Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study

Abdominal and Bowel Ultrasound Knowledge Among Young Gastroenterologists: Results of an Italian Survey

Background: The diagnostic accuracy of abdominal ultrasound (US) is operator-dependent and, therefore, influenced by inadequate training and lack of continuous medical education. To fill this gap, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has developed guidelines to identify minimum training requirements for US. The aim of our survey was to assess the self-reported overall US education level among young Italian gastroenterologists. Methods: The Italian Association of Young Gastroenterologists and Endoscopists (Associazione Giovani Gastroenterologi ed Endoscopisti Italiani, AGGEI) developed a web-based survey with a multiple-choice test with images, based on the EFSUMB recommendations. The survey was distributed via e-mail to AGGEI members. Results: The questionnaire was filled out by 110 participants from all over Italy. Most of the respondents worked in academic hospitals and were gastroenterology residents or PhD students. More than half (58.9%) learned US during their gastroenterology training and 8.2% attended specific courses. During their training participants performed a median number of 320 abdominal USs and 240 bowel USs. Participants receiving a longer training period ranked significantly better in the knowledge questionnaire. Conclusions: Young Italian gastroenterologists show heterogeneous training in residencies across the country. In the future learning and hands-on training courses endorsed by academies are needed to fill this knowledge and skill gap.

Impact and reception of point-of-care ultrasound training across medical education levels

BACKGROUND

Point-of-care ultrasound (POCUS) is a versatile and cost-effective technology that can significantly enhance medical education and clinical practice. This study examines the acceptance of POCUS among medical students and explores strategies to optimize its integration into their training.

MATERIALS AND METHODS

A total of 318 medical students, spanning both preclinical and clinical semesters, participated in seminars that included POCUS demonstrations and hands-on practice. Their perceptions were assessed through a voluntary questionnaire based on the Technology Acceptance Model (TAM), which furthermore explored the ideal timing and potentially suitable subjects for integrating POCUS into the curriculum, with an emphasis on its role in developing clinical skills and supporting decision-making.

RESULTS

Among preclinical students, 60.7% had no prior ultrasound exposure, while 97% of clinical students reported some experience, albeit often limited. Despite the majority of senior students having some ultrasound experience, many lacked confidence in its use. Confidence in sonography skills was generally low across both groups, with 95.9% of preclinical and 79.4% of clinical students expressing a lack of confidence. Importantly, both preclinical and clinical students recognized the high usefulness of POCUS skills and rated the technology as user-friendly, with clinical students perceiving it as slightly easier to use. When asked to identify the most suitable subjects for POCUS training, students most frequently cited anatomy (35.2%) and internal medicine (16.7%). Additionally, a majority of students (57.7%) advocated for POCUS education to begin as early as the first semester.

CONCLUSION

This study highlights a significant gap in ultrasound training among medical students, while also underscoring their strong motivation to learn and their positive perception of POCUS as a valuable tool for enhancing clinical skills and decision-making. The findings emphasize that early integration of sonography into the medical curriculum is both highly desired by students and essential for advancing medical education. This is particularly timely and important given the growing role of artificial intelligence in ultrasound technology and the opportunities expected to emerge from this integration.

Ultrasound education, competencies and expected future use among medical interns in Denmark: a national cross-sectional study

BACKGROUND

Point-of-care ultrasound is increasingly used across medical specialties, calling for timely and relevant ultrasound education in specialty training. To enable customizing such education, we aimed to explore medical interns' received ultrasound education during medical school and internship, perceived scanning competencies, evaluation of received education, future expectations for using ultrasound, and tendencies for perceiving ultrasound competence.

METHODS

This was a national cross-sectional study. We developed a questionnaire based on a theoretical conceptual model, individual interviews with medical interns and focus groups with medical students, followed by pilot testing. The questionnaire was distributed to all medical interns in Denmark (N = 1231). Data were summarized with descriptive statistics. Differences between universities and tendencies for perceiving ultrasound competence were analyzed with Fisher's exact tests and modified Poisson regression, respectively.

RESULTS

Responses from 420 (34.1%) interns were included. Although varying across medical schools, 95.7% received formal ultrasound training and 86.0% encountered ultrasound examinations through clinical rotation. During internship, 44.2% received formal training, while 68.5% had to pursue it independently. Ultrasound examinations during clinical work were observed by 73.2% and performed by 47.6%. Common ultrasound usage barriers were insufficient scanning routine, supervision, knowledge, confidence and mental surplus. Ultrasound competence gain from medical school and internship was reported by 75.2% and 55.3%, respectively, but mainly to lesser/some extent. Most desired more training, expected to use ultrasound in the future (71.0%) and considered it a core competence (73.0%). Perceived ultrasound competence was significantly associated with receiving practical (RR: 4.08) or both practical and theoretical education (RR: 4.34) in medical school, and practical training on patients (RR: 1.09), required number of performed scans (RR: 1.06), competence test(s) (RR: 1.07), and/or consulting books/encyclopedia (RR:1.07) during internship.

CONCLUSIONS

Ultrasound training is part of medical school curricula but varies in type and extent. While most encounter and many use ultrasound during internships, formal training is less integrated. Most desire more training and attitudes towards future ultrasound usage are positive. Filled curricula pose dilemmas for prioritization and several barriers prevail for using ultrasound, representing missed opportunities for competence development and maintenance. Training governance and scaffolding continuous learning may be needed.

TRIAL REGISTRATION

None.

Undergraduate musculoskeletal ultrasound training based on current national guidelines-a prospective controlled study on transferability

INTRODUCTION

Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university.

METHODS

A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students' medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a "Direct Observation of Practical Skills" practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2.

RESULTS

The study group rated their skills significantly higher after the course (p < 0.01). Participants expressed high satisfaction with the course design, the teaching materials, and the teachers. The study group's performance on the final written test was comparable to those of control group 2 (p = 0.06) and significantly superior to control group 1 (p < 0.001). Additionally, the study group's performance on the practical final exam was not significantly different from control group 2 (p = 0.28), with both groups achieving scores exceeding 80%.

CONCLUSION

Both subjective and objective measures of learning suggest that an MSUS course designed for postgraduates can be effectively adapted for undergraduate medical students. Incorporating MSUS training into the clinical curriculum is recommended to enhance future medical professionals' educational experience and practical skills.

