Ultrasound Core Laboratory for the Household Air Pollution Intervention Network Trial: Standardized Training and Image Management for Field Studies Using Portable Ultrasound in Fetal, Lung, and Vascular Evaluations

Ultrasound Core Laboratories (UCL) are used in multicenter trials to assess imaging biomarkers to define robust phenotypes, to reduce imaging variability and to allow blinded independent review with the purpose of optimizing endpoint measurement precision. The Household Air Pollution Intervention Network, a multicountry randomized controlled trial (Guatemala, Peru, India and Rwanda), evaluates the effects of reducing household air pollution on health outcomes. Field studies using portable ultrasound evaluate fetal, lung and vascular imaging endpoints. The objective of this report is to describe administrative methods and training of a centralized clinical research UCL. A comprehensive administrative protocol and training curriculum included standard operating procedures, didactics, practical scanning and written/practical assessments of general ultrasound principles and specific imaging protocols. After initial online training, 18 sonographers (three or four per country and five from the UCL) participated in a 2 wk on-site training program. Written and practical testing evaluated ultrasound topic knowledge and scanning skills, and surveys evaluated the overall course. The UCL developed comprehensive standard operating procedures for image acquisition with a portable ultrasound system, digital image upload to cloud-based storage, off-line analysis and quality control. Pre- and post-training tests showed significant improvements (fetal ultrasound: 71% ± 13% vs. 93% ± 7%, p < 0.0001; vascular lung ultrasound: 60% ± 8% vs. 84% ± 10%, p < 0.0001). Qualitative and quantitative feedback showed high satisfaction with training (mean, 4.9 ± 0.1; scale: 1 = worst, 5 = best). The UCL oversees all stages: training, standardization, performance monitoring, image quality control and consistency of measurements. Sonographers who failed to meet minimum allowable performance were identified for retraining. In conclusion, a UCL was established to ensure accurate and reproducible ultrasound measurements in clinical research. Standardized operating procedures and training are aimed at reducing variability and enhancing measurement precision from study sites, representing a model for use of portable digital ultrasound for multicenter field studies.

Education in Ultrasonography - when to start and when to stop

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Ultrasound Lumbar Spine Clinical Training Phantom: Which is the Best Embedding Medium?

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Influence of the Instructional Approach "Mastery Learning" versus "See One, Do One" on Acquiring Competencies in Abdomen Sonography: A Comparative Effectiveness Analysis

Ultrasound is an important diagnostic tool in patients with abdominal pain and after injury. However, it is highly dependent on the skills and training of the examiner. Thus, ultrasound competencies should be acquired early during medical education. The instructional approach affects the retention and performance of skills. A promising approach is "mastery learning." The aim of the study was to evaluate the effectiveness of "mastery learning" compared with the "see one, do one" approach by performing a focused assessment of sonography for trauma (FAST) in undergraduate medical students based using an academic assessment tool (Objective Structured Clinical Examination [OSCE]). In a prospective controlled trial, 146 participants were randomly allocated to two groups (see one, do one and mastery learning) and trained in a 90-min module. In the see one, do one group, the trainer demonstrated the complete FAST routine, and then the students trained each other on it under supervision and received direct oral feedback from the tutors. In the mastery learning group, each student received a routing slip. The routing slip contained five levels of competence for the FAST routine, each of which had to be achieved (e.g., choosing the correct probe) and verified by the trainer before working toward the next competency level. The acquired competencies were assessed after training using the OSCE, which is a standardized practical exam using checklists. The mastery learning group attained 40.69 ± 5.6 points on average (of a maximum of 46 points), and the see one, do one group, 33.85 ± 7.7 points (p < 0.001). Mastery learning is an effective teaching method for undergraduate medical students performing FAST and is superior to the see one, do one approach, as assessed with the OSCE.

Simulation-Based Structured Education Supports Focused Neonatal Cranial Ultrasound Training

OBJECTIVES

Brain injury in preterm neonates may cause clinical deterioration and requires timeous bedside diagnosis. Teaching cranial ultrasound (US) skills using fragile preterm neonates is challenging. The purpose of this study was to test the effectiveness and feasibility of using task-trainer computer-based simulators and US-suitable cranial phantoms in combination with teaching sessions in teaching novices to perform focused cranial US evaluations for identifying substantial intraventricular hemorrhage.

METHODS

This was a prospective interventional educational study targeting participants with no prior skills in neonatal cranial US. Participants attended a 2-day training workshop, with didactic and hands-on interactive sessions using computer-based and 3-dimensional printed phantom simulators. Participants then performed a cranial US scan on a healthy neonate to assess the diagnostic quality of the images acquired. Individual precourse and postcourse knowledge tests were compared. To test recall, participants also submitted US images acquired on neonates within 3 and 6 months of attending the course.

RESULTS

Forty-five participants completed the training modules. Mean knowledge scores increased significantly (in brain anatomy, brain physiology, intracranial disorders, and US physics domains). Thirty-eight cranial US scans were acquired during the course, 22 within 3 months after completion, and 34 within 6 months after completion. Thirty-two (84%) of the initial 38 case images, 17 (77%) of 22 images submitted within 3 months, and 32 (94%) of 34 images submitted within 6 months after course completion were of diagnostic quality.

CONCLUSIONS

A structured training module with didactic and hand-on training sessions using simulators and phantoms is feasible and supports training of clinicians to perform focused cranial US examinations.

Use of a Real-Time Stress Map for Assessment of Applied Stress for Strain Elastography: Utility in Training and Computation of Strain Ratios

OBJECTIVES

There is a significant learning curve in strain elastography. Uniform appropriate levels of stress must be applied for accurate elastograms. If the stress is not applied appropriately, inaccurate results will be obtained, particularly when strain ratios are being estimated. This paper describes a new technique which allows the real-time visualization of the applied stress with a color-coded stress map. The potential use of this map is discussed.

