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Weimer JM, Beer D, Schneider C, Yousefzada M, Gottwald M, Züllich TF, Weimer A, Jonck C, Buggenhagen H, Kloeckner R, Merkel D. Inter-System Variability of Eight Different Handheld Ultrasound (HHUS) Devices-A Prospective Comparison of B-Scan Quality and Clinical Significance in Intensive Care. Diagnostics (Basel) 2023; 14:54. [PMID: 38201363 PMCID: PMC10795594 DOI: 10.3390/diagnostics14010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND the use of handheld ultrasonography (HHUS) devices is well established in prehospital emergency diagnostics, as well as in intensive care settings. This is based on several studies in which HHUS devices were compared to conventional high-end ultrasonography (HEUS) devices. Nonetheless, there is limited evidence regarding potential variations in B-scan quality among HHUS devices from various manufacturers, and regarding whether any such differences hold clinical significance in intensive care medicine settings. METHODS this study included the evaluation of eight HHUS devices sourced from diverse manufacturers. Ultrasound videos of five previously defined sonographic questions (volume status/inferior vena cava, pleural effusion, pulmonary B-lines, gallbladder, and needle tracking in situ) were recorded with all devices. The analogue recording of the same pathologies with a HEUS device served as gold standard. The corresponding findings (HHUS and HEUS) were then played side by side and evaluated by sixteen intensive care physicians experienced in sonography. The B-scan quality and the clinical significance of the HHUS were assessed using a five-point Likert scale (5 points = very good; 1 point = insufficient). RESULTS both in assessing the quality of B-scans and in their ability to answer clinical questions, the HHUS achieved convincing results-regardless of the manufacturer. For example, only 8.6% (B-scan quality) and 9.8% (clinical question) of all submitted assessments received an "insufficient" rating. One HHUS device showed a significantly higher (p < 0.01) average points score in the assessment of B-scan quality (3.9 ± 0.65 points) and in the evaluation of clinical significance (4.03 ± 0.73 points), compared to the other devices. CONCLUSIONS HHUS systems are able to reliably answer various clinical intensive care questions and are-while bearing their limitations in mind-an acceptable alternative to conventional HEUS devices. Irrespective of this, the present study was able to demonstrate relevant differences in the B-scan quality of HHUS devices from different manufacturers.
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Affiliation(s)
- Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Diana Beer
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Masuod Yousefzada
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Michael Gottwald
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Tim Felix Züllich
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Christopher Jonck
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (C.J.); (H.B.)
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein—Campus Lübeck, 23538 Lübeck, Germany;
| | - Daniel Merkel
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School, 15562 Rüdersdorf bei Berlin, Germany; (D.B.); (C.S.); (M.Y.); (M.G.); (T.F.Z.)
- BIKUS—Brandenburg Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane (MHB), 16816 Neuruppin, Germany
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Wen S, Naqvi TZ. Point-of-Care Ultrasound in Detection, Severity and Mechanism of Significant Valvular Heart Disease and Clinical Management. J Clin Med 2023; 12:6474. [PMID: 37892613 PMCID: PMC10607262 DOI: 10.3390/jcm12206474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Early diagnosis of significant valvular heart disease (VHD) enables appropriate implementation of the best therapeutic strategy and follow-up. Cardiac auscultation remains suboptimal in early detection of VHD. The aim of this study was to evaluate the utility of point-of-care ultrasound (POCUS) for early detection of VHD and its severity. METHODS All consecutive patients with VHD who did not have a standard echocardiogram prior to first outpatient cardiology consultation underwent history and physical examination followed by POCUS study by an experienced physician in a general cardiology clinic from June 2017 to August 2022 at our institution. Subsequent standard transthoracic echocardiography (sTTE) was performed as the gold standard. Comparison was performed between POCUS and sTTE for the presence and severity of VHD. sTTE was performed by registered cardiac sonographers and interpreted by another cardiologist blinded to the POCUS results. RESULTS A total of 77 patients were studied (ge 72 ± 11 years, 58.4% males). A total of 89 significant valvular abnormalities were diagnosed. There were 39 (43.8%) cases of regurgitant VHD, 16 (18.0%) of stenotic VHD and 34 (38.2%) had evaluation for prosthetic valve function. The sensitivity (90.9%; 82.4%; 83.3%; 100%) and specificity (100%; 96.7%; 100%; 100%) were high for detecting ≥ moderate aortic regurgitation (AR), mitral regurgitation (MR), aortic stenosis (AS) and prosthetic valvular abnormality, respectively. The weighted κ coefficient between POCUS and sTTE for the assessment of ≥ moderate MR, AR and AS was 0.81 (95% CI, 0.65-0.97), 0.94 (95% CI, 0.84-1.00) and 0.88 (95% CI, 0.76-1.0), respectively, indicating excellent agreement. CONCLUSIONS POCUS can identify patients with significant VHD and may serve as a powerful screening tool for early detection of significant VHD in the outpatient clinical practice with downstream impact on clinical management of significant VHD.