Point-of-Care Ultrasound training in undergraduate education in the European Union: current situation and perspectives

BACKGROUND

Given the widespread use of Point-of-Care UltraSound (PoCUS) in clinical practice, with ultrasound machines becoming more portable and affordable, recommendations and position statements from ultrasound societies now promote teaching PoCUS in the undergraduate curriculum. Nevertheless, surveys about PoCUS teaching in European medical schools are lacking. This survey aims to overview the current and future undergraduate PoCUS courses in the European Union (EU).

RESULTS

A questionnaire was sent to medical schools in 26 of the 27 countries of the EU; Luxembourg is the only country without a medical school. The survey was completed by the dean or a member of the medical school with knowledge of the medical curriculum. Of the 58 medical schools from 19 countries that responded to the survey, 18 (31.0%) from 13 (68.4%) EU countries reported the existence of an undergraduate PoCUS curriculum and a further 16 (27.6%) from 12 (41.4%) EU countries intended to offer it in the future. No significant difference was observed between the current and future PoCUS curricula regarding its content and purpose. Less than 40 h of theoretical teaching is provided in all the medical schools and less than 40 h of practical training is provided in 12 (75%) of the 16 medical schools which answered this specific question. Of the 40 (69%) surveyed medical schools that do not currently teach PoCUS, 20 (50%) intend to offer PoCUS courses in the future.

CONCLUSION

Although the lack of teaching hours in curricula suggests that most PoCUS courses are introductory in nature and that medical students are possibly not trained to become autonomous in clinical practice, evaluating the feasibility and impact of PoCUS teaching on clinical practice should be promoted. The medical schools that intend to develop this curriculum should be encouraged to implement validated tools to objectively assess their programs and students' performances.

Near-peer compared to faculty teaching of abdominal ultrasound for medical students - A randomized-controlled trial

PURPOSE

Medical schools increasingly rely on near-peer tutors for ultrasound teaching. We set out to compare the efficacy of a blended near-peer ultrasound teaching program to that of a faculty course in a randomized controlled trial.

METHODS

152 medical students received 21 hours of ultrasound teaching either by near-peer teachers or medical doctors. The near-peer course consisted of blended learning that included spaced repetition. The faculty-led course was the European common course for abdominal sonography. The primary outcome measurement was the students' ultrasound knowledge at month 6, assessed by structured examination (score 0 to 50). Secondary outcomes included scores at month 0 and changes in scores after the course.

RESULTS

Students in the near-peer group scored 37 points, and students in the faculty group scored 31 points six months after course completion. The difference of 5.99 points (95% CI 4.48;7.49) in favor of the near-peer group was significant (p<0.001). Scores immediately after the course were 3.8 points higher in the near-peer group (2.35; 5.25, p<0.001). Ultrasound skills decreased significantly in the six months after course completion in the faculty group (-2.41 points, [-3.39; -1.42], p<0.001]) but barely decreased in the near-peer group (-0.22 points, [-1.19; 0.75, p=0.66]).

CONCLUSION

The near-peer course that combined blended learning and spaced repetition outperformed standard faculty teaching in basic ultrasound education. This study encourages medical schools to use peer teaching combined with e-learning and spaced repetition as an effective means to meet the increasing demand for ultrasound training.

Principles for teaching sonography - current status

Since many young medical residents require sonographic skills early on during training, increased attention has been paid to including sonography classes in undergraduate medical education, among both professional societies and medical educators responsible for medical licensing exams. Medical schools worldwide have developed and implemented a variety of ultrasound teaching formats.This article addresses evidence-based solutions to crucial challenges in planning and implementing undergraduate sonography education. In order to achieve a sustainable increase in practical sonographic competence, we suggest small-group classes with sufficient individual hands-on scanning time for each student. We recommend concentrating on a circumscribed topic and teaching it thoroughly and practically rather than superficially outlining a broad subject area. Provided that peer teachers undergo adequate training, student peer teachers are not inferior to physicians as teachers, as far as student satisfaction, theoretical knowledge and practical skills acquisition are concerned. The assessment of acquired practical skills should consist of practical examinations, such as an objective structured clinical examination (OSCE) or a direct observation of procedural skills (DOPS). In contrast to using healthy volunteers as training models, simulation trainers allow the demonstration of pathological findings in authentic sonographic images, with the disadvantages of unrealistically easy image acquisition, as well as the lack of interaction with the patient.

Effects of standardized language on remote ultrasound-guided percutaneous nephrolithotomy training: A mixed-methods explorative pilot study

Background

Remote teaching of procedural skills has demonstrated equivalence in knowledge acquisition compared to in-person teaching. Variations in terminology for probe and needle movements may serve as a barrier in remote training of ultrasound (US)-guided renal access for percutaneous nephrolithotomy (PCNL). This pilot study investigated the utility of standardized terminology in remote training of US-guided renal access for PCNL.

Hypothesis

Standardization of verbal terminology to describe US probe and needle movement instruction improves remote teaching of US-guided renal access.

Methods

Fifteen urology residents (PGY1-6) were stratified by year and randomized into two groups. We provided participants with images illustrating US probe and needle movements labeled with predetermined standardized terminology for the intervention group and images without labels for the control group. Both groups were asked to perform US-guided renal access on a training mannequin with a remote faculty educator with (intervention) or without (control) use of standardized movement instructions. Quantitative outcomes included number of attempts and time to achieve access. All trainees completed pre- and post-session surveys and participated in focus groups; authors conducted thematic analysis of focus group transcripts.

Results

Differences in primary outcomes between groups, including number of attempts and time to achieve access of the renal pole, were not statistically significant. Analysis of focus group interviews revealed that the use of standardized terminology in the setting of remote training can reduce trainee confusion by clarifying ambiguity in educator feedback.

Discussion

Use of standardized terminology during remote surgical skills training allows for more effective feedback to trainees.

Feasibility and impact of a bespoke pre-hospital point of care ultrasound teaching and training programme at London's air ambulance service

Introduction

Point-of-care ultrasound has seen an increase in its use in pre-hospital emergency care. There is lack of literature around the training requirement for point-of-care ultrasound of pre-hospital clinicians. This service evaluation assesses the effectiveness of a bespoke hybrid teaching programme.

Methods

This is a service evaluation of the point-of-care ultrasound teaching programme at London's Air Ambulance from 1 April to 28 May 2021. Subjects' knowledge, image interpretation and confidence were assessed at two different points. Data were gathered using REDCap and exported to Excel for analysis. Mean values and delta were calculated, and t-test was applied for statistical significance.