METHODS

Ten patients (5 breast, 5 thyroid) and phantoms were scanned using the stress map. The stress applied was varied and the resultant change in the strain image evaluated.

RESULTS

The stress map was able to document if appropriate stress was applied when performing strain elastography. When inappropriate stress was applied or physiological process effected the strain image the stress map demonstrated the areas of inaccurate measurements in the stress map.

CONCLUSIONS

The display of a stress map that depicts the degree and uniformity of applied stress would be helpful both for training of the appropriate technique, for confirming that the elastogram is appropriate for evaluation, and that strain ratio estimates are accurate.

Technically Adequate Images for Preparticipation Screening Echocardiography Can Be Obtained by Novices After a Single Day of Training

OBJECTIVES

Echocardiography-naïve physicians were trained in a 1-day course to determine whether they could obtain images adequate for preparticipation screening in athletes.

METHODS

Twenty-six physicians with no previous experience in echocardiography were trained to perform preparticipation screening echocardiography during a 6-hour course. Each image was rated for its technical quality on a diagnostic adequacy score. The time taken to perform the images was also evaluated.

RESULTS

The images obtained a median score of 3 (interquartile range, 2-4), which was considered adequate for preparticipation screening. Video clips achieved a higher rating than the still images, with a median score of 4 (interquartile range, 3-4). The best-performing 50% of the participants obtained adequate images for screening 95% of the time after the initial training. Considering the group overall, 79.2% of all video clips were adequate. The median time to perform the scans was 39 seconds. The correlation between the time and adequacy score showed that the quickest novices were also able to obtain the best images.

CONCLUSIONS

It is feasible to use novice sonographers to perform preparticipation screening echocardiography provided that the skill of the candidates is assessed after training, and competent individuals are selected. Video images should be used rather than still images.

Training in Ultrasound for Resident Physicians in Gastroenterology: a survey and training project by the Spanish Association of Digestive Ultrasound (Asociación Española de Ecografía Digestiva - AEED)

BACKGROUND

the training program of the gastroenterology specialty that is mandatory for resident physicians, obliges them to be proficient in diagnostic and therapeutic digestive ultrasound tools.

METHODOLOGY

the Asociación Española de Ecografía Digestiva (AEED) performed a survey of the 93 Departments of Gastroenterology with training programs for resident physicians in gastroenterology, in order to assess the exact situation of training in digestive ultrasound in Spain.

RESULTS

only 31 of the 93 (33%) Departments of Gastroenterology were able to provide training in Digestive Ultrasound. Moreover, 33% (48 out of 148) of the residents in gastroenterology did not receive specific training in digestive ultrasound. Whereas, 31% (46 out of 148) had received some specific training, but with ample room for improvement. These deficiencies were spread throughout the Spanish regions (Autonomous Communities) in an uneven manner, with almost half totally lacking gastroenterology departments that were capable of providing digestive ultrasound training.

CONCLUSIONS

there is a significant deficit of gastroenterology departments capable of providing training in digestive ultrasound to residents, causing a significant training inequality. Until this situation can be reversed, the AEED has designed a training project in digestive ultrasound aimed at providing adequate training to all residents in gastroenterology as required.

The quality of abdominal ultrasound: a much-needed consensus

The abdominal ultrasound (AU) is a diagnostic imaging modality that is yet to be established in most Gastrointestinal (GI) Units in Spain. This is largely due to the difficulties that GI specialists face with regard to the appropriate training received when starting the specialty. Insufficient resources have been allocated to develop AU units in many GI units where AUs are performed. The equipment is obsolete and there are no adaptations to the needs of the GI specialist to provide good medical care. Thus, due to all the above, the AU does not hold the position it deserves in our specialty. This probably stems from a lack of impulse and/or support to the technique, which has underestimated its usefulness and has limited the implementation of resources in the GI units. For the AU to overcome these obstacles, it needs to be considered as a process or a series of activities based on scientific evidence and the experience of professionals that achieves a result that covers the patients' needs with minimal risk. In this article, we defend the need to boost AU as a key discipline for the diagnosis of digestive diseases. Quality is considered as the key aspect on which this transformation and improvement is founded.

Evaluation of the Acquisition of Ultrasound Proficiency in Hand Surgery Fellows

OBJECTIVES

To evaluate hand surgery fellow ultrasound (US) evaluations and performance of clinically relevant tasks after brief instruction.

METHODS

Six hand surgery fellows completed an US assessment and a survey on US use before and 1 month after a 30-minute US course.

RESULTS

The time to obtain an adequate image decreased from 4 minutes 42 seconds (4:42; range, 3:57-7:55) to 0:52 (range, 0:30-1:14; P < .001). Participants' performance for structure identification improved from 9.7 (range, 8-13) to 12 (range, 10-13) of 14 structures (P < .05). The average time to completion decreased from 14:6 (range, 12:08-18:30) to 9:34 (range, 4:40-15:54; P < .01). After instruction, all 6 participants identified and measured the cross-sectional area of the median nerve, identified and measured a zone 3 flexor tendon gap, and identified a simulated flexor digitorum profundus avulsion and its level of retraction (P < .05). Five of 6 successfully administered an US-guided injection to the extensor carpi ulnaris subsheath.

CONCLUSIONS

After a 30-minute instructional session, hand surgery fellows can achieve a basic level of US competency.

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda

Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013-2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second- and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings.

Three-Dimensional Printed Cardiac Models for Focused Cardiac Ultrasound Instruction

BACKGROUND

Focused cardiac ultrasonography (FCU) is an increasingly integral component of routine medical training and practice. While various instructional methods have been described, few attempts have been made to incorporate a physical 3-dimensional (3D) instructional aid.

OBJECTIVE

The aim of this study was to determine if a 3D printed heart model workshop for FCU instruction leads to equivalent structure recognition and scanning ability compared to traditional didactic FCU instruction.