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Affiliation(s)
| | - Tasneem Z. Naqvi
- Department of Cardiovascular Medicine, Division of Echocardiography, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA;
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Höhne E, Recker F, Dietrich CF, Schäfer VS. Assessment Methods in Medical Ultrasound Education. Front Med (Lausanne) 2022; 9:871957. [PMID: 35755059 PMCID: PMC9218354 DOI: 10.3389/fmed.2022.871957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Medical schools are increasingly incorporating ultrasound into undergraduate medical education. The global integration of ultrasound into teaching curricula and physical examination necessitates a strict evaluation of the technology's benefit and the reporting of results. Course structures and assessment instruments vary and there are no national or worldwide standards yet. This systematic literature review aims to provide an up-to-date overview of the various formats for assessing ultrasound skills. The key questions were framed in the PICO format (Population, Intervention, Comparator, and Outcome). A review of literature using Embase, PubMed, Medline, Cochrane and Google Scholar was performed up to May 2021, while keywords were predetermined by the authors. Inclusion criteria were as follows: prospective as well as retrospective studies, observational or intervention studies, and studies outlining how medical students learn ultrasound. In this study, 101 articles from the literature search matched the inclusion criteria and were investigated. The most frequently used methods were objective structured clinical examinations (OSCE), multiple choice questions, and self-assessments via questionnaires while frequently more than one assessment method was applied. Determining which assessment method or combination is ideal to measure ultrasound competency remains a difficult task for the future, as does the development of an equitable education approach leading to reduced heterogeneity in curriculum design and students attaining equivalent skills.
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Affiliation(s)
- Elena Höhne
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
- *Correspondence: Florian Recker
| | | | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
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Brown CC, Arrington SD, Olson JF, Finch CA, Nydam RL. Musculoskeletal ultrasound training encourages self-directed learning and increases confidence for clinical and anatomical appreciation of first-year medical students. ANATOMICAL SCIENCES EDUCATION 2022; 15:508-521. [PMID: 34674381 DOI: 10.1002/ase.2145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 09/12/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Best-practice guidelines have incorporated ultrasound in diagnostic and procedural medicine. Due to this demand, the Arizona College of Osteopathic Medicine initiated a comprehensive integration of ultrasound into its first-year anatomy course attended by more than 280 students. Ultrasound workshops were developed to enhance student conceptualization of musculoskeletal (MSK) anatomy through visualizing clinically important anatomical relationships, a simulated lumbar puncture during the back unit, carpal tunnel and shoulder evaluations during the upper limb unit, and plantar fascia, calcaneal tendon, and tarsal tunnel evaluations during the lower limb unit. A 5-point Likert scale survey evaluated if ultrasound improved students' self-perceived anatomical and clinical comprehension of relevant anatomy, improved students' ability to orient to ultrasound imagery, and prompted further independent investigation of the anatomical area. Ultrasound examination questions were added to the anatomy examinations. Two-tailed one-sample t-tests for the back, upper limb, and lower limb units were found to be significant across all Likert survey categories (P < 0.001). Positive student responses to the Likert survey in conjunction with examination question average of 84.3% (±10.3) demonstrated that the ultrasound workshops are beneficial to student education. Ultrasound enhances medical students' clinical and anatomical comprehension and ability to orient to ultrasound imagery for MSK anatomy. This study supports early ultrasound education as a mechanism to encourage students' independent learning as evidenced by many undertaking voluntary investigation of clinical concerns associated with MSK anatomy. This study establishes the successful integration of MSK ultrasound into a large medical school program and its benefit to student clinical education.