Results

In total, 57 participants were included; out of which 11 were excluded, as they did not complete a post-course survey. Of these, 41.3% participants were point-of-care ultrasound naïve. Mean pre- and post-course scores were 76.5% and 81.7%, respectively, with an average delta improvement of 5.2% (95% confidence interval = 4.70%-5.68%) which was statistically significant (p < 0.002). There was a statistically significant mean improvement of pre- and post-course scores between point-of-care ultrasound naïve and point-of-care ultrasound experienced groups (p = 0.014). Confidence in using point-of-care ultrasound showed mean overall improvement from 2.36/4 to 3.34/4, a mean difference of 0.98 (95% confidence interval = 0.61-1.34), which was statistically significant (p = 0.0039).

Conclusion

Our service evaluation highlighted that a hybrid teaching model used by London's Air Ambulance was feasible and had shown significant improvement in the knowledge, image interpretation and confidence of both the point-of-care ultrasound naïve and the PoCUS experienced cohort of clinicians.

Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards

BACKGROUND

A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills.

METHODS

Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed.

RESULTS

A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor's didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05).

CONCLUSION

These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.

Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School-A Prospective Study

INTRODUCTION

Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses.

METHODS

From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum".

RESULTS

Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills.

CONCLUSIONS

Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.

Development and Integration of DOPS as Formative Tests in Head and Neck Ultrasound Education: Proof of Concept Study for Exploration of Perceptions

In Germany, progress assessments in head and neck ultrasonography training have been carried out mainly theoretically and lack standardisation. Thus, quality assurance and comparisons between certified courses from various course providers are difficult. This study aimed to develop and integrate a direct observation of procedural skills (DOPS) in head and neck ultrasound education and explore the perceptions of both participants and examiners. Five DOPS tests oriented towards assessing basic skills were developed for certified head and neck ultrasound courses on national standards. DOPS tests were completed by 76 participants from basic and advanced ultrasound courses (n = 168 documented DOPS tests) and evaluated using a 7-point Likert scale. Ten examiners performed and evaluated the DOPS after detailed training. The variables of "general aspects" (6.0 Scale Points (SP) vs. 5.9 SP; p = 0.71), "test atmosphere" (6.3 SP vs. 6.4 SP; p = 0.92), and "test task setting" (6.2 SP vs. 5.9 SP; p = 0.12) were positively evaluated by all participants and examiners. There were no significant differences between a basic and advanced course in relation to the overall results of DOPS tests (p = 0.81). Regardless of the courses, there were significant differences in the total number of points achieved between individual DOPS tests. DOPS tests are accepted by participants and examiners as an assessment tool in head and neck ultrasound education. In view of the trend toward "competence-based" teaching, this type of test format should be applied and validated in the future.

FoCUS cardiac ultrasound training for undergraduates based on current national guidelines: a prospective, controlled, single-center study on transferability

INTRODUCTION

In emergency and critical-care medicine, focused cardiac ultrasound (FoCUS) is indispensable for assessing a patient's cardiac status. The aim of this study was to establish and validate a peer-to-peer-supported ultrasound course for learning FoCUS-specific skills during undergraduate studies at a German university.

METHODS

A 1-day, 12 teaching units training course was developed for students in the clinical section of medical college, with content based on the current national guidelines. A total of 217 students participated in the study (97 in the course group and 120 in the control group). The course and the participants' subjective assessment of improved skills were evaluated using a questionnaire (7-point Likert scale; 7 = complete agreement and 1 = no agreement at all). Objective learning gains were assessed by tests before and after the course. These consisted of a test of figural intelligence (eight items) and a test of technical knowledge (13 items).

RESULTS

The course participants experienced significant improvement (P < 0.001) from before to after the course, with a large effect size of η²_part = 0.26. In addition, the course group had significantly better results (P < 0.001) than the control group in the post-test, with a medium to large effect size of η²_part = 0.14. No significant differences (P = 0.27) were detected in the test section on figural intelligence. The evaluations showed that the participants had a high degree of satisfaction with the course approach, teaching materials, and tutors. There was also a positive increase in their subjective assessment of their own skills, including areas such as technical knowledge, ultrasound anatomy, and performance of the examination.

CONCLUSION

The results of both the objective learning assessment and the subjective evaluations suggest that a FoCUS course originally intended for qualified physicians is equally suitable for students. With the development and provision of modern digital teaching media, even more students will be able to benefit from this approach in the future.

Development and implementation of a comprehensive ultrasound curriculum for medical students: The Bonn internship point-of-care-ultrasound curriculum (BI-POCUS)

Background

Point-of-care ultrasound (POCUS) is rapidly gaining ground within different areas of applications. Despite the high and increasing relevance of ultrasound, the availability of structured training programs in medical schools is still limited. Therefore, many doctors keep acquiring all their ultrasound skills throughout their postgraduate training. As a result, new residents lack theoretical and practical ultrasound abilities that are critical in everyday clinical practice. In order to improve this, we created and implemented a complete ultrasound curriculum for all medical students throughout their internship year that focuses on hands-on abilities in ultrasound imaging.

Methods

We used Kern's six-step model of curricular development comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback by board-certified ultrasound experts. A two rounds Delphi process with multilevel, self-completed questionnaires and individual using a 9-point Likert scale and free text comments was used to identify learning objectives and reach agreement on the content of the curriculum.

Results

The curriculum developed is aimed at students with no or little experience in their internship year and will be taught as part of their weekly-based internship training courses consisting of 2 hours of theory and 3 hours of practical training. The training will be conducted within a modular framework focusing on the key requirements of POCUS with increasing levels of complexity in accordance with the recommendations of the German Society for Ultrasound in Medicine (DEGUM), the European Federation of Societies for ultrasound in Medicine and Biology (EFSUMB) and the World Federation for ultrasound in Medicine and Biology (WFUMB). A longitudinal e-learning system will be implemented in addition to the practical and theoretical teaching units to track and examine the progress of the students.

Conclusion

Early integration of ultrasound training into medical education as part of a structured and standardized broad ultrasound curriculum enables medical students to acquire basic skills and apply them practically. Fundamental scanning skills are acquired by hands-on exercises in small, supervised groups as part of BI-POCUS. BI-POCUS therefore provides an excellent opportunity to improve the clinical skills of future physicians. More research is needed to analyze the learning outcomes for medical students and the improvement of the patient's outcome by establishing such an ultrasound curriculum.

International consensus conference recommendations on ultrasound education for undergraduate medical students

OBJECTIVES

The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students.

METHODS

64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting.

RESULTS

A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care.