INTERVENTION

Twenty first-year medical students with no point-of-care ultrasonography experience were randomly assigned to a traditional lecture (n = 10) or a 3D printed heart model workshop (n = 10). Written examinations at 0 and 3 months as well as image acquisition at 3 months were compared.

RESULTS

The median scores from the initial written structure identification in the traditional and 3D heart groups were 74% and 90%, respectively (P = 0.7). The second written exam at 3 months yielded median scores of 56% and 58% in the traditional and 3D heart groups, respectively (P = 0.8). The average scores on the image acquisition practical at 3 months were 3.3 of 5 and 2.7 of 5 (P = 0.1) in the traditional and 3D heart groups, respectively.

CONCLUSIONS

Utilizing 3D heart models in an FCU workshop format results in similar skill acquisition and knowledge retention as traditional didactics. The 3D heart models are relatively inexpensive, portable, and reusable, enabling learners to practice repeatedly and at flexible intervals. The reduction in ongoing expenses and the ability to teach large groups may decrease training costs as well as the need for local faculty expertise.

Prevalence and Scope of Point-of-Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine-Pediatric Residency Programs in the United States

OBJECTIVES

The purpose of this study was to determine the prevalence and scope of point-of-care ultrasound (US) education in internal medicine, pediatric, and medicine-pediatric residency programs nationwide.

METHODS

Program directors were surveyed between January and June 2016 with a 15-item online questionnaire to assess the state of point-of-care US training in their programs. The survey aimed to identify whether programs had an established point-of-care US curriculum and, if not, what reasons may have existed for a lack of point-of-care US training in their programs.

RESULTS

The survey was distributed to 685 program directors, and the response rate was 19.2%. Only 31.5% of respondents reported having a formal point-of-care US curriculum in their program, and in 12.4% of programs, there was no US training at all. The presence of point-of-care US training as reported by internal medicine (n = 64) and medicine-pediatric (n = 24) respondents showed formal point-of-care US curriculum rates of 37.5% and 43.5%, respectively. Pediatric programs (n = 24) reported limited point-of-care US training, with formal curriculum in only 12.4% of programs and 27.3% having no point-of-care US training at all. The most common reasons for lack of a point-of-care US curriculum among program directors were lack of trained faculty/instructors (70.4%), lack of guidelines/standards by governing societies (44.4%), and lack of the necessary technology (33.3%).

CONCLUSIONS

Less than half of residents with internal medicine training will have trained at a program with a point-of-care US curriculum, and point-of-care US training in pediatrics is even more limited. The major reason for the lack of point-of-care US education is a lack of trained faculty or instructors.

Accessible Personal Ultrasound Training Simulator

OBJECTIVES

Ultrasound simulators are increasingly used for teaching and training purposes, but development has been limited by the need for dedicated and often expensive hardware. The objective of this study was to develop and deploy an accessible and very low-cost personal ultrasound training simulator and obtain trainee feedback.

METHODS

An ultrasound simulator software program that uses a smartphone as a "mock-probe" and a laptop computer as a "mock ultrasound machine" was created. Spatial positional data is acquired from the smartphone's inbuilt accelerometer and gyroscope and transmitted to the laptop computer for processing and display of simulated ultrasound images in real time by the software program. After obtaining institutional review board approval and informed consent, all first-year radiology residents at our institution were provided access to the simulator program during the "bootcamp" introductory conference series, and a written survey was conducted to obtain feedback.

RESULTS

A personal ultrasound training simulator software program (Persimus) that reliably performs motion sensing along 2 axes and displays simulated ultrasound images was developed. Nine of 12 (75%) first-year residents at our institution participated in the written survey. Residents' scored values were 8.44 ± 1.33 and 8.44 ± 1.33 (mean + standard deviation) for perceived utility and overall impression and satisfaction, respectively, of the simulator on the Likert scale (1-10, with 10 being the highest score).

CONCLUSION

Personal ultrasound simulators are technically feasible. These are well received by first-year radiology residents and perceived as useful to their education.

The Use of Ultrasound Simulators to Strengthen Scanning Skills in Medical Students: A Randomized Controlled Trial

OBJECTIVES

This study evaluates the use of ultrasound simulators for retaining and improving ultrasound skills acquired in undergraduate ultrasound training.

METHODS

Fourth-year medical students (n = 19) with prior training in point-of-care sonography for shock assessment were recruited for this study. Students were randomly assigned to a study group (n = 10) that followed an undergraduate ultrasound training curriculum, then used a simulator to complete 2 self-directed practice ultrasound sessions over 4 weeks. The control group (n = 9) followed the same undergraduate ultrasound training curriculum and received no additional access to a simulator or ultrasound training. A blinded assessment of the students was performed before and after the 4-week study period to evaluate their image acquisition skills on standardized patients (practical examination). To evaluate the student's clinical understanding of pathological ultrasound images, students watched short videos of prerecorded ultrasound scans and were asked to complete a 22-point questionnaire to identify their findings (visual examination).

RESULTS

All results were adjusted to pretest performance. The students in the study group performed better than those in the control group on the visual examination (80.1% versus 58.9%; P = .003) and on the practical examination (77.7% versus 57.0%; P = .105) after the 4-week study period. The score difference on the postintervention practical examinations was significantly better for the study group compared to the control group (11.6% versus -9.9%; P = .0007).

CONCLUSION

The use of ultrasound simulators may be a useful tool to help previously trained medical students retain and improve point-of-care ultrasound skills and knowledge.

A Primary Care Ultrasound Fellowship: Training for Clinical Practice and Future Educators

As ultrasound devices become smaller, more portable, and more user friendly, there is now widespread use of this technology by physicians of all specialties, yet there are currently few structured opportunities for ultrasound education outside of emergency and critical care medicine. Anticipating the rising educational demand in the primary care specialties, the University of South Carolina School of Medicine created a primary care ultrasound fellowship in 2011, the first yearlong training program in point-of-care ultrasonography for graduates of internal medicine, medicine-pediatrics, pediatrics, and family medicine residencies. This paper reviews the history of point-of-care ultrasonography fellowships and then provides an overview of the primary care ultrasound fellowship.