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Affiliation(s)
- Casey C Brown
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Shalynn D Arrington
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
- Universal Health Services (UHS) Southern California Medical Education Consortium, Temecula Valley Hospital, Temecula, California, USA
| | - Jay F Olson
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
- Comanche County Memorial Hospital, Lawton, Oklahoma, USA
| | - Charles A Finch
- Department of Integrated Medicine, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
| | - Randall L Nydam
- Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona, USA
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Cantisani V, Jenssen C, Dietrich CF, Ewertsen C, Piscaglia F. Clinical Practice Guidance and Education in Ultrasound: Evidence and experience are two sides of one coin! ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:7-11. [PMID: 35135016 DOI: 10.1055/a-1699-7473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Vito Cantisani
- Radiological and Anatomo-Pathological and Oncological Sciences, Univ. Sapienza, Rome
| | - Christian Jenssen
- Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany and Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM) Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
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Slader M, Young H, Barker M, Prentice K, Bogaard K, Yuan C, Saadat S, Lahham S. A comparison of handheld and standard ultrasound in Swiss medical students. World J Emerg Med 2022; 13:85-90. [PMID: 35237360 PMCID: PMC8861347 DOI: 10.5847/wjem.j.1920-8642.2022.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/20/2021] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The use of ultrasound (US) within healthcare has inspired the development of new US technology. There have been few studies comparing the use of handheld US to standard US for medical education. This research aims to determine whether a handheld US device can provide a comparable primary learning experience to that of a standard US machine. METHODS Over two days of instruction, participants were taught and evaluated on core US fundamentals. The standard group received instruction on standard US machines, while the handheld group received instruction on handheld US devices. Participants completed a qualitative survey regarding their experience. Six hundred and four images were obtained and graded by two emergency medicine physicians. RESULTS A total of 119 Swiss medical students were enrolled in our study. There was no statistically significant difference in the US assessment measurements, except for faster endpoint septal separation (EPSS) vascular setup time in the handheld group (P=0.001). There was no statistically significant difference in participants' perceived difficulty of US learning (P=0.198), comfort level (P=0.188), or self-estimated capability to perform US in the future (P=0.442). There was no statistically significant difference in the percentage of correctly obtained images (P=0.211) or images that were clinically useful (P=0.256). The median quality score of images obtained by the standard group was eight compared to seven in handheld group (P<0.01). CONCLUSION Our data suggest a handheld US machine can perform as well as a standard US machine as an educational tool despite sacrifices in image quality.
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Affiliation(s)
- Mark Slader
- School of Medicine, University of California, Irvine 92617, USA
| | - Hayley Young
- School of Medicine, University of California, Irvine 92617, USA
| | - Margot Barker
- School of Medicine, University of California, Irvine 92617, USA
| | - Kylie Prentice
- School of Medicine, University of California, Irvine 92617, USA
| | | | - Charlene Yuan
- School of Medicine, University of California, Irvine 92617, USA
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine 92868, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California, Irvine 92868, USA
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Rice JA, Brewer J, Speaks T, Choi C, Lahsaei P, Romito BT. The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making. Int J Gen Med 2021; 14:9789-9806. [PMID: 34938102 PMCID: PMC8685447 DOI: 10.2147/ijgm.s339476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jake A Rice
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Brewer
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler Speaks
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Lahsaei
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Correspondence: Bryan T Romito Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9068, USATel +1 214 648 7674Fax +1 214 648 5461 Email
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Medical imaging community outreach program: lesson to students and impact to the community. J Ultrasound 2020; 24:493-498. [PMID: 33236258 DOI: 10.1007/s40477-020-00530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The community outreach program is one of the main activities of the University of Rwanda, and both staff and students get involved in this tremendous initiative to serve the community free of charge. PURPOSE The main objectives of this community engagement activity were to raise awareness of medical imaging services and abdominal ultrasound screening. METHODS The project proposal was planned by the Medical Imaging Department, University of Rwanda College of Medicine and Health Sciences, Remera Campus. It took place at Kigali's main car park. Two ultrasound machines were used, and screening was done by students under supervision of registered sonographers. A cross-sectional design with random sampling was employed, and SPSS version 21 was used for data analysis. Statistical techniques were used to calculate inter-observer reliability by comparing patient complaints and sonographic diagnosis. RESULTS Herein we report the first medical imaging community outreach, on which 86 patients received ultrasound abdominal scans free of charge. Of these, 33 (38.5%) were male and 53 (61.5%) were female. Their ages varied from 20 to 76 years, with a mean age of 48. The screened organs included the liver, gall bladder, pancreas, spleen, kidneys, urinary bladder, prostate, uterus and ovaries, and abnormalities were identified in different organs. The results showed a high degree of reliability between what was presented by the patients and measurements found after diagnosis by the sonographer. The average measure of the intraclass correlation coefficient was 0.973, with 95% confidence intervals ranging from 0.959 to 0.983 (F (85,85) = 37.537, p < 0.001). CONCLUSION This experience was beneficial to the Medical Imaging Sciences Department staff and students, as well as to the Society of Medical Imaging and Radiation in Rwanda. The results showed that this outreach was also very positive for the community at large.
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Position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee. Insights Imaging 2020; 11:115. [PMID: 33165666 PMCID: PMC7652945 DOI: 10.1186/s13244-020-00919-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
This document summarises best practice recommendations for medical imaging use of ultrasound in Europe, representing the agreed consensus of experts from the Ultrasound Subcommittee of the European Society of Radiology (ESR), the European Union of Medical Specialists (UEMS) Section of Radiology, and the European Federation of Societies for Ultrasound in Medicine and Biology. Recommendations are given for education and training, equipment and its maintenance, documentation, hygiene and infection prevention, and medico-legal issues.
