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Ultrasound in Premedical Student Education
mchilstrom@gmail.com
Posted: Monday, May 13, 2013
Joined: 12/3/2010
Posts: 1


Evidence for Using Ultrasound to teach Medical Students

 

Student perceptions of including ultrasound in anatomy:

 

University of Nebraska

Three 20 minute focused ultrasound didactic sessions integrated into Gross Anatomy curriculum (ultrasound basics, neck anatomy,us-guided procedures.)  Lectures were available via Blackboard.  Students voluntarily participated.  The majority of medical students who took the course believed it is feasible and beneficial to use ultrasound in conjunction with traditional teaching methods to teach Gross Anatomy. Medical students were very accurate in identifying sonographic vascular anatomy of the neck after brief didactic sessions.

Brown B, Adhikari S, Marx J, Lander L, Todd GL.  Introduction of ultrasound into gross anatomycurriculum: perceptions of medical students. J Emerg Med. 2012 Dec;43(6):1098-102. doi:10.1016/j.jemermed.2012.01.041. Epub 2012 Mar 28.

 

Ohio State University College of Medicine

Two 1 hour ultrasound lectures, three 1.5 hour small group hands-on sessions.  219 students, 63 completed post-course survey. 84% agreed or strongly agreed that ultrasound facilitated their understanding of anatomy. 94% agreed or strongly agreed that the hands-on sessions were useful.

Corliss B. Ultrasound in anatomy. Abstract #17 from First World Congress on Ultrasound in Medical Education April 29-May 1,2011

 

University of South Carolina School of Medicine

RCT- does integrating ultrasound in gross anatomy improve student knowledge of anatomy?  In the abdomen unit students were divided into dissection groups: anterior wall, viscera, and posterior wall.  Students in each dissection group were randomly assigned to intervention or control group. Intervention= two-hour ultrasound class before the unit quiz. Control group attended the class after the quiz.  The unit quiz consisted of 25 multiple choice questions created by the anatomy faculty; the quiz scores were compared.  Mean score was 5% greater for the intervention group (p<.05).  In the visceral dissection group, the intervention group scored 9% higher(p<0.02) than controls and also exceeded scores in both the control and intervention groups in the other two dissection groups.  Perhaps the combination of dissecting the viscera and learning ultrasound give students more opportunities to develop a3D understanding of anatomy.

Paulman L, Blanck E, Rao V, Howe D, Poston M, Hoppman R. Utility of ultrasound in teaching gross anatomy. Abstract #33 from First World Congress on Ultrasound in Medical Education April 29-May 1,2011

 

University of Melbourne

Medical, dental, and science students were given the option of participating in a one hour session.  After traditional cardiac anatomy course involving prosections, demonstrated sonographic heart anatomy on a volunteer using an AV projector,students were surveyed afterwards and felt the experience was an effective way to teach anatomy.

Ivanusic J, Cowie B, Barrington M. Undergraduate student perceptions of the use of ultrasonography in the study of "living anatomy".Anat Sci Educ. 2010 Nov-Dec;3(6):318-22. doi: 10.1002/ase.180.Epub 2010 Sep 24.

 

The University of Notre Dame Australia School of Medicine

Two hour small group session on abdominal anatomy. Students value ultrasound education, but assessments did not show appreciable impact on skills or understanding related to abdominal anatomy and examination. (Abstract)

Sweetman GM, Crawford G, Hird K, Fear MW.  The benefits and limitations of using ultrasonography to supplement anatomical understanding. N Z Med J. 2012 Sep 7;125(1361):37-45.

 

Southampton University Hospital Trust, United Kingdom.

Students took a pretest on anatomy and then were randomized to learn cardiac anatomy with prosection versus ultrasound. Post tests showed similar increase in scores. (Abstract)

Griksaitis MJ, Sawdon MA, Finn GM.  Ultrasound and cadaveric prosections as methodsfor teaching cardiac anatomy: a comparative study. Anat Sci Educ. 2012 Jan-Feb;5(1):20-6.

 

Hannover Medical School, Germany

Hands-on ultrasound workshops taught with anatomy.(Abstract)

Teichgräber UK, Meyer JM, Poulsen Nautrup C, von Rautenfeld DB. Ultrasound anatomy: a practical teaching system in human gross anatomy. MedEduc. 1996 Jul;30(4):296-8.