An Exploratory Study of Sectra Table Visualization Improves the Effectiveness of Emergency Bedside Echocardiography Training

OBJECTIVES

Echocardiography is an essential tool in emergency medicine, and its training is the most challenging of all types of bedside ultrasound (US) training. This study investigated the effectiveness of the Sectra Table (Sectra AB, Linköping, Sweden), an anatomy visualization and collaboration tool, in improving the quality of echocardiography training for emergency medicine physicians.

METHODS

We conducted an exploratory prospective observational study from 2015 to 2017 and enrolled 66 trainees who participated in a 2.5-day bedside US course organized by the emergency department (ED) of Peking Union Medical College Hospital. The study participants underwent 2 different training programs: the first group received standard training, and the second group was trained with Sectra Table experiences integrated into the echocardiography training curriculum. After the training sessions, both groups were evaluated for their hands-on echocardiography performance.

RESULTS

The new training program with the Sectra Table significantly increased trainees' self-confidence in performing bedside echocardiography. The Sectra Table trainees had a higher performance rating than the trainees in the traditional program, with a mean total assessment score of 40.5 versus 26.5 for traditional training (P < .01). The improved performance was evident for all subcategories of echocardiography. The higher performance rating of the Sectra Table trainees was also statistically significant after adjusting for confounders, including prior training experiences, baseline confidence in independently performing ED US examinations, the number of ED US examinations performed, years in ED practice, and physician seniority.

CONCLUSIONS

Our analysis suggests that integrating the Sectra Table into echocardiography training may improve the effectiveness of training programs.

Current Experience of Ultrasound Training in Otolaryngology Residency Programs

OBJECTIVES

The applications of using ultrasound for the evaluation and management of otolaryngologic diagnoses are expanding. The purpose of this study was to evaluate the current experience of ultrasound training in otolaryngology residency programs.

METHODS

All allopathic and osteopathic otolaryngology residency programs in the United States were surveyed online via an e-mailed survey link to the resident representatives of the Section for Residents and Fellows in Training of the American Academy of Otolaryngology-Head and Neck Surgery. We present a descriptive analysis of the survey results.

RESULTS

A total of 110 responses were obtained from resident representatives at MD and DO otolaryngology residency programs, representing a response rate of 94.8%. Forty-four percent of residents reported that they would not feel comfortable with performing ultrasound-guided procedures after residency; 43% reported that they do not perform ultrasound procedures as a part of their residency training; and 60% of those trainees performing ultrasound procedures do not log the procedures. Twenty-three percent of residents did not have access to an ultrasound machine. Most respondents (71%) desired more exposure to diagnostic and/or interventional ultrasound training during residency.

CONCLUSIONS

Although current experience is variable, there is a strong interest in increasing resident skill acquisition in ultrasound training among otolaryngology residents. Some barriers to these goals may be a lack of trained faculty members using ultrasound and insufficient recording mechanisms for residents performing ultrasound procedures.

The Value of Needle-Guidance Technology in Ultrasound-Guided Percutaneous Procedures Performed by Radiology Residents: A Comparison of Freehand, In-Plane, Fixed-Angle, and Electromagnetic Needle Tracking Techniques

OBJECTIVES

Radiology residents typically learn ultrasound-guided procedures by performing supervised procedures on patients who may experience longer procedure times and higher complication rates. The purpose of this study was to determine if existing technologies, such as in-plane, fixed-angle guidance (IPFA) and electromagnetic needle tracking (ENT), can improve resident procedure time and accuracy.

METHODS

Radiology residents (18 total) were randomized to 1 of 3 ultrasound-guidance technique groups-freehand, IPFA, or ENT-and instructed to place a needle into 4 liver lesions in a humanoid phantom, each increasing in difficulty. For each lesion, residents were timed from skin puncture to needle placement, and the number of times the needle was pulled back and redirected (pullbacks) was recorded. Primary outcomes were total time and total number of pullbacks for all 4 lesions. Secondary outcomes were individual time and number of pullbacks for each lesion.

RESULTS

Compared to the freehand group, the IPFA and ENT groups demonstrated lower procedural time and number of pullbacks both in total and for each individual lesion. Differences in total time and total number of pullbacks were significant (P < .001), as were differences for lesion 3 (P = .002-.02) and lesion 4 (P < .001). Differences for lesions 1 and 2 were not statistically significant.

CONCLUSIONS

Radiology resident procedure time and procedure accuracy (as judged by number of pullbacks) are significantly improved by the use IPFA and ENT guidance technologies.

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.

Longitudinal Ultrasound Curriculum Incorporation at West Virginia University School of Medicine: A Description and Graduating Students' Perceptions

OBJECTIVES

Sonography is a clinical tool being incorporated in multiple medical specialties with evidence of improved patient care and cost. Some schools have begun implementing ultrasound curricula. We hope to build upon that foundation and provide another potential framework of incorporation. There are several barriers, including curricular space, equipment and physical space, adequate faculty, and performing assessment.

METHODS

At West Virginia University, we began a longitudinal ultrasound curriculum in 2012 with incorporation of didactic and practical sessions into gross anatomy, our systems-based second-year curriculum, physical diagnosis course, and clinical rotations. We included both written and practical assessment from the onset. After the initial 4 years, the first graduates were surveyed on their perceptions of the curriculum. Responses were correlated with specialty choice and clinical campus site.

RESULTS

Based on our survey (90% response rate), students felt sonography was useful for anatomical understanding and patient care. Overall, 93% of our respondents reviewed the curriculum favorably. Qualitative feedback was very positive, with students desiring more ultrasound education and more required components, specifically in clinical rotations.