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Prosch H, Radzina M, Dietrich CF, Nielsen MB, Baumann S, Ewertsen C, Jenssen C, Kabaalioğlu A, Kosiak W, Kratzer W, Lim A, Popescu A, Mitkov V, Schiavone C, Wohlin M, Wüstner M, Cantisani V. Ultrasound Curricula of Student Education in Europe: Summary of the Experience. Ultrasound Int Open 2020; 6:E25-E33. [PMID: 32885138 PMCID: PMC7458842 DOI: 10.1055/a-1183-3009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background
Despite the increasing role of ultrasound, structured
ultrasound teaching is only slowly being integrated into the curricula of
medical schools and universities all over Europe.
Aim
To survey the current situation at European universities regarding
the integration of ultrasound in student medical education and to report on
models of student ultrasound training from selected European universities.
Methods
A questionnaire survey focusing on the implementation of
curricular ultrasound education was sent out to the 28 presidents of the
national ultrasound societies of the European Federation of Societies for
Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the
questionnaires to the medical universities of their countries.
Results
Overall, 53 questionnaires were returned from 46 universities in
17 European countries. In most of the universities (40/46 universities,
87%), the theoretical background of ultrasound is taught. However, in
only a minority of universities is ultrasound integrated in anatomy courses
(8/46 universities, 17%) or basic science courses (16/46
universities, 35%). Practical skills in ultrasound are taught in
56% of the universities (26/46 universities) and tested in a
practical exam in seven of the responding universities (15%). The number
of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The
respondents reported that lack of time and limited faculty funding were major
hurdles.
Conclusion
According to our survey, only a minority of European
universities has integrated ultrasound into the preclinical curriculum thus far.
Future EFSUMB initiatives will continue to promote the introduction of
ultrasound as an integrative part of the core curriculum of student medical
education, and the preparation of proper teaching material.
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Affiliation(s)
- Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Maija Radzina
- Riga Stradins University, Radiology department, Riga, Latvia.,University of Latvia, Medical Faculty, Paula Stradina clinical university hospital, Diagnostic Radiology Institute Riga, Latvia
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sven Baumann
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | | | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg, and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
| | | | - Wojciech Kosiak
- Department of Paediatrics, Haematology and Oncology, Medical University of Gdansk, Poland
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare Trust, UK
| | - Alina Popescu
- Department of Gastroenterology, "Victor Babeș" University of Medicine and Pharmacy Timișoara, Timișoara, Romania
| | - Vladimir Mitkov
- Diagnostic Ultrasound Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation)
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Matthias Wüstner
- Central Interdisciplinary Sonography, Krankenhaus der Barmherzigen Brüder Trier, Germany
| | - Vito Cantisani
- Department of Radiological, Oncologic and Anatomo-pathologic Sciences, University of Rome La Sapienza, Roma, Italy
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Nausheen F, Young C, Brazil J, Dunagan T, Bhupathy R, Elango S, Crowley J. Confidence Level and Ability of Medical Students to Identify Abdominal Structures After Integrated Ultrasound Sessions. Ultrasound Int Open 2020; 6:E7-E13. [PMID: 32728657 PMCID: PMC7383059 DOI: 10.1055/a-1199-1578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/10/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose Determine the confidence level and ability of first year medical
students to identify abdominal structures using a wireless portable ultrasound
scanner. Methods The students were assessed for their confidence and ability to
perform abdominal ultrasound. The 5-point Likert survey included questions on
their perception about ultrasound as a resource for learning anatomy, physical
examination skills, and the quality of the pre-session instructions. Data was
also recorded by the faculty about the students’ ultrasound skills and
confidence. Goodman and Kruskal's gamma was used to demonstrate an
association between the students’ ability to identify the structures and
the self-reported student confidence level. Results Most of the students had confidence and were able to identify the
liver, kidney, and urinary bladder, while almost half of them needed faculty
help them to identify the inferior vena cava and aorta. The spleen and gall
bladder were the most difficult to locate even for the very confident students.
The perception of supervising faculty was that the confidence level was low in
most of the students and only 13–20% of students felt
“very confident” about performing ultrasound. Almost 37%
needed encouragement and support and almost 10% of the students were not
willing to try to locate difficult organs. Some students started locating the
ureteric jet and portal vein. Most of the students agreed that ultrasound is an
excellent resource for learning anatomy and physical examination skills. All
students suggested having more ultrasound sessions. Conclusion Most of the students feel confident about performing
ultrasound and they perceive that ultrasound can enhance their basic sciences
and physical examination skills.