CONCLUSIONS

The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic

The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.

Evaluation of an elective ultrasound course for medical students

To evaluate the educational benefits of teaching ultrasound in an elective radiological course for medical students. We conducted a single-center retrospective analysis of a one-week elective ultrasound course in which 39 medical students (25 female; median age 25.8 ± 2.8 years, range 21-35, 4th and 5th years of undergraduate medical education) participated as part of their radiological training. The students completed a pre- and post-course questionnaire using a five-point Likert scale for self-assessment of technical knowledge, confidence in the procedure regarding different organs, motivation for performing ultrasound, and the importance of ultrasound in medical education. The students also assessed the value of ultrasound teaching in the context of their general medical degree. Pre-test and post-test scores showed significantly improved radiology knowledge (p ≤ 0.001) concerning all abdominal organs (liver, spleen, gallbladder, kidney, urinary bladder, aorta and retroperitoneum). A significant improvement was registered in performing ultrasound of peripheral arteries and venous structures (each p = 0.001), and also of the thyroid gland (p = 0.006). General surveys at the end of the elective were overwhelmingly positive, with constructive criticism and complimentary comments. Systematic training in ultrasound markedly improved the students' skills. This was especially pronounced for solid organ structures, while students requested more education regarding the retroperitoneum and vascular structures. Teaching ultrasound in an elective hands-on training course improves anatomical understanding and practical skills associated with increased motivation. The results affirm the necessity and clinical relevance of the course during the radiological training of medical students.

Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey

Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors' ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians' confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with > 15 years of experience and POCUS-naïve doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%, p < 0.001) and pleural effusion (80% vs 34%, p < 0.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.

A Study to Evaluate the Practice and Training in Obstetric Ultrasound at Accredited Obstetrics and Gynaecology Training Institutions in Nigeria

Background

There is a global trend towards domiciling Obstetric and Gynaecologic ultrasound scan services and training within the Obstetrics and Gynaecology Department. This requires readiness on the part of the Obstetrics and Gynaecology residency programmes to offer hands-on training and mentorship to its trainees. This study aims to assess the services and training potential of these centres in Obstetrics and Gynaecology ultrasound in Nigeria.

Methodology

A cross-sectional descriptive questionnaire-based survey among the various tertiary health facilities which offer post graduate fellowship training in Obstetrics and Gynaecology in Nigeria was conducted. A list of all the centres accredited for obstetrics and gynaecology residency training by the National Postgraduate Medical College of Nigeria was obtained. An obstetrician was identified, and a pretested self-administered questionnaire was mailed to him as a hard copy and an electronic copy was forwarded as well. The questionnaire was filled by the Obstetrician and returned for collation. The completed forms were populated into an excel spreadsheet and summary and descriptive statistics carried out.

Results

There was a valid 71% response rate from the 56 accredited centres. Thirty five percent of the centres had established subspecialty units. Only 10% had fully functional ultrasound service that catered for over half of their clients. Half of the responding centres did not have any ultrasound scan machines, and these too lacked any trained personnel in ultrasound within the department. Nearly all respondents supported the drive towards an obstetrician led ultrasound scan service but majority cited lack of protocols, trained personnel and dedicated time as major impediments to achieving this ideal.

Conclusions

There is a lack of preparedness for domestication of obstetric ultrasound service and training in the obstetrics and gynaecology Department in Nigeria. There is the need to address the acute shortage of personnel to expand the frontiers of ultrasound service and training.

Students' Perspectives on Curricular Ultrasound Education at German Medical Schools

Background: Despite ultrasound being an inherent part of medical education, only a few German medical schools have established a comprehensive ultrasound curriculum. This study aimed to explore medical students' perspectives on ultrasound in medical education (USMed).

Results: Between January 1^st, 2019 und June 30^th, 2019, an online survey was conducted among German medical students via the students' associations and their respective teaching facilities. The survey consisted of 17 items regarding USMed. Statements were rated on a 4-point Likert scale for agreement. In total, 1040 students from 31 German medical faculties participated. The majority (1021, 98.2%) reported a very high to high interest in curricular USMed. Students agreed (n = 945, 90.9%) that USMed would be helpful along their entire course of medical studies. Considering the best starting time for USMed, the opinions of German medical students diverged: students studying in a model curriculum preferred to start in the second year (40.7%) while 49% of the students studying in a traditional curriculum preferred to start in the third year (p ≤ 0.001). An insufficient allotment of time for USMed in the planned curriculum (675, 65%) and a lack of courses run by medical faculty (305, 29.4%) were listed as perceived significant barriers to the participation in USMed. Peer teaching was regarded as an effective method in realizing USMed by 731 (70.3%) students.

Conclusion: German medical students are very interested and willing to participate in USMed. There appears to be a high demand for US courses offered by medical schools.

Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students

OBJECTIVES

The authors aim to evaluate the "point-of-care" transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol.

METHODS

The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction.

RESULTS

The cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions.

CONCLUSION

Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.

Clinical Ultrasound Education for Medical Students: Virtual Reality Versus e-Learning, a Randomized Controlled Pilot Trial

ABSTRACT

The primary aim was to evaluate the effect of immersive virtual reality learning for training medical students in basic clinical ultrasound. Secondary outcomes were to explore if virtual reality learning had an effect on hand-eye coordination skills and if the medical students wanted more virtual reality learning.This pilot study was a double-blind, parallel-group, block-randomized, controlled trial. Participants (n = 20) were blinded and randomized to virtual reality or e-learning for basic ultrasound education. Medical students with no previous ultrasound education were recruited voluntarily from the University of Southern Denmark. Data were collected during introductory courses on ultrasound from March to May 2019. Participants were assessed with Objective Structured Assessment on Ultrasound Skills. Assessing supervisors were blinded.The virtual reality group (n = 11) scored a significantly higher Objective Structured Assessment on Ultrasound Skills score (143 [95% confidence interval {CI}, 135 to 151]) compared with the e-learning group (n = 9; 126 [95% CI, 113 to 138]; mean difference, 17 points [95% CI, 4 to 30]; P < 0.01). No significant effect on the hand-eye score was found (mean difference, 3 points [95 % CI, -3 to 9]; P = 0.32). Ninety-one percent of the virtual reality group wanted more virtual reality learning.Immersive virtual reality learning improved medical students' ultrasound skills significantly compared with e-learning. The hand-eye score was higher in the virtual reality group, although not at a significant level. Students wanted more virtual reality learning. Further research is needed to clarify immersive virtual reality's educational role in the future.