CONCLUSIONS

Based on these results, some changes have already been implemented, including decreased student-to-instructor ratios, more open scan time, and more required components. The breadth of formal assessment has increased. Multiple pilot programs for clinical rotations are being developed. There is an ongoing need for faculty development and continued assessment of ultrasound competency.

Education in ultrasonography -a stringent and constant necessity

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Remote Mentoring of Point-of-Care Ultrasound Skills to Inexperienced Operators Using Multiple Telemedicine Platforms: Is a Cell Phone Good Enough?

OBJECTIVES

Telemedicine technology contributes to the teaching of point-of-care ultrasound (US); however, expensive equipment can limit its deployment in resource-challenged settings. We assessed 3 low-cost telemedicine solutions capable of supporting remote US training to determine feasibility, acceptability, and effectiveness. We also explored the value of instructional videos immediately before telementoring.

METHODS

Thirty-six participants were randomly assigned to receive US mentoring in 1 of 3 telemedicine conditions: multiple fixed cameras, a smartphone, and traditional audio with a live US stream. Participants were then asked to perform a standardized US examination of the right upper quadrant under remote guidance. We measured observer's global ratings of performance along with the mentor's and student's rating of effort and satisfaction to determine which of the 3 approaches was most feasible, acceptable, and effective. During the second phase, students were randomized to watch an instructional video or not before receiving remote coaching on how to complete a subxiphoid cardiac examination. Effort, satisfaction, and performance from the independent observer's and student's perspective were surveyed.

RESULTS

There was no significant difference between the different telemedicine setups from the observer's perspective; however, the mentor rated the smartphone significantly worse (P = .028-.04) than other technologies. Platforms were rated equivalent from the student's perspective. No benefit was detected for watching an instructional video before the mentored task.

CONCLUSIONS

Remote US skills can be taught equally effectively by using a variety of telemedicine technologies. Smartphones represent a viable option for US training in resource-challenged settings.

Ultrasound simulation utilization among point of care ultrasound users: Results of a survey

PURPOSE

While ultrasound simulation devices have long been available as adjuncts to ultrasound education, it is unclear how they are used. We conducted a survey to determine the current utilization of emergency point-of-care ultrasound simulation and describe the current trends in the use of ultrasound simulation.

METHODS

A survey was sent to 1270 members of the American College of Emergency Physicians Ultrasound Section via email. The survey listed 23 questions that queried how survey participants used ultrasound simulation devices.

RESULTS

One hundred and fifty-one survey responses were collected. The majority of survey respondents (83%) indicated that ultrasound simulation devices are available at their institution, with nearly half (45%) survey participants reporting both high- and low-fidelity ultrasound simulators available, and fewer describing low-fidelity simulators only (33%) or high-fidelity simulators only (5%). Most respondents (84%) with ultrasound simulators use them for training residents, students, fellows, and faculty. Only 20% of survey participants use ultrasound simulators for credentialing purposes.

CONCLUSIONS

Ultrasound simulation devices are widespread amongst our survey respondents, who represent a small percentage of the ACEP ultrasound section. Ultrasound simulators are used to help ultrasound learners at various levels of training.

SonoGames: Effect of an Innovative Competitive Game on the Education, Perception, and Use of Point-of-Care Ultrasound

OBJECTIVES

Gamification is a powerful tool in medical education. SonoGames is a competitive games-based event designed to educate and inspire emergency medicine (EM) residents about point-of-care ultrasound. We sought to describe: (1) the perceived effectiveness of a competitive event on both immediate learning and long-term education; and (2) the resultant attitudes of participants and program directors regarding ultrasound training.

METHODS

The SonoGames Organizational Committee designed 2 surveys: 1 for SonoGames V EM resident participants and a second for EM program directors. Survey questions used a 5-point Likert scale to assess overall perceptions and attitudes about ultrasound, changes in self-reported content knowledge and competency, effects on clinical use, and perceived impacts of a competitive game format on education.

RESULTS

Seventy-three resident participants and 42 program directors responded to the survey. Ninety-four percent of participants thought that the competitive gaming format of SonoGames was effective in making the event an educational experience. Participants reported that their ultrasound knowledge increased (81%), their enthusiasm for ultrasound increased (87%), and their clinical use of ultrasound increased (61%). Residency program directors reported similar increases to a lesser degree. Greater advancement through the event was associated with more positive responses. Residencies that participated in the event saw greater increases in the use of ultrasound by residents than those that did not.

CONCLUSIONS

A competitive games-based educational event focused on point-of-care ultrasound is an effective educational tool. SonoGames increases EM residents' knowledge, enthusiasm, and clinical use of ultrasound both during and after the event.

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.

Point-of-Care Ultrasound in Undergraduate Urology Education: A Prospective Control-Intervention Study

OBJECTIVES

The effect of point-of-care ultrasound (US) training on clinical reasoning in undergraduate medical education remains largely unknown, with concerns arising about possible confusion among learners when such clinical tools are introduced too early. We studied the effect of a urology point-of-care US module on the performance of questions designed to assess clinical reasoning in urinary tract obstruction and voiding dysfunction.

METHODS

All second-year medical students at the University of Saskatchewan (Regina [n = 36] and Saskatoon [n = 61]) were enrolled in the study. Each cohort participated in the urology point-of-care US module concurrently with its Foundations in the Kidney and Urinary Tract course. The Regina cohort completed the point-of-care US module 1 week before the Saskatoon cohort, thus allowing for a control-intervention comparison of script concordance question scores to evaluate the effect that the urology point-of-care US module had on clinical reasoning skills. Secondary outcomes included program evaluation metrics, such as overall course performance, urology point-of-care US objective structured clinical examination performance, and student course evaluation data.

RESULTS

The introduction of the urology point-of-care US module was not associated with a deterioration in scores on script concordance questions. There were no statistically significant differences between the Regina and Saskatoon students in their responses to the script concordance questions. There were statistically significant increases in student self-reported achievement of learning objectives, with the effect size being medium to large (Cohen d, 0.5-0.8).

