBJECTIVES

The purpose of this study was to assess bedside ultrasound skill acquisition and retention in medical students after completion of the first year of a new undergraduate bedside ultrasound curriculum at McGill University.

METHODS

Skill acquisition was assessed in first-year medical students (n = 195) on completion of their bedside ultrasound instruction. Instruction included 6 clinically based 60-minute practical teaching sessions evenly spaced throughout the academic year. Students' ability to meet course objectives was measured according to a 4-point Likert rating scale. Evaluations were performed by both instructors and the students themselves. Retention of skill acquisition was evaluated 8 months later on a year-end practical examination.

RESULTS

The mean percentage ± SD of students assigned a rating of "strongly agree" or "agree" by instructors was 98% ± 0.4% for all 6 teaching sessions (strongly agree, 52% ± 3%; agree, 46% ± 3%). According to student self-evaluations, the mean percentage of students assigned a rating of strongly agree was significantly greater than the percentage assigned by instructors for all teaching sessions (86% ± 2% versus 52% ± 3%; P < .0005). Evaluation of skill retention on the year-end examination showed that 91% ± 2% of students were assigned a rating of strongly agree or agree for their ability to demonstrate skills learned 8 months previously. Ninety-five percent of students reported that bedside ultrasound improved their understanding of anatomy for all 6 teaching sessions (mean, 95% ± 0.01%).

CONCLUSIONS

These results demonstrate that first-year medical students show acquisition and long-term retention of basic ultrasound skills on completion of newly implemented bedside ultrasound instruction.