Video-based, student tutor- versus faculty staff-led ultrasound course for medical students - a prospective randomized study

BACKGROUND

Ultrasound education is propagated already during medical school due to its diagnostic importance. Courses are usually supervised by experienced faculty staff (FS) with patient bedside examinations or students among each other but often overbooked due to limited FS availability. To overcome this barrier, use of teaching videos may be advantageous. Likewise, peer teaching concepts solely with trained student tutors have shown to be feasible and effective. The aim was to evaluate 1) objective learning outcomes of a combined video-based, student-tutor (ViST) as compared to a FS-led course without media support, 2) acceptance and subjective learning success of the videos.

METHODS

Two ultrasound teaching videos for basic and advanced abdominal ultrasound (AU) and transthoracic echocardiography (TTE) were produced and six students trained as tutors. Fourth-year medical students (N = 96) were randomized to either the ViST- or FS course (6 students per tutor). Learning objectives were defined equally for both courses. Acquired practical basic and advanced ultrasound skills were tested in an objective structured clinical examination (OSCE) using modified validated scoring sheets with a maximum total score of 40 points. Acceptance and subjective learning success of both videos were evaluated by questionnaires based on Kirkpatrick's evaluation model with scale-rated closed and open questions.

RESULTS

79 of 96 medical students completed the OSCE and 77 could be finally analyzed. There was no significant difference in the mean total point score of 31.3 in the ViST (N = 42) and 32.7 in the FS course (N = 35, P = 0.31) or in any of the examined basic or advanced ultrasound skill subtasks. Of the 42 ViST participants, 29 completed the AU and 27 the TTE video questionnaire. Acceptance and subjective learning success of both videos was rated positively in 14-52% and 48-88% of the rated responses to each category, respectively. Attendance of either the student or faculty tutor was deemed necessary in addition to the videos.

CONCLUSIONS

A ViST versus FS teaching concept was able to effectively teach undergraduate students in AU and TTE, albeit acceptance of the teaching videos alone was limited. However, the ViST concept has the potential to increase course availability and FS resource allocation.

Importance of Ultrasound Education in Undergraduate Medical Curriculum: A Survey Study Based on First-Year Medical Students' Perception of the 6-Year Doctor of Medicine Program of the University of Nicosia Medical School in Cyprus

Ultrasound imaging modality is a tool used in clinical practice and is being introduced gradually in the undergraduate curriculum of several medical schools worldwide. This study aims to assess medical students' perception regarding the integration of ultrasound training as part of undergraduate education. A questionnaire was given to first-year medical students after a 2-hour-long session, which was developed to introduce them in the fundamental physics theory and function of ultrasound equipment in the clinical practice. Analysis of the results indicated that students acknowledged that ultrasound training would improve their knowledge of internal medicine (P = 0.027) and of different diagnostic modalities (P = 0.019), and enhance their medical decision making (P = 0.0004). Moreover, students found beneficial the ultrasound education regarding correlating clinical knowledge with basic sciences (P = 0.0004). The study pointed out that the majority of first-year students have the opinion that the integration of ultrasound training in the medical program is valuable in medical education and patient care. However, work is needed to determine how to provide an optimal learning environment and to assess the competency of the training sessions.

Position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee

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.

Pre-operative transthoracic echocardiography in ambulatory surgery-A cross-sectional study

BACKGROUND

Cardiac disease and aberrations in central volume status are risk factors for perioperative complications, and should be identified prior to surgery. This study investigated the benefit of transthoracic echocardiography (TTE) for pre-operative identification of cardiac disease and hypovolemia in ambulatory surgery.

METHODS

Ninety-six patients, with a mean age of 63.5 ± 12.2 years and body mass index of 27.0 ± 4.3 kg/m² , scheduled for ambulatory surgery (breast, thyroid, and minor gastrointestinal), were consecutively enrolled in this prospective observational study. Pre-operative comprehensive TTE was performed in order to assess heart failure (HF), asymptomatic left ventricular dysfunction, valvular disease, and aberrations in central volume status.

RESULTS

Pre-operative TTE identified a total of 28 cases of HF, 13 cases of HF with reduced or moderately reduced, ejection fraction (EF), and 15 cases of HF with preserved EF. Furthermore, 46 cases of asymptomatic left ventricular (LV) dysfunction were identified. 44/96 patients were hypovolemic, 16 of whom in severe hypovolemia. Seven cases of previously unknown obstructive valvular or myocardial disease and six cases of right ventricular systolic dysfunction were identified. A total of 24% (23/96) were classified as potential critical hemodynamic findings. The number needed (NNT) to treat for pre-operative TTE in order to find one critical finding was 4.2.

CONCLUSION

In this ambulatory surgical cohort, a high prevalence of pre-operative LV dysfunction and aberrations in volume status was observed. The results demonstrate that pre-operative TTE contributed valuable hemodynamic information. The standard pre-operative assessment for this cohort might need to be revised.

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.

Ultrasound Curricula of Student Education in Europe: Summary of the Experience

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.

Consensus-Based Expert Development of Critical Items for Direct Observation of Point-of-Care Ultrasound Skills

BACKGROUND

Point-of-care ultrasound (POCUS) is increasingly used in a number of medical specialties. To support competency-based POCUS education, workplace-based assessments are essential.

OBJECTIVE

We developed a consensus-based assessment tool for POCUS skills and determined which items are critical for competence. We then performed standards setting to set cut scores for the tool.

METHODS

Using a modified Delphi technique, 25 experts voted on 32 items over 3 rounds between August and December 2016. Consensus was defined as agreement by at least 80% of the experts. Twelve experts then performed 3 rounds of a standards setting procedure in March 2017 to establish cut scores.

RESULTS

Experts reached consensus for 31 items to include in the tool. Experts reached consensus that 16 of those items were critically important. A final cut score for the tool was established at 65.2% (SD 17.0%). Cut scores for critical items are significantly higher than those for noncritical items (76.5% ± SD 12.4% versus 53.1% ± SD 12.2%, P < .0001).

CONCLUSIONS

We reached consensus on a 31-item workplace-based assessment tool for identifying competence in POCUS. Of those items, 16 were considered critically important. Their importance is further supported by higher cut scores compared with noncritical items.