CONCLUSIONS

Point-of-care US training complements standard undergraduate classroom teaching of urology. Students effectively learned the skills to apply point-of-care US in their assessment of patients, and this process did not interfere with achieving the course objectives.

The Current State of Ultrasound Training in Obstetrics and Gynecology Residency Programs

OBJECTIVES

We evaluated the current state of ultrasound training in obstetrics and gynecology (OB-GYN) residency programs across the United States.

METHODS

An electronic survey was sent to OB-GYN residency program directors and OB-GYN residents. Responses were obtained in September 2016. Program directors and residents were asked to reflect on their current ultrasound curriculum.

RESULTS

A total of 93 program directors and 437 residents responded. Respondents were mostly from university programs located in tertiary centers. Ultrasound curricula varied: 11% of program directors and 23% of residents did not have any ultrasound-related didactics; of those who did, 27% of program directors and 40% of residents had it yearly or less. Three-quarters had mandatory ultrasound rotations, and few offered ultrasound electives (program directors, 52%; residents, 28%). Most residents were required to perform ultrasound examinations daily or weekly (98%). Most stated that the main focus of the rotation was OB only. Skill was evaluated mainly subjectively by direct observation. Although most program directors stated that residents were satisfactory/excellent in ultrasound, 22% would not treat patients on the basis of ultrasound examinations performed by their senior residents. Similarly, of all postgraduate year 4 respondents (n = 86), 76% stated that they will require additional training to be able to perform or read ultrasound examinations independently, and 43% would not treat a patient on the basis of their own ultrasound examinations without further confirmation. Residents believed that the biggest obstacle in ultrasound training is lack of dedicated faculty time (41%).

CONCLUSIONS

Recognizing the lack of clearly defined milestones in ultrasound training in OB-GYN residency, this study confirms the substantial heterogeneity in curricula between programs, highlighting a need for a standardized ultrasound curriculum.

Telepresent Focused Assessment With Sonography for Trauma Examination Training Versus Traditional Training for Medical Students: A Simulation-Based Pilot Study

OBJECTIVES

Telepresent education is becoming an important modality in medical education, as it provides a means for instructors to lead education sessions via videoconferencing technologies. This study aimed to compare the effectiveness of telepresent ultrasound training versus traditional in-person ultrasound training.

METHODS

Medical student cohorts were educated by either traditional in-person instruction or telementoring on how to perform a focused assessment with sonography for trauma (FAST) examination. Effectiveness was evaluated by pre- and post-multiple-choice tests (knowledge), confidence surveys, and summative simulation scenarios (hands-on FAST simulation). Formative simulation scenario debriefings were evaluated by each student using the Debriefing Assessment for Simulation in Healthcare student version (DASH-SV).

RESULTS

Each method of instruction had significant increases in knowledge, confidence, and hands-on FAST simulation performance (P < .05). The collective increase in knowledge was greater for the in-person group, whereas the improvement in FAST examination performance during simulations was greater for the telementored group. Confidence gains were comparable between the groups. The DASH-SV scores were significantly higher for the in-person group for each criterion; however, both methods were deemed effective via median scoring.

CONCLUSIONS

Telepresent education is a viable option for teaching the FAST examination to medical students.

Evaluation of Examiner Performance Using a Duplex Ultrasound Simulator. Flow Velocity Measurements in Dialysis Access Fistula Models

We developed a duplex ultrasound simulator for training and assessment of scanning skills. We used the simulator to test examiner performance in the measurement of flow velocities in dialysis access fistulas. Test cases were created from 3-D ultrasound scans of two dialysis access fistulas by reconstructing 3-D blood vessel models and simulating blood flow velocity fields within the lumens. The simulator displays a 2-D B-mode or color Doppler image corresponding to transducer position on a mannequin; a spectral waveform is generated according to Doppler sample volume location and system settings. Examiner performance was assessed by comparing the measured peak systolic velocity (PSV) with the true PSV provided by the computational flow model. The PSV measured by four expert examiners deviated from the true value by 7.8 ± 6.1%. The results indicate the ability of the simulator to objectively assess an examiner's measurement accuracy in complex vascular targets.

Quantitative Analysis of Needle Navigation under Ultrasound Guidance in a Simulated Central Venous Line Procedure

Complications in ultrasound-guided central line insertions are associated with the expertise level of the operator. However, a lack of standards for teaching, training and evaluation of ultrasound guidance results in various levels of competency during training. To address such shortcomings, there has been a paradigm shift in medical education toward competency-based training, promoting the use of simulators and quantitative skills assessment. It is therefore necessary to develop reliable quantitative metrics to establish standards for the attainment and maintenance of competence. This work identifies such a metric for simulated central line procedures. The distance between the needle tip and ultrasound image plane was quantified as a metric of efficacy in ultrasound guidance implementation. In a simulated procedure, performed by experienced physicians, this distance was significantly greater in unsuccessful procedures (p = 0.04). The use of this metric has the potential to enhance the teaching, training and skills assessment of ultrasound-guided central line insertions.

An economical strategy for early medical education in ultrasound

BACKGROUND

A movement to include ultrasound training in undergraduate medical education is slowly taking place. However, many educational institutions are hesitant to include formal ultrasound training as a part of their curricula due to curricular time constraints, high cost of ultrasound equipment, and a lack of sufficient faculty skilled with ultrasound. We suggest that an economical ultrasound training strategy is needed to resolve these obstacles and enable hesitant medical programs to include ultrasound training.

METHODS

Twenty-eight first year medical students volunteered to attend extra-curricular ultrasound training sessions covering topics related to 11 commonly used sonographical imaging categories. Study assessments included subjective pre/post-training skill evaluation surveys, and objective numerical scores awarded by the session instructor during real-time evaluation of each participant's performance in obtaining each target ultrasound view.