 

Can ultrasound be taught in conjunction with the physical exam? Does it improve PE accuracy?

 

Northwestern

First year students were taught ultrasound in conjunction with learning abdominal PE- estimation of liver size.  Taught by radiologists- 45 min session.  Proper abdominal exam technique(as assessed by standardized patients) was better with delayed US instruction.  Estimates of liver size were highly inaccurate regardless. US may boost level of skill in PE after a certain level of competency.

Butter J, Grant TH, Egan M, Kaye M, Wayne DB, Carrión-Carire V, McGaghie WC.

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination? Med Educ. 2007 Sep;41(9):843-8. Epub 2007 Aug 13.

 

Wayne State

After training in the physical examination, 307 MS2's were introduced to CV and abdominal ultrasound scanning in the form of a demonstration of the ultrasound examination and practice on standardized patients (SPs). Pre-post tests were administered to evaluate students' knowledge and understanding of ultrasound.Pre-post test data revealed significant improvements in image recognition. On the final exam, the highest scores (98.4%) were obtained for the internal jugular vein and lowest scores (74.6%) onthe Focused Assessment with Sonography for Trauma images.Eighty-nine percent of students' surveyed felt ultrasound was a valuable tool for physicians.

Afonso N, Amponsah D, Yang J, Mendez J, Bridge P, Hays G, Baliga S, Crist K, Brennan S, Jackson M, Dulchavsky S. Adding new tools to the black bag--introduction of ultrasound into the physical diagnosis course. J Gen Intern Med. 2010 Nov;25(11):1248-52

 

Cedars-Sinai

One of two medical students with 18 hours of echo training to detect valvular disease, left ventricular dysfunction, enlargement,and hypertrophy evaluated 61 patients with cardiac disease using"hand-carried ultrasound," accuracy was compared to 1 of 5board-certified cardiologists using standard physical examinations.  Standard echo was the gold standard. The students correctly identified 75% (180 of 239) of the pathologies,whereas cardiologists found 49% (116 of 239) (p<0.001). 

Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, Neuman Y, Mirocha J, Kar S, Forrester JS, Siegel RJ. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination.  Am J Cardiol. 2005 Oct 1;96(7):1002-6.

University of South Carolina School of Medicine

Six patients vertical liver spans at the mid clavicular line were measured by 10 rising second year medical students using ultrasound and 5 Internal Medicine physicians using standard physical exam (percussion/palpation) and compared to the reference gold standard of an ultrasound measurement by the GI section leader.  Students had already had up to 15 hours ultrasound instruction in their first year anatomy and physiology course and received 1 hour additional training on ultrasound for VLS measurement.  The medical student measurements were 4-22%(1.5-2.8 cm) above the reference with low inter-observer variability.  The physician measurements were 42-58% lower than the reference.

Mouratev G, Howe D, Poston M, Rao V, Reid R, Varnadoe J, Smith S, Demarco P, Hoppman R. A comparison of vertical liver span (VLS)measurements made by medical students with ultrasound and by physicians with physical exam. Abstract #34 from First World Congress on Ultrasound in Medical Education April 29-May 1,2011

 

Are Medical Students able to learn ultrasound?

 

University of Pennsylvania

MS3/MS4 volunteers taught US in context of Radiology elective,Four 2-hour sessions including reading texts, scanning with tech,questions.  All students improved knowledge and scanning skills.

Arger PH, Schultz SM, Sehgal CM, Cary TW, Aronchick J. Teaching medical students diagnostic sonography. J Ultrasound Med. 2005Oct;24(10):1365-9.

 

Mayo

First year medical students took a 3 week course on echo (90 min intro, 60 min small group training, 2 weeks independent practice oneach other) concurrent with anatomy.  Images were recorded and later evaluated by cardiologists.  Correct labeling of images and quality of images improved.

Wittich CM, Montgomery SC, Neben MA, Palmer BA, Callahan MJ, Seward JB, Pawlina W, Bruce CJ. Teaching cardiovascular anatomy to medical studentsby using a handheld ultrasound device. JAMA. 2002 Sep 4;288(9):1062-3.

 

UC Irvine

Evaluated and compared students who took 2 and 4 week 4th year ultrasound elective. The four-week student post-test score was significantly better than the two- weekpost-test score (81% vs 72%, p=0.003). On the six-month exam, the four-week student post-test score was significantly better than thetwo-week post-test score (77% vs 69%, p=0.009.)

Fox JC, Cusick S, Scruggs W, Henson TW, Anderson CL, Barajas G, Zlidenny A, McDonough J, Langdorf MI.

Educational assessment of medical student rotation in emergency ultrasound. West J Emerg Med. 2007 Aug;8(3):84-7.

 

Lake Erie College of Osteopathic Medicine-Bradenton

Five second year osteopathic medical students received 10 hours of training from a tech, then completed 40 hours scanning on each other.  Post-test training demonstrated proficiency.

Syperda VA, Trivedi PN, Melo LC, Freeman ML, Ledermann EJ, Smith TM, Alben JO. Ultrasonography in preclinical education: a pilotstudy. J Am Osteopath Assoc. 2008 Oct;108(10):601-5.

 

Imperial College London

25 volunteer medical students (MS3-5) participated in a 5 hour theoretical and practical course on the FAST exam and a subsequent1 hour OSCE (cases, problem solving exercises, FAST on a volunteerand a simulator with pathology.)  Mean score 86%. 85% of students could perform adequate FAST in <6 minutes.

Gogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P. Is basic emergency ultrasound training feasible as part of standard undergraduate medical education? J Surg Educ. 2010 May-Jun;67(3):152-6.

 

School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, UK.

14 students received focused didactic on aorta scanning, bedside training, and self-directed learning over 20 days, then did a vivaand an OSCE. 62% passed.

Wong I, Jayatilleke T, Kendall R, Atkinson P.  Feasibility of a focused ultrasound trainingprogramme for medical undergraduate students. Clin Teach. 2011 Mar;8(1):3-7.

 

University of Texas Southwestern Medical Center at Dallas

28 MS1-MS4's were randomized to receive basic ultrasound training (reading, lecture, and hands-on) vs. no training. Written test scores and hands-on task performance improved in thetrained group.

Yoo MC, Villegas L, Jones DB.Basic ultrasound curriculum for medical students:validation of content and phantom. Laparoendosc Adv Surg Tech A. 2004 Dec;14(6):374-9.

 

Mt. Sinai

Five students between MS2 and MS3 received 3 day course inultrasound and then 4 weeks of performing PE and ultrasounds onpatients in the ED and US dept.  Scans were graded for quality after the first and fifth weeks and quality improved.

Shapiro RS, Ko PK, Jacobson S.A pilot project to study the use of ultrasonography for teaching physical examination to medical students. Comput Biol Med. 2002 Nov;32(6):403-9.

 

University of Arkansas for Medical Sciences

Medical students were taught abdominal sonography by sonographers and were accurate. (Abstract)

Angtuaco TL, Hopkins RH, DuBose TJ, Bursac Z, Angtuaco MJ, Ferris EJ. Sonographic physical diagnosis 101: teaching senior medical students basic ultrasound scanning skills using a compact ultrasound system. Ultrasound Q. 2007 Jun;23(2):157-60.

 

 

 

How should we teach medical students ultrasound?

 

Peer mentoring- senior medical students are effective educators of first year students.

Jeppesen KM, Bahner DP. Teaching bedside sonography using peer mentoring: aprospective randomized trial. J Ultrasound Med. 2012 Mar;31(3):455-9.

 

Fox JC, Chiem AT, Rooney KP, Maldonaldo G. Web-based lectures, peer instruction andultrasound-integrated medical education. Med Educ. 2012 Nov;46(11):1109-10.

 

Celebi N, Zwirner K, Lischner U, Bauder M, Ditthard K, Schürger S, Riessen R, Engel C, Balletshofer B, Weyrich P. Student tutors are able to teach basic sonographic anatomy effectively - a prospective randomized controlled trial. Ultraschall Med. 2012 Apr;33(2):

 

Lecture with live model alone?

Otago School of Medical Sciences, University of Otago, New Zealand

1-hour ultrasound demonstration of 'living anatomy' of the abdomen, pelvis and neck was conducted using a young female modelas the subject.  Anonymous evaluation of 152 returnedquestionnaires (greater than and equal to 63% response rate) showed that more than 80% of respondents considered the session had stimulated and improved their understanding of anatomy

Stringer MD, Duncan LJ, Samalia L. Using real-time ultrasound to teach living anatomy:an alternative model for large classes. N Z Med J. 2012 Sep 7;125(1361):37-45. 


 
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