Use of gelatin puzzle phantoms to teach medical students isolated ultrasound transducer movements and fundamental concepts

BACKGROUND

Psychomotor skills related to the use of medical ultrasound are a fundamental, but often overlooked component of this ubiquitous medical imaging technology. Although discussions of image production/orientation, sonographic planes, and imaging/scanning techniques are common in existing literature, these discussions rarely address practical skills related to these basic concepts. The cognitive load of transducer movements and machine operation, in conjunction with learning the ultrasound representation of anatomy, may overwhelm a novice learner. Our goal was to develop and evaluate a set of ultrasound puzzle phantoms for students to use as they learn isolated, specific transducer movements and sonographic concepts. We intentionally created phantoms that contain objects that are likely familiar to students to reduce the cognitive load associated with simultaneously learning the ultrasound interpretation of anatomy.

METHODS

This preliminary evaluation of our novel, homemade, gelatin ultrasound puzzle phantoms was performed using pretests and posttests obtained by scanning an assessment phantom, and student questionnaires. Two phases of training and testing occurred with feedback from Phase 1 allowing for refinement of the puzzles and techniques for testing. Skills taught and evaluated included probe rotation, depth assessment, sliding, and tilting.

RESULTS

Twenty-eight students attended the Phase 1 training session with positive trends in students' abilities to use rotation, sliding, and tilting to answer questions, while only depth showed statistically significant improvements (p = 0.021). Overall students agreed the experience a productive use of time (86%), was beneficial (93%), and would recommend to others (93%). Fifteen (54%) students returned 3 months later. There was no significant decay in skills obtained from the prior training session. In Phase 2, 134 medical students participated, and 76 (57%) completed an online questionnaire. A majority of students agreed they had a better understanding of rotation (83%), depth (80%), sliding (88%) and tilting (55%). Similar to Phase 1, many students (75%) felt the experience was beneficial.

CONCLUSIONS

This preliminary study gave us insight into student opinions, as well as information to guide future scalability and development of additional ultrasound puzzle phantoms to aid in medical student education of isolated transducer movements and sonographic concepts prior to imaging human anatomy.

Short- and Long-Term Effects on Knowledge, Skills, and Attitudes About a Sonography Training Concept for Medical Students

Objectives:

Worldwide medical schools that provide sonography training appear to be very heterogeneous in their offerings. A medical school has developed a training program with limited resources, which used a peer teaching method, to provide sonography training. The implemented courses consist of a voluntary laboratory practical and a required didactic seminar.

Methods:

To analyze this concept, the effects on knowledge, skills, and attitudes were examined by using surveys, multiple-choice tests, and practical tests.

Results:

The teaching concept demonstrated a positive effect on theoretical knowledge, practical skills, and attitudes. Nevertheless, some practical skills such as conducting gallbladder sonography deteriorated over the time of the study.

Discussion:

The peer-teaching approach with well-trained students as instructors and tutorials in smaller groups appeared to be a key element for success. This cohort study underlines the need to provide both theoretical and practical mandatory training.

Conclusion:

Peer teaching may be a cost-effective way to teach sonography skills to medical students during their training.

Undergraduate ultrasound education at German-speaking medical faculties: a survey

Background: The purpose of this study was twofold: to assess the status of undergraduate medical ultrasound (US) education in the German-speaking area and to suggest a possible framework for a longitudinal undergraduate medical US curriculum based on the study results and a literature review. Methods: The survey included 44 medical faculties in the German-speaking area: 37 in Germany, four in Austria and three in German-speaking Switzerland. A standardized questionnaire focused on the following aspects of undergraduate medical US education: general information, organization, resources, assessment methods and evaluation. Results: Data from 28 medical faculties were analysed. 26 out of 28 medical faculties offered US courses, 21 offered compulsory as well as elective courses, four offered compulsory and one elective courses only. 27 medical faculties supported US skills implementation. Abdominal US (n=25) was most common in teaching basic US skills. A learning objective catalogue was provided at 15 medical faculties. At 22 medical faculties, medical specialists were involved in undergraduate medical US education. 24 out of 26 medical faculties thought that peer-teaching is important to convey US skills. Medical faculties used the following methods to assess US skills: objective structured clinical examination (OSCE, n=7), non-standardized practical exams (n=4), non-standardized combined oral-practical exams (n=2) or direct observation of procedural skills (DOPS, n=1). 25 out of 26 medical faculties evaluated their US courses and 19 made suggestions for improvements in undergraduate medical US education. Conclusion: Medical faculty members in the German-speaking area have recognized the relevance of undergraduate medical US education. So far, courses are offered heterogeneously with rather short hands-on scanning time and high student-instructor ratio. Based on the results of this study and a literature review we suggest a possible framework and milestones on the way to a longitudinal undergraduate medical US curriculum.

Implementation of pulmonary ultrasound training for critical care advanced practice providers

BACKGROUND AND PURPOSE

The use of pulmonary ultrasound (US) in the critical care setting has been increasing over the past 2 decades. The use of advanced practice providers (APPs) in the critical care setting is also increasing. Limited data exist regarding the clinical and educational impact of a formal pulmonary US training course for APPs working in critical care settings.

METHODS

A preimplementation and postimplementation comparative design focused on the development and implementation of a formal pulmonary US course for novice critical care APPs.

CONCLUSIONS

Eleven APPs underwent formal pulmonary US training. There was a significant increase in pulmonary US knowledge after the course, with pretest median of 13 and posttest median of 22 (p < .001; maximum score = 23). Presurvey and postsurvey comparison showed overall increase in skill and clinical use of pulmonary US. After the course, participating APPs reported a greater frequency of clinical decision-making based on US examination as measured by presurvey and postsurvey results.

IMPLICATIONS FOR PRACTICE

Implementation of a formal pulmonary US course for critical care APPs improved pulmonary US knowledge, skill, and utilization, and impacted clinical decision-making and should be a highly recommended addition to the practice setting.

[Impact of sonography simulation in the training of midwifery students]

OBJECTIVE

During their studies, French midwives need to acquire basic ultrasound skills to measure the amniotic fluid index, fetal biometry and identify fetal lie and placental positions. They have a clinical ultrasound training during their curriculum to acquire these skills. Assess the contribution that a training on an obstetrical ultrasound simulator (OUS) could make to the competence of midwives and to evaluate the best time to integrate it into their curriculum.

METHODS

Forty students in their 4th and final year in midwifery were randomized into 2 groups. Group A learned with the traditional academic course, with a clinical ultrasound training which was followed by an evaluation on an OUS (E1A). Group B was evaluated on a simulator before the clinical ultrasound training (E1B). After these initial assessments, both groups were provided with learning and training sessions on OUS, and re-evaluated in the same exercise (E2A and E2B). Group B then completed its clinical ultrasound training and was evaluated one month later on the simulator (E3B). The evaluation consisted of scoring the biometry images according to previously published quality criteria, and of assessing their competence based on a published objective and structured assessment score of ultrasound skills (OSAUS).