RESULTS

A Wilcoxon matched-pairs signed rank test was performed to evaluate the difference between pre-training and post-training survey questions. P values < 0.05 were considered significant. Moreover, following analysis the p value for all test was found to be < 0.0001. Of the 308 total ultrasound-related tasks attempted collectively by all 28 participants, only 7 (2.3%) tasks were deemed unsuccessful by an instructor.

CONCLUSIONS

The training program presented in this study requires one faculty member, a single ultrasound machine, and time to conduct six 30-min training sessions with small groups of students over 4 weeks. Many medical schools are concerned that they don't have adequate time or resources to include ultrasound training in their curricula. Our intention is to negate these concerns by providing a simple and practical training method that is both temporally and fiscally economical.

Knowledge of Safety, Training, and Practice of Neonatal Cranial Ultrasound: A Survey of Operators

OBJECTIVES

Ultrasound can lead to thermal and mechanical effects in interrogated tissues. This possibility suggests a potential risk during neonatal cranial ultrasound examinations. The aim of this study was to explore safety knowledge and training of neonatal cranial ultrasound among Australian operators who routinely perform these scans.

METHODS

An online survey was administered on biosafety and training in neonatal cranial ultrasound, targeting all relevant professionals who can perform neonatal cranial ultrasound examinations in Australia: namely, radiologists, neonatologists, sonographers, and pediatricians. The survey was conducted between November 2013 and May 2014.

RESULTS

A total of 282 responses were received. Twenty of 208 (10%) answered all ultrasound biosafety questions correctly, and 49 of 169 (29%) correctly defined the thermal index. Two-thirds (134 of 214 [63%]) of respondents failed to recognize that reducing the overall scanning time is the most effective method of reducing the total power exposure. Only 13% (31 of 237) indicated that a predetermined fixed period of training or that a specified minimum number of supervised scans was used during training. The reported number of supervised scans during training was highly variable. Almost half of the participants (82 of 181 [45%]) stated that they had received supervision for 10 to 50 scans (median, 20 scans).

CONCLUSIONS

There is a need to educate operators on biosafety issues and approaches to minimize power outputs and reduce the overall duration of cranial ultrasound scans. Development of standardized training requirements may be warranted.

Establishing an Ultrasound Curriculum in Undergraduate Medical Education: How Much Time Does It Take?

OBJECTIVES

Over the years, the use of ultrasound in the medical profession has become a common occurrence. As a result, many medical schools are considering an ultrasound curriculum for first- and second-year medical students. The question posed by many of these programs is how much time and effort are required to establish such a curriculum. We at the University of Colorado School of Medicine sought to quantify the resources and time required.

METHODS

We conducted a cohort study that analyzed the time spent teaching, as well as the types of instructors (eg, faculty, resident, and peer student) that contributed to our ultrasound curriculum. The study population consisted of instructors who participated in the curriculum during the 2014-2015 academic year. We analyzed the amount of time that facilitators spent teaching and tabulated these data using their specialty.

RESULTS

Our data revealed that within an academic year, a combined total of 484 hours were spent teaching ultrasound to first- and second-year medical students combined. A total of 6 days were required to teach ultrasound to first-year medical students, and a total of 5 days were required for second-year medical students. It required 1 instructor for every 8 students, and most the faculty who volunteered time were from the field of emergency medicine, followed by family medicine and radiology.

CONCLUSIONS

We describe the number of hours and instructors required to implement an ultrasound curriculum for undergraduate medical education.

Evaluation of a Novel Out-of-Plane Needle Guide

OBJECTIVES

Most ultrasound-guided regional procedures use an in-plane approach. Out-of-plane approaches may be desirable in some situations but can be difficult because of an inability to visualize the needle until it intersects the plane of the ultrasonic beam. Here we present a novel out-of-plane needle guide, using a retreating depth stop, and compare its performance with unguided in-plane and out-of-plane techniques.

METHODS

First- and third-year medical students with no or minimal ultrasound experience were recruited for the study. After a brief training session on in-plane and out-of-plane needling techniques, as well as use of the retreating-stop needle guide, they attempted to place a needle as close as possible to a target embedded in porcine tissue. The total time to complete the procedure was measured. Accuracy was measured by a skilled sonographer, who identified the needle tip and measured the distance to the target. The data were tested for significance using an analysis of variance.

RESULTS

The mean total time spent differed significantly between groups (novel needle guide, 34 seconds; in-plane, 120 seconds; out-of-plane, 113 seconds; P = .021). Needle proximity was on average more accurate with the needle guide, although this difference was not statistically significant (novel needle guide, 8 mm; in-plane, 15 mm; out-of-plane, 14 mm; P = .289).

CONCLUSIONS

In relatively inexperienced sonographers, the retreating-stop needle guide reduced the procedure time compared with in-plane and out-of-plane techniques. No significant changes in needling accuracy were observed.

A Novel Low-Cost Ultrasound-Guided Pericardiocentesis Simulation Model: Demonstration of Feasibility

Pericardiocentesis is a rare life-saving procedure for patients with cardiac tamponade. Due to the infrequency of this procedure, simulation models are often used for training. Commercial models are generally expensive. Proposed homemade models offer a lower-cost alternative but can be labor and time intensive. The purpose of this study was to determine the feasibility of a limited use, low-cost ultrasound-guided pericardiocentesis model as a training tool for emergency physicians. Our model proved to be a practical, easily implemented, and acceptable model for training emergency physicians, including residents and students, in ultrasound-guided pericardiocentesis.

Emergency Ultrasound: A Survey Study of Fellowship Graduate Characteristics and Career Paths

OBJECTIVES

There are sparse data on the career pathways of graduates of emergency ultrasound fellowships. The authors sought to define the characteristics of graduates and their reported career paths after training through this survey study.

METHODS

A 26-question anonymous survey was emailed to 597 graduates of 70 fellowships over a 4-week period. No incentives were provided for completion of the questionnaire. Descriptive statistics are reported. For qualitative data, open- and axial-coding methods were used.

