The Ultrasound Challenge

Undergraduate ultrasound education is becoming increasingly important to medical student development; as a result, innovative training methods are being designed and implemented. The Ultrasound Challenge was created to help students learn core ultrasound techniques and apply them in a friendly competition where they showcase their abilities. The Ultrasound Challenge consisted of 6 events: focused assessment with sonography for trauma, cardiac ultrasound, aortic ultrasound, pelvic ultrasound, vascular access, and musculoskeletal ultrasound. Thirty‐three students from all 4 years of medical school participated. Medical center residents and faculty served as judges. The Ultrasound Challenge successfully provided medical students with ultrasound experience for future clinical endeavors.     

A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review.

OBJECTIVE: Ultrasound is a versatile diagnostic modality used in a variety of medical fields. Wayne State University School of Medicine (WSUSOM) is one of the first medical schools in the United States to integrate an ultrasound curriculum through both basic science courses and clinical clerkships. METHODS: In 2006, 25 portable ultrasound units were donated to WSUSOM. First-year medical students were provided an ultrasound curriculum consisting of 6 organ-system sessions that addressed the basics of ultrasound techniques, anatomy, and procedural skills. After the last session, students were administered 2 anonymous and voluntary evaluations. The first assessed their overall experience with the ultrasound curriculum, and the second assessed their technical skills in applying ultrasound techniques. RESULTS: Eighty-three percent of students agreed or strongly agreed that their experience with ultrasound education was positive. On the summative evaluation, nearly 91% of students agreed or strongly agreed that they would benefit from continued ultrasound education throughout their 4 years of medical school. Student performance on the technical assessment was also very positive, with mean class performance of 87%. CONCLUSIONS: As residency programs adopt ultrasound training, medical school faculty should consider incorporating ultrasound education into their curriculum. Portable ultrasound has the potential to be used in many different settings, including rural practice sites and sporting events. The WSUSOM committee's pilot ultrasound curriculum will continue to use student feedback to enhance the ultrasound experience, helping students prepare for challenges that they will face in the future.     

Hunger Games: Interactive Ultrasound Imaging for Learning Gastrointestinal Physiology

Ultrasound is playing an increasingly important role in medical student education. Although most uses of ultrasound have focused on learning purely anatomic relationships or augmentation of the physical examination, there is little documentation of the value of ultrasound as a learning tool regarding physiology alone or in association with anatomy. We devised an interactive learning session for first‐year medical students using ultrasound to combine both anatomic and physiologic principles as an integration of gastrointestinal and vascular function. The incorporation of our activity, The Hunger Games, provides the foundation for a powerful integration tool for medical student education.     

The case for an ultrasound mandate

Emergency Medicine pioneered the use of ultrasound at the bedside. All of the Colleges of Emergency Medicine in the Anglo‐American system have incorporated Emergency Ultrasound into their training curriculum, and all but ACEM have made training and proficiency mandatory. Emergency Ultrasound has not taken hold in Australasia the way it has in other parts of the world. It is a unique procedure that requires a College mandate to overcome the political and financial arguments that have kept it from flourishing in our hospitals. ACEM needs to instate such a mandate.     

Early Innovative Immersion

In preparing for medical school admissions, premedical students seek opportunities to expand their medical knowledge. Knowing what students seek and what point‐of‐care ultrasound offers, we created a novel educational experience using point‐of‐care ultrasound. The innovation has 3 goals: (1) to use point‐of‐care ultrasound to highlight educational concepts such as the flipped classroom, simulation, hands‐on interaction, and medical exposure; (2) to work collaboratively with peers; and (3) to expose premedical students to mentoring for the medical school application process. We believe that this course could be used to encourage immersive innovation with point‐of‐care ultrasound, progressive education concepts, and preparation for medical admissions.     

Implementation of transvaginal ultrasound in an emergency department residency program: an analysis of resident interpretation

Background

Emergency physicians are increasingly performing transvaginal ultrasound (TVUS) to rule out ectopic pregnancy. However, little is known about appropriate educational pathways to train emergency medicine residents in TVUS.

Study Objectives

To evaluate the ability of Emergency Medicine (EM) residents who underwent a training program in TVUS to detect the presence or absence of an intrauterine pregnancy (IUP) in patients of < 13 weeks gestation with vaginal bleeding or abdominal pain, as compared to the final interpretation of each study as determined by the Emergency Department (ED) Director of Ultrasound.

Methods

This was a prospective, observational study in a single residency program. Training included a lecture, competency examination, and 10 supervised TVUSs. The EM residents then performed TVUSs with the goal of determining the presence or absence of an IUP without input from an attending physician. Correlation with the ED Director of Ultrasound was assessed for the cohort, and stratified by year of training. Results: There were 22 residents who performed 75 TVUSs over 17 months. Correlation with the ED Director of Ultrasound was 93.3%. Differences in correlation with the ED Director of Ultrasound were noted when compared by year of training: post-graduate year (PGY)-3 (93.3%), PGY-2 (92.1%), and PGY-1 (100%); p < 0.001.

Conclusion

Residents were able to perform TVUSs to determine the presence or absence of an IUP in patients in whom the diagnosis of ectopic pregnancy was being considered with a high degree of correlation with the ED Director of Ultrasound after a brief training program. Correlation with the ED director of ultrasound was influenced by year of training.     

Ultrasound Exposure During Gross Anatomy

Background

As medical schools seek to standardize ultrasound training and incorporate clinical correlations into the basic science years, we proposed that ultrasonography should have a greater role in the anatomy curriculum.

Objectives

To describe the introduction of ultrasound into the curriculum of a first-year medical student anatomy course and evaluate the utility of this introduction.

Methods

First-year medical students attended two ultrasound lectures and three small-group hands-on sessions that focused on selected aspects of musculoskeletal, thoracic, abdominal, and neck anatomy. Pre and post surveys were administered to assess student perception of their ability to obtain and interpret ultrasound images and the utility of ultrasound in the anatomy course. Understanding of basic ultrasound techniques and imaging was tested in the practical examinations.

Results

Of the 269 first-year medical students who completed the course, 144 students completed both surveys entirely, with a response rate of 53%. Students' interest and self-perceived experience, comfort, and confidence in ultrasound skills significantly increased (p < 0.001) as a result of this early introduction to ultrasonography. Objective evidence, provided by practical examination scores on ultrasound images, is consistent with this self-perceived confidence reported by students.

Conclusions

Ultrasound can be effectively incorporated into an anatomy course for first-year medical students by utilizing didactics and hands-on exposure. Medical students found the addition of ultrasound training to be valuable, not only in enhancing their understanding of anatomy, but also in increasing their interest and experience in ultrasound imaging.     

Medical students' encounters with the cadaver: A poetic response

For the past four years, the Human Values in Medicine program at the Northeastern Ohio Universities College of Medicine has sponsored the William Carlos Williams Poetry Competition for medical students (U. S. only). With over 1700 entries from hundreds of students representing nearly every medical school in the U.S., the competition has been highly successful. The pervasive themes expressed in the poetry have included personal experiences and relationships outside of medicine, the medical school experience, nature, and the physician-patient encounter. Within this last theme, I found dozens of poems on the medical student's encounter with the cadaver.

This paper examines what the medical student-poets wrote about that experience. The texts of the twenty poems each fell into one of the following categories: the attempt of the student to know the cadaver as a person, the medical secrets students discovered through dissection, and the intimate relationship between student and cadaver.

Discussion and excerpts from the poetry which illuminate each category are found in the following narrative.     

Point‐of‐Care Ultrasound Education

This article reviews the current technology, literature, teaching models, and methods associated with simulation‐based point‐of‐care ultrasound training. Patient simulation appears particularly well suited for learning point‐of‐care ultrasound, which is a required core competency for emergency medicine and other specialties. Work hour limitations have reduced the opportunities for clinical practice, and simulation enables practicing a skill multiple times before it may be used on patients. Ultrasound simulators can be categorized into 2 groups: low and high fidelity. Low‐fidelity simulators are usually static simulators, meaning that they have nonchanging anatomic examples for sonographic practice. Advantages are that the model may be reused over time, and some simulators can be homemade. High‐fidelity simulators are usually high‐tech and frequently consist of many computer‐generated cases of virtual sonographic anatomy that can be scanned with a mock probe. This type of equipment is produced commercially and is more expensive. High‐fidelity simulators provide students with an active and safe learning environment and make a reproducible standardized assessment of many different ultrasound cases possible. The advantages and disadvantages of using low‐ versus high‐fidelity simulators are reviewed. An additional concept used in simulation‐based ultrasound training is blended learning. Blended learning may include face‐to‐face or online learning often in combination with a learning management system. Increasingly, with simulation and Web‐based learning technologies, tools are now available to medical educators for the standardization of both ultrasound skills training and competency assessment.     

A Comprehensive, Unembalmed Cadaver-based Course in Advanced Emergency Procedures for Medical Students

Background: Preparing medical students for residency in emergency medicine involves education in many areas of knowledge and skill, including instruction in advanced emergency procedures. Objectives: To outline the logistics involved in running a training course in advanced emergency procedures for fourth‐year medical students and to report students' perceptions of the impact of the course. Methods: The course is a cadaver‐based training laboratory that utilizes several teaching modalities, including a Web‐based syllabus and online streaming video, didactic lecture, hands‐on practice with models and ultrasound, and hands‐on practice with unembalmed (fresh) cadavers. The course focuses on seven emergent procedural skills, including deep venous access via the subclavian, internal jugular, and femoral veins; tube thoracostomy; saphenous vein cutdown; intraosseous line placement; and emergency cricothyrotomy. The course is taught by attending emergency physicians and anatomy department faculty. After completion of the course, students reported their self‐assessments on a five‐point Likert scale. Data were evaluated using a paired t‐test (two‐tailed). Results: Thirty‐three students completed the evaluation. The students reported a mean (± standard deviation [SD]) increase in their understanding of the indications for all procedures from 3.3 (± 1.1) before to 4.8 (± 0.4) after the course (p = 0.004, 95% CI = 0.7 to 2.0). The students reported a mean increase in their understanding of how to perform all procedures from 2.1 (± 0.9) before to 4.6 (± 0.6) after the course (p = 0.003, 95% CI = 1.9 to 3.0). The students reported a mean increase in their comfort level performing all procedures from 1.6 (± 0.8) before to 4.2 (± 0.7) after the course (p < 0.001, 95% CI = 2.0 to 2.9). Conclusions: These findings support the value of an advanced emergency procedural training course using an unembalmed cadaver‐based laboratory and incorporating several teaching modalities.     

Overview of therapeutic ultrasound applications and safety considerations

Applications of ultrasound in medicine for therapeutic purposes have been accepted and beneficial uses of ultrasonic biological effects for many years. Low-power ultrasound of about 1 MHz has been widely applied since the 1950s for physical therapy in conditions such as tendinitis and bursitis. In the 1980s, high-pressure-amplitude shock waves came into use for mechanically resolving kidney stones, and "lithotripsy" rapidly replaced surgery as the most frequent treatment choice. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. Undesirable bioeffects can occur, including burns from thermal-based therapies and severe hemorrhage from mechanical-based therapies (eg, lithotripsy). In all of these therapeutic applications of ultrasound bioeffects, standardization, ultrasound dosimetry, benefits assurance, and side-effect risk minimization must be carefully considered to ensure an optimal benefit to risk ratio for the patient. Therapeutic ultrasound typically has well-defined benefits and risks and therefore presents a manageable safety problem to the clinician. However, safety information can be scattered, confusing, or subject to commercial conflicts of interest. Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the American Institute of Ultrasound in Medicine, to the medical ultrasound community. In this overview, the Bioeffects Committee of the American Institute of Ultrasound in Medicine outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for ensuring therapeutic ultrasound safety.     

Contrast‐enhanced ultrasound findings in a case of renal extramedullary hematopoiesis

We present the case of an 80‐year‐old man with two renal solid masses found at sonography, which were imaged by contrast‐enhanced ultrasound, CT, and MRI and confirmed histologically. Contrast‐enhanced ultrasound findings suggested a benign mass and a CT‐guided biopsy yielded a diagnosis of extramedullary hematopoiesis. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

Community-based obstetrical ultrasound reports: Documentation of compliance with suggested minimum standards

The objective of this study was to determine the degree of documented compliance of community-based ultrasound reports with suggested standards/guidelines for basic ultrasound examinations as published by the American College of Obstetricians and Gynecologists (