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Affiliation(s)
- Fauzia Nausheen
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Corey Young
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - John Brazil
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Timothy Dunagan
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Renu Bhupathy
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Sambandam Elango
- Medical Education, California University of Science and Medicine, San Bernardino, United States
| | - Jason Crowley
- Medical Education, California University of Science and Medicine, San Bernardino, United States
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Nayahangan LJ, Albrecht-Beste E, Konge L, Brkljačić B, Catalano C, Ertl-Wagner B, Riklund K, Bachmann Nielsen M. Consensus on technical procedures in radiology to include in simulation-based training for residents: a European-wide needs assessment. Eur Radiol 2020; 31:171-180. [PMID: 32725331 DOI: 10.1007/s00330-020-07077-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/21/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify and prioritize technical procedures for simulation-based training that should be part of the education of residents in radiology. METHODS This European-wide needs assessment study used a modified Delphi technique to gather consensus from different key education stakeholders in the field. The first round was a brainstorming phase to identify all procedures that a newly specialized radiologist should potentially be able to do. In the second round, each procedure was explored for the need for simulation training; the participants determined frequency, number of radiologists performing the procedure, impact on patient comfort and safety, and feasibility of simulation. The result of this round was sent back to the participants for final evaluation and prioritization. RESULTS Seventy-one key education stakeholders from 27 European countries agreed to participate and were actively involved in the Delphi process: response rates were 72% and 82% in the second and third round, respectively. From 831 suggested procedures in the first round, these were grouped and categorized into 34 procedures that were pre-prioritized in the second round according to the need for simulation-based training. In the third round, 8 procedures were eliminated resulting in final inclusion of 26 procedures. Ultrasound procedures were highly ranked including basic skills such as probe handling; abdominal ultrasound; and ultrasound of kidneys, retroperitoneum, intestines, and scrotum. CONCLUSION The prioritized list of procedures represents a consensus document decided upon by educational stakeholders in radiology across Europe. These procedures are suitable for simulation and should be an integral part of the education of radiologists. KEY POINTS • The 26 identified procedures are listed according to priority and should be included as an integral part of simulation-based training curricula of radiologists across Europe. • This needs assessment is only the first step towards developing standardized simulation-based training programs that support the harmonization of education and training across Europe.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES) and The Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark.
| | - Elisabeth Albrecht-Beste
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES) and The Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Boris Brkljačić
- Department of Diagnostic and Interventional Radiology, University Hospital "Dubrava", Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Carlo Catalano
- Department of Radiological Sciences, University La Sapienza, Rome, Italy
| | - Birgit Ertl-Wagner
- Institute of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Michael Bachmann Nielsen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Abstract
Background: Focused cardiac ultrasound (FCU) is widely used by healthcare providers to answer specific questions about cardiac structure and function at the bedside. Currently, no widely accepted FCU image acquisition checklist exists to assess learners with varying skill levels from different specialties. Objective: The primary objective of this project was to develop a consensus-based FCU image acquisition checklist using a multispecialty group of point-of-care ultrasound (POCUS) experts. Methods: The essential components of an FCU examination were identified on the basis of published recommendations from echocardiography and international ultrasound societies. A checklist of the essential components of an FCU examination was drafted. A panel of POCUS experts from different medical specialties in the United States and Canada was convened to vote on each checklist item by answering two questions: 1) Is this item important to include in a checklist of essential FCU skills applicable to any medical specialty? and 2) Should the learner be required to successfully complete this item to be considered competent? A modified Delphi approach was used to assess the level of agreement for each checklist item during four rounds of voting. Checklist items that achieved an agreement of 80% or greater were included in the final checklist. Results: Thirty-one POCUS experts from seven different medical specialties voted on sixty-five items to be included in the FCU image acquisition assessment tool. The majority of POCUS experts (61%) completed all four rounds of voting. During the first round of voting, 59 items reached consensus, and after revision and revoting, an additional 3 items achieved 80% or greater consensus. A total of 62 items were included in the final checklist, and 57 items reached consensus as a requirement for demonstration of competency. Conclusion: We have developed a multispecialty, consensus-based FCU image acquisition checklist that may be used to assess the skills of learners from different specialties. Future steps include studies to develop additional validity evidence for the use of the FCU assessment tool and to evaluate its utility for the translation of skills into clinical practice.
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Cevik AA, Cakal ED, Abu-Zidan F. Point-of-care Ultrasound Training During an Emergency Medicine Clerkship: A Prospective Study. Cureus 2019; 11:e6118. [PMID: 31723483 PMCID: PMC6844539 DOI: 10.7759/cureus.6118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim This study evaluated the effects of three-hour instructor-led training courses in the Extended Focused Assessment Sonography for Trauma (EFAST) and Rapid Ultrasound in Shock and Hypotension (RUSH) protocols on knowledge gain and retention by final-year medical students. Methods This prospective study evaluated 79 final year medical students participating in an emergency medicine (EM) clerkship during the 2017-2018 academic year. None of the included students had prior formal ultrasound training or hands-on experience. All students participated in three-hour training courses on the EFAST and RUSH protocols, with training on each protocol involving one hour of didactic training and two hours of practical training. Knowledge improvement was measured by testing before and after each course, and knowledge retention was evaluated on a final clerkship multiple choice question (MCQ) examination. Results Median scores were significantly higher after rather than before both the EFAST (15; range, 12-19 vs. 7; range, 2-18; p < 0.0001) and RUSH (16; range, 6-20 vs. 6; range, 1-13; p < 0.0001) courses. EFAST knowledge was significantly higher than RUSH knowledge before (p = 0.04) but not after (p = 0.82) taking the respective course. The RUSH score was significantly lower than the EFAST score on the final clerkship MCQ examination (p < 0.0001). Conclusions Three hours of instructor-led ultrasound training given during an EM clerkship significantly increased knowledge of both the EFAST and RUSH protocols. Knowledge retention after two weeks was higher for the EFAST than the RUSH protocol. A longer period of RUSH training may improve the retention of knowledge.
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Affiliation(s)
- Arif Alper Cevik
- Internal Medicine, Emergency Medicine Section, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, ARE
| | - Elif Dilek Cakal
- Emergency Medicine, Mersin City Education and Research Hospital, Mersin, TUR
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15
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Abstract
Ultrasound (US) is an important imaging tool and the most commonly used imaging modality worldwide. Although US requires expertise to be performed at the highest quality levels, basic US exams can be learned by most physicians and medical technologists with knowledge of human anatomy and with physical examination skills. The full potential of US is achieved when it is more than a pure “imaging modality”, but instead an integrated clinical, physical, and imaging assessment in which the examiner interacts directly and personally with the patient. Specific diagnostic US knowledge is strongly encouraged for specialist training in clinical disciplines.
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Dietrich CF, Hoffmann B, Cantisani V, Dong Y, Hari R, Nisenbaum H, Nicholls D, Nolsøe CP, Radzina M, Recker F, Serra A, Sweet L, Westerway S, Blaivas M. Medical Student Ultrasound Education, a WFUMB Position Paper, Part I, response to the letter to the Editor. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1857-1859. [PMID: 30981532 DOI: 10.1016/j.ultrasmedbio.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Ultrasound Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Vito Cantisani
- Department of Imaging Diagnostics, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Roman Hari
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern, Bern, Switzerland
| | - Harvey Nisenbaum
- Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Delwyn Nicholls
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Christian Pállson Nolsøe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital Copenhagen Academy for Medical Education and Simulation Ultrasound Section, University of Copenhagen, Copenhagen, Denmark
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, And Radiology Research Laboratory, Riga Stradins University University of Latvia, Riga, Latvia
| | - Florian Recker
- Department of Obstetrics and Gynecology And Sono Education Academy, University Hospital Bonn, Bonn, Germany
| | - Andreas Serra
- Department of Internal Medicine and Nephrology, EFSUMB Learning Center, Klinik Hirslanden, Zürich, Switzerland
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sue Westerway
- School of Dentistry & Health Science, Charles Sturt University, New South Wales, Australia
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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17
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Byrne C, Kahl N, Knight B, Lee M, Morley S, Lahham S, Bingisser R, Thompson M, Shniter I, Valdes V, Fox JC. A Prospective Evaluation of Point of Care Ultrasound Teaching in Switzerland. J Med Ultrasound 2019; 27:92-96. [PMID: 31316219 PMCID: PMC6607874 DOI: 10.4103/jmu.jmu_57_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023] Open
Abstract
Context: As the utility of point-of-care ultrasound (POCUS) continues to expand in the medical field, there is a need for effective educational methods. In Switzerland, medical education follows the European model and lasts 6 years, focusing on preclinical training during the first 2 years. No previous studies have evaluated the optimal time for teaching ultrasound in European medical education. Aims: The aim of this study is to provide ultrasound training to medical students in Switzerland at varying times during their clinical training to determine if the level of training plays a role in their ability to comprehend and to apply basic POCUS skills. Methods: We performed an observational study utilizing a convenience sample of Swiss medical students between July 11, 2016 and August 6, 2016. They were taught a 2-day POCUS course by five American-trained 1st-year medical students. Following this course, students were evaluated with written and clinical examination. Results: 100 Swiss medical students were enrolled in the study. A total of 59 of these students were early clinical students, and 41 students were late clinical students. A two-tailed t-test was performed and demonstrated that the late clinical students performed better than the early clinical students on the written assessment; however, no difference was found in clinical skill. Conclusion: Our data suggest that Swiss medical students can learn and perform POCUS after a 2-day instructional taught by trained 1st-year American medical students. No difference was found between students in early clinical training and late clinical training for the ability to perform POCUS.
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Affiliation(s)
- Connor Byrne
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Nico Kahl
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Brian Knight
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Monica Lee
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Stephanie Morley
- School of Medicine, University of California Irvine, Irvine, California, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | | | - Maxwell Thompson
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - Inna Shniter
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - Victoria Valdes
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
| | - John C Fox
- Department of Emergency Medicine, University of California Irvine, Irvine, California, USA
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18
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Feilchenfeld Z, Kuper A, Whitehead C. Stethoscope of the 21st century: dominant discourses of ultrasound in medical education. MEDICAL EDUCATION 2018; 52:1271-1287. [PMID: 30334276 DOI: 10.1111/medu.13714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/11/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education. METHODS We conducted a Foucauldian critical discourse analysis (CDA) to identify and analyse discourses that legitimise and privilege the use of POCUS in medical education. We assembled an archive of 473 texts published between 1980 and 2017. Each article in the archive was analysed to identify frequently occurring truth statements (expressing concepts whose truths are unquestioned within particular discourses) that we used to characterise the major discourses that construct representations of POCUS in medical education. RESULTS We identified three dominant discourses: (i) a visuo-centric discourse prioritising the visual information as truth over other clinical data; (ii) a utilitarian discourse emphasising improvements in patient care; and (iii) a modernist discourse highlighting the current and future needs of clinicians in our technological world. These discourses overlap and converge; the core discursive effect makes the further elevation of POCUS in medical education, and the resulting attenuation of other curricular priorities, appear inevitable. CONCLUSIONS The three dominant discourses identified in this paper engender ideal conditions for the proliferation of POCUS in medical education through curricular guidelines, surveys of adherence to these guidelines and authoritative position statements. By identifying and analysing these dominant discourses, we can ask questions that do not take for granted the assumed truths underpinning the discourses, highlight potential pitfalls of proposed curricular changes and ensure these changes truly improve medical education.
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Affiliation(s)
- Zac Feilchenfeld
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- The Wilson Centre, Toronto, ON, Canada
| | - Cynthia Whitehead
- The Wilson Centre, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
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19
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Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 45:271-281. [PMID: 30497768 DOI: 10.1016/j.ultrasmedbio.2018.09.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
The introduction of ultrasound into medical student education is well underway in many locations around the world, but is still in its infancy or has yet to begin in others. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. In this article, we discuss the state of the art of ultrasound in medical education throughout the world, as well as various methodologies utilized to improve student education and to incorporate ultrasound into every facet of training. Experiences from various educational systems and available evidence regarding the impact of ultrasound education are summarized. Representing multiple societies and specialties throughout the world, we discuss established modern as well as novel education structures and different successful approaches.
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20
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Dietrich CF. [Ultrasound in Student Education]. PRAXIS 2018; 107:1267-1271. [PMID: 30424694 DOI: 10.1024/1661-8157/a003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ultrasound in Student Education Abstract. The subject 'Ultrasound in Medicine', already introduced during the studies increases the motivation of students by its practical character and combines basic medical knowledge (anatomy, physiology) and imaging with clinical applications in a unique way. This is done on the one hand as a point of care method (POCUS) at the point of decision-making, and on the other hand as a 'radiological' method with intervention options. POCUS is the use of ultrasound by physicians to correctly identify problems and implement solutions at the point of action. Both the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB) have published position papers on the targeted application of ultrasound technology (point of care), the status of which is reported here.
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21
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Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nuernberg D, Schreiber-Dietrich D, Dietrich CF. How to perform gastrointestinal ultrasound: Anatomy and normal findings. World J Gastroenterol 2017; 23:6931-6941. [PMID: 29097866 PMCID: PMC5658311 DOI: 10.3748/wjg.v23.i38.6931] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/30/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatory bowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both low-frequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth.
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Affiliation(s)
- Nathan S S Atkinson
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Robert V Bryant
- School of Medicine, University of Adelaide, Adelaide, South Australia, 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie, Klinikum Lüneburg, 21339 Lüneburg, Germany
| | - Torsten Kucharzik
- Department of Gastroenterology, Städtisches Klinikum Luneburg gGmbH, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, 20157 Milan, Italy
| | - Anil K Asthana
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne 3004 Vic, Australia
| | - Michael Blaivas
- Piedmont Hospital, Department of Emergency Medicine, Atlanta, GA 30076, United States
| | - Adrian Goudie
- Fremantle Hospital and Health Service, Emergency Department, Fremantle, WA 6160, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen N-5021, Norway
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Dieter Nuernberg
- Department of Gastroenterology, Brandenburg Medical School, 16816 Neuruppin, Germany
| | | | - Christoph F Dietrich
- Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim, D-97980 Bad Mergentheim, Germany
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22
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Feilchenfeld Z, Dornan T, Whitehead C, Kuper A. Ultrasound in undergraduate medical education: a systematic and critical review. MEDICAL EDUCATION 2017; 51:366-378. [PMID: 28118684 DOI: 10.1111/medu.13211] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/26/2016] [Accepted: 08/15/2016] [Indexed: 05/18/2023]
Abstract
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.
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Affiliation(s)
- Zac Feilchenfeld
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Cynthia Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
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Damjanovic D, Goebel U, Fischer B, Huth M, Breger H, Buerkle H, Schmutz A. An easy-to-build, low-budget point-of-care ultrasound simulator: from Linux to a web-based solution. Crit Ultrasound J 2017; 9:4. [PMID: 28211003 PMCID: PMC5313493 DOI: 10.1186/s13089-017-0061-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hands-on training in point-of-care ultrasound (POC-US) should ideally comprise bedside teaching, as well as simulated clinical scenarios. High-fidelity phantoms and portable ultrasound simulation systems are commercially available, however, at considerable costs. This limits their suitability for medical schools. A Linux-based software for Emergency Department Ultrasound Simulation (edus2TM) was developed by Kulyk and Olszynski in 2011. Its feasibility for POC-US education has been well-documented, and shows good acceptance. An important limitation to an even more widespread use of edus2, however, may be due to the need for a virtual machine for WINDOWS® systems. Our aim was to adapt the original software toward an HTML-based solution, thus making it affordable and applicable in any simulation setting. METHODS We created an HTML browser-based ultrasound simulation application, which reads the input of different sensors, triggering an ultrasound video to be displayed on a respective device. RFID tags, NFC tags, and QR Codes™ have been integrated into training phantoms or were attached to standardized patients. The RFID antenna was hidden in a mock ultrasound probe. The application is independent from the respective device. RESULTS Our application was used successfully with different trigger/scanner combinations and mounted readily into simulated training scenarios. The application runs independently from operating systems or electronic devices. CONCLUSION This low-cost, browser-based ultrasound simulator is easy-to-build, very adaptive, and independent from operating systems. It has the potential to facilitate POC-US training throughout the world, especially in resource-limited areas.
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Affiliation(s)
- Domagoj Damjanovic
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Benedikt Fischer
- Information Technology Section, Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Martin Huth
- Information Technology Section, Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Hartmut Breger
- Information Technology Section, Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Axel Schmutz
- Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
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24
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Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nolsøe C, Nürnberg D, Dietrich CF. WFUMB Position Paper. Learning Gastrointestinal Ultrasound: Theory and Practice. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2732-2742. [PMID: 27742140 DOI: 10.1016/j.ultrasmedbio.2016.08.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Gastrointestinal ultrasound (GIUS) is an ultrasound application that has been practiced for more than 30 years. Recently, GIUS has enjoyed a resurgence of interest, and there is now strong evidence of its utility and accuracy as a diagnostic tool for multiple indications. The method of learning GIUS is not standardised and may incorporate mentorship, didactic teaching and e-learning. Simulation, using either low- or high-fidelity models, can also play a key role in practicing and honing novice GIUS skills. A course for training as well as establishing and evaluating competency in GIUS is proposed in the manuscript, based on established learning theory practice. We describe the broad utility of GIUS in clinical medicine, including a review of the literature and existing meta-analyses. Further, the manuscript calls for agreement on international standards regarding education, training and indications.
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Affiliation(s)
- Nathan S S Atkinson
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert V Bryant
- School of Medicine, University of Adelaide, Adelaide, South Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Torsten Kucharzik
- Stadtisches Klinikum Luneburg gGmbH, Department of Gastroenterology, Lüneburg, Germany
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy
| | - Anil K Asthana
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Medicine. Department of Emergency Medicine, Piedmont Hospital Newnan, Georgia, USA
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Denmark
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25
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Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2:E2-7. [PMID: 27689163 DOI: 10.1055/s-0035-1569413] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.
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Affiliation(s)
- V Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - C F Dietrich
- Medizinische Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
| | - R Badea
- Department of Ultrasonography, 3rd Medical Clinic, Institute of Gastroenterology and Hepatology Octavian Fodor; Imaging Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - S Dudea
- Radiology Department "Iuliu Hatieganu" Univ. Med. Pharm. Cluj-Napoca, Romania
| | - H Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Austria
| | - E Cerezo
- Calle Francisco Silvela #124, lo 3 Madrid, Spain
| | - D Nuernberg
- Department of Gastroenterology, Brandenburg University of Medicine Theodor Fontane, Neuruppin
| | - A L Serra
- Department of Internal Medicine and Nephrology, Ultrasound Learning Center, Hirslanden Clinic, Zürich, Switzerland
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, UK
| | - M Radzina
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - F Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - M Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Ewertsen
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Săftoiu
- Gastroenterology Department, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | | | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
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