RESULTS

A total of 336 participants completed the study for a response rate of 56%. The average age of respondents was 36.4 years, and 58% were male. Most graduates had MD degrees (89%) or DO degrees (10%). Sixty percent of graduates attended a 3-year emergency medicine residency, and 29% attended a 4-year residency. Only 11% pursued additional fellowship training, most commonly pediatric emergency medicine (n = 14). After fellowship, 63% (95% confidence interval [CI], 62.9, 63.1) of graduates began working full-time in an academic setting, whereas 24% (95% CI, 23.9, 24.1) worked full-time in a community setting. Thirty-three percent (95% CI, 32.7, 33.3) took an immediate position as ultrasound division director, whereas 4% (95% CI, 3.7, 4.3) became fellowship directors and 3% (95% CI, 2.7, 3.3) became ultrasound medical student directors. Currently, 67% (95% CI, 66-68%) identify ultrasound as their leading academic focus.

CONCLUSIONS

Although not all fellowship graduates pursue academic positions, most note the impact of fellowship on their career paths. Graduates hold a variety of leadership positions. Approximately two thirds still consider ultrasound as their academic focus.

Does Ultrasound-Enhanced Instruction of Musculoskeletal Anatomy Improve Physical Examination Skills of First-Year Medical Students?

OBJECTIVES

Ultrasound imaging is commonly used to teach basic anatomy to medical students. The purpose of this study was to determine whether learning musculoskeletal anatomy with ultrasound improved performance on medical students' musculoskeletal physical examination skills.

METHODS

Twenty-seven first-year medical students were randomly assigned to 1 of 2 instructional groups: either shoulder or knee. Both groups received a lecture followed by hands-on ultrasound scanning on live human models of the assigned joint. After instruction, students were assessed on their ability to accurately palpate 4 anatomic landmarks: the acromioclavicular joint, the proximal long-head biceps tendon, and the medial and lateral joint lines of the knee. Performance scores were based on both accuracy and time. A total physical examination performance score was derived for each joint. Scores for instructional groups were compared by a 2-way analysis of variance with 1 repeated measure. Significant findings were further analyzed with post hoc tests.

RESULTS

All students performed significantly better on the knee examination, irrespective of instructional group (F = 14.9; df = 1.25; P = .001). Moreover, the shoulder instruction group performed significantly better than the knee group on the overall assessment (t = -3.0; df = 25; P < .01). Post hoc analyses revealed that differences in group performance were due to the shoulder group's higher scores on palpation of the biceps tendon (t = -2.8; df = 25; P = .01), a soft tissue landmark. Both groups performed similarly on palpation of all other anatomic structures.

CONCLUSIONS

The use of ultrasound appears to provide an educational advantage when learning musculoskeletal physical examination of soft tissue landmarks.

Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology

The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.

Obstetric and Gynecologic Ultrasound Curriculum and Competency Assessment in Residency Training Programs: Consensus Report

Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at, or close to, 75% for each, and obtaining a set of 5 ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the task force expects that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum and the competency assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology.

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.

Integration of ultrasound imaging into pre-clinical dental education

INTRODUCTION

Patients have complex healthcare needs and typically require more than one healthcare discipline to address issues regarding their health. Interprofessional teams of healthcare professionals may be able to address these complex needs and improve patient outcomes by combining resources. To evaluate the feasibility of integrating ultrasound into a dental school curriculum to teach anatomy as part of an interprofessional education experience, the current study surveyed first-year dental students to determine their perceptions of the integration of ultrasound techniques into the curriculum.

MATERIALS AND METHODS

Ultrasound laboratory exercises were developed for first-year dental students as part of their anatomy course. The exercises were focused on head, neck and abdominal anatomy. To assess student perception of the integration of ultrasound into the dental curriculum, a survey was created specifically for the current study.

RESULTS

Between 2013 and 2015, two classes of first-year dental students participated in the ultrasound laboratory exercise and completed the survey (n = 83). Student survey responses suggested ultrasound was a valuable teaching tool because it allowed them to visualise anatomical structures using live imaging. They also agreed that the ultrasound laboratory exercises were an efficient learning tool, but the majority did not believe that they would use ultrasound regularly in their future practice.

CONCLUSIONS

Results of the current study suggested first-year dental students were satisfied with the integration of ultrasound techniques into the dental curriculum. Survey results indicated that the students enjoyed the ultrasound laboratory exercise and felt ultrasound was an effective learning tool.

Use and Education of Point-of-Care Ultrasound in Pediatric Emergency Medicine in Saudi Arabia

OBJECTIVES

Point-of-care ultrasound (US) is an emerging tool used by pediatric emergency physicians in the last decade. Currently in the Middle East, point-of-care US use and education are at an early stage, with no designed curriculum or guidelines for its implementation in pediatric emergency medicine (EM). The objective of this article is to describe the clinical and educational uses of point-of-care US among certified pediatric EM physicians.

METHODS

A 19-question survey was sent to all certified pediatric emergency physicians and fellows in pediatric emergency fellowships in Saudi Arabia in February 2016. Reminders were sent weekly for 4 weeks.

RESULTS

The response rate was 84 of 88 (95%). Fifty-one of 84 (61%) reported using point-of-care US. Focused assessment with sonography for trauma was the most frequent use of point-of-care US (37%), followed by procedures (19%). The most common barrier for not using point-of-care US was limited training (86%). The most preferred tool for point-of-care US teaching was courses by EM physicians. Currently, there is no specific curriculum designed for pediatric EM in the Middle East.

CONCLUSIONS

Despite the multiple applications of point-of-care US in pediatric EM, its use is still limited. Formal point-of-care US training with bedside sessions and courses was the mort preferred method of education. A designed curriculum needs to be implemented in pediatric emergency fellowships in Saudi Arabia.