RESULTS

Evaluation 1 found comparable OSAUS scores (2.375/5 vs. 2.24/5 P=0.52) between the two groups (E1A vs. E1B) but a significantly higher image quality score for Group A (P=0.02). In Evaluation 2, an improvement was noted for both groups with comparable OSAUS averages between the two groups (P=0.76). After the clinical training of Group B, their OSAUS score (E3B) was significantly better than that of Group A (E1A) after their clinical training (3.45/5 vs. 2.375/5 [P=0.00017]). The same was true for the quality of their images (12.67/16 vs. 9.95/16 [P=0.003]).

CONCLUSION

Ultrasound simulation-based training, as an adjunct to ultrasound clinical training, significantly improves obstetrical ultrasound skills. The best time to train on simulators seems to be prior to clinical training on real patients.

Development and implementation of a comprehensive ultrasound curriculum for undergraduate medical students - a feasibility study

BACKGROUND

Ultrasound is one of the most important imaging techniques in clinical medicine with unique advantages. Skills in ultrasound imaging are very usefull for physicians including novices and thus also mandated by the Task Force "National Competence-Based Learning Objectives for Undergraduate Medical Education" (NKLM) in Germany and as well as by the German Ultrasound Society (Deutsche Gesellschaft für Ultraschall in der Medizin, DEGUM). Since ultrasound is best learned hands-on in very small supervised groups, we developed and implemented a comprehensive ultrasound-curriculum for all undergraduate medical students of our faculty using a peer-teaching concept.

METHODS

We used Kern's six-step model of curricular development comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational stategies, (5) implementation, and (6) evaluation and feedback.

RESULTS

The developed curriculum covers basic ultrasound of the abdomen and the throat, eFAST (Extended Focused Assessment with Sonography for Trauma), lung-ultrasound, FEEL (Focused Echocardiography in Emergency Life Support) and compression duplex sonography of the thigh deep vein system. All 5th year medical students receive a 90 min lecture on ultrasound basics by a faculty member and then a 12.5 h hands-on course divided into three sessions with one student tutor for every 4 students. The students are provided with a script (PDF-File) that covers all the learning goals, including example images of pathologies. The student tutors are trained during a 1 week ultrasound course and a 21-day rotation through seven different ultrasound laboratories. In addition, they undergo a standardized 1.5 day didactical training. Prior to the implementation for all students, the overall course was tested on 27 volunteer students. These students rated (on a 6-point Likert scale from 1 = excellent to 6 = very poor) the satisfaction with the student tutors and the faculty members as 1.4 ± .9 (mean ± stddev) and 1.3 ± .5 respectively.

CONCLUSION

A comprehensive ultrasound curriculum for all undergraduate medical students using a peer-teaching concept is feasible. Further studies are needed to evaluate in detail the learning outcomes for students and student tutors.

Outcomes of three different ways to train medical students as ultrasound tutors

BACKGROUND

In order to provide faculty-wide undergraduate ultrasound training in times of scarce resources, many medical faculties employ trained peer-student tutors to oversee the hands-on training. However, data to guide the training of ultrasound peer-student tutors are scarce. We conducted a prospective quasi-randomized study to assess the gain in theoretical knowledge and practical scanning skills of peer-student tutors who were trained with a course only, an internship only, or the combination of a course and an internship.

METHODS

A total of 44 peer-student tutors were trained by a one-week course only (C-Group, n = 21), by an internship only (I-Group, n = 10) or by a course and an internship (CI-Group, n = 13). Prior to and after the completion of the training the peer-student tutors completed an MC-test (theoretical knowledge) and an OSCE (practical scanning skills).

RESULTS

With all three education concepts, the peer-student tutors had significant and comparable gains in theoretical knowledge (C-group + 90%, I-group + 61.5%, CI-group + 114.0%) and practical scanning skills (C-group + 112.0%, I-group + 155.0% and CI-group + 123.5%), all p < 0.001.

CONCLUSION

Peer-student tutors, who were trained with a course or an internship or a course and internship improved their theoretical knowledge and their practical scanning skills significantly and to a comparable degree.

Assessing how emergency and trauma ultrasonography is taught to medical students

Objective

To evaluate a method aimed at teaching ultrasound techniques to medical students in emergency settings.

Methods

A prospective study conducted with 66 sixth-year undergraduate medical students. Students participated in theory and practicing sessions with a 5-hour load; knowledge acquisition was assessed through pre- and post-course and 90-day tests. A questionnaire were distributed to the students after course completion for theoretical and practical knowledge assessment.

Results

Average pre-test grade in theoretical content evaluation was 4.9, compared to 7.6 right after course completion, and 5.9 within 90 days (p<0.001). Questions addressing technical aspects and image acquisition were mostly answered correctly; in contrast, questions related to clinical management of patients tended to be answered incorrectly. In practical evaluation, 54 students (81.8%) were able to correctly interpret images.

Conclusion

Ultrasound applicability and image acquisition techniques can be taught to medical students in emergency settings. However, teaching should be focused on technical aspects rather than clinical management of patients.

Medical Student Ultrasound Education: A WFUMB Position Paper, Part I

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.

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.

A Single Static Breast Model Education of Ultrasound Skill in Final Year Medical Students of Burapha University

Background:

Ultrasound (US) is widely used among physicians. There has been no standardized curriculum in US for undergraduate medical students. This study aimed to assess the US image acquisition skill of final year medical students after adding 2 weeks dedicated radiology rotation.

Methods:

At our institution, there are two hospital affiliations. Two-week radiology rotation was added for the final-year students of one affiliation. These students had a chance to do the US in real-life clinical settings proctored by radiologists. At the end of the academic year, US image acquisition skill was assessed by objective structured clinical examination (OSCE) in students from both affiliations.

Results:

From 48-final-year medical students, 28 students finished the 2 week radiology rotation. OSCE mean score of the students who received radiology rotation was significantly higher than other groups with a score of 65.5 compared to 53.3, respectively (P = 0.006). The student background characteristics had no relationship with the OSCE score (P = 0.565).

Conclusion:

Results showed that exposure through a dedicated radiology rotation in only 2 weeks is helpful to improve the US skill of the medical students regardless of their background performances. Exposure to live patients is essential for students' experiences. OSCE can be used as a standardized assessment tool.

Informing the Revolution: A Needs Assessment of Ultrasound Knowledge and Skills Among Graduating Physician Assistant Students

PURPOSE

We performed a needs assessment to understand how existing physician assistant (PA) program curricula and clinical training affect students' ultrasound knowledge, skills, and competence and prepare students for performing ultrasound techniques in clinical practice.

METHODS

Students graduating from a PA program completed a 23-item questionnaire examining their ultrasound training experiences, their self-assessment of competency, and their demographics. Students also completed a 15-item ultrasound knowledge assessment.

RESULTS

Thirty-eight of 39 students (97%) completed the survey. Students received little hands-on ultrasound training, with the most hands-on training being offered during emergency medicine (44.7%), obstetrics and gynecology (42.1%), and inpatient internal medicine (39.5%) rotations. This lack of preparedness was reflected in a mean score of 47.1% (±16.4%) on the ultrasound knowledge assessment. Most students (84.2%) indicated that the ultrasound instruction they received during clinical rotations was insufficient to prepare them for clinical practice, and 84.2% desired a formal ultrasound training program in the PA program curriculum.

CONCLUSIONS

Existing PA program curricula are insufficient for developing critical skills related to ultrasonography.

Emergency physicians’ attitudes to implementing ultrasound in Dutch emergency departments after a 2-day training: A qualitative study

Background:

Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome.

Objectives:

This study aims to explore individual experiences of Dutch emergency physicians.

Methods:

We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis.

Results:

Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced.

Conclusion:

This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with.

Ultrasonography in Gastroenterology: The Need for Training

The use of ultrasonography (US) as an imaging modality in medicine has spread across almost every clinical specialty. This diffusion is based on the simplicity, accessibility, portability and affordability of the technique producing real-time high-resolution images using non-ionising radiation. On the other hand, this trend also extended the technique to settings other than healthcare, such as public facilities, private houses or remote sites. This tendency can be observed worldwide, from developing countries to prestigious medical schools and tertiary referral hospitals. Furthermore, point-of-care US (POCUS), i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. In gastroenterology, despite the essential role of endoscopy, clinical practice is highly dependent on non-endoscopic imaging techniques. However, as in other specialties, the indications of US in gastroenterology have been increasing steadily, covering a broad range of conditions. In response to the generalised employment of US by non-radiologists, institutions such as the European Federation of Societies for Ultrasound in Medicine and Biology and the Royal College of Radiologists issued recommendations to ensure high-quality practice. These theoretical and practical requisites include performing a certain number of examinations and mandatory skills in order to achieve certification to execute unsupervised US. Therefore, there is a need for modern gastroenterology to include US as a basic skill in its clinical practice. To ensure the provision of high-quality US, adequate instruction of future specialists should be guaranteed by the gastroenterology departments and required in the residency training programme.

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.

Effectiveness of a 1-Hour Extended Focused Assessment With Sonography in Trauma Session in the Medical Student Surgery Clerkship

OBJECTIVE

To demonstrate the effectiveness of incorporating 1 hour of ultrasound training on the extended focused assessment with sonography in trauma (eFAST) into the year-3 medical student surgical clerkship.

DESIGN

A prospective cohort study where participants served as self-controls. One hour of instruction in the eFAST examination, along with 3 required observed examinations, was incorporated into the year-3 surgery clerkship. Effectiveness of the training was evaluated by a preliminary and posttraining assessment. An online survey was used assessing comfort based on a 5-point Likert scale. An online quiz was used assessing knowledge, and a 2-part objective structured clinical examination (OSCE) was used assessing skill and speed. Participants also logged 3 eFAST examinations during the 10-week clerkship where they reported their comfort in performing and interpreting the eFAST on a 5-point Likert scale. Postassessment was held during the last week of the clerkship and included the same online quiz, survey, and 2-part OSCE.

SETTING

The study was performed at Loma Linda University and affiliated hospitals where surgical clerkship students rotate.

PARTICIPANTS

A total of 148 year-3 medical students completed the study.

RESULTS

All testing modalities showed improvement. The mean average of the OSCE improved from 46% ± 27% to 81% ± 18%. The percentage of participants able to perform the examination in less than 6 minutes increased from 18% ± 27% to 84% ± 36%. Participants' comfort level in recognizing eFAST pathology increased from a mean of 2.40 ± 0.94 to 3.55 ± 0.87 out of 5. Comfort in performing the eFAST examination improved from 2.81 ± 0.79 to 3.77 ± 0.68. Comfort in interpreting the eFAST examination improved from 2.88 ± 0.87 to 3.65 ± 0.72.

CONCLUSIONS

This study demonstrates that incorporating 1 hour of eFAST training into the general surgery clerkship is feasible and may lead to improved competency in performing and interpreting the eFAST examination.

Virtual Dissection by Ultrasound: Probe Handling in the First Year of Medical Education

OBJECTIVES

The aim of the present study was to assess the educational plan of first-year students of medicine by analyzing their scores in ultrasound body scanning.

METHODS

Since 2009, the San Paolo Medical School (Milan, Italy) has vertically integrated the study of anatomy with ultrasound-assisted virtual body dissection. Three modules were supplied: musculoskeletal system, heart and abdomen pelvis. 653 first-year students were trained. The students alternated as mutual model and operator. A skillfulness score was assigned to each student. The scores were consequently listed. Nonparametric exact multiple contrast tests were employed to determine relative group effects.

RESULTS

Statistical analysis showed that: no gender-related differences were found (0:49; p=0.769); peer learners performed less well than peer tutors (0.677; p=0); between modules, scores in the musculoskeletal system (pMS=0.726) tend to be higher (p<0.001) than those obtained in the heart and abdomen pelvis (pH=0.398; pAP=0.375 p=0.270); significant differences were found compared to the beginning of the project's academic year.

CONCLUSION

The students considered this didactic course an engaging and exciting approach. Acceptance of peer teaching was extraordinarily high. Autonomous exercitation allowed the students to improve self-criticism and enhance their own skills. The level of expertise obtained by peer tutors and by peer learners can be considered satisfactory. The main objective of training future physicians on personal stethoechoscope with the necessary competence seems to have been successfully started.

Teaching the basics of echocardiography in the undergraduate: Students as mentors

OBJECTIVE

To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design.

METHODOLOGY

Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures.

RESULTS

The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers.

CONCLUSIONS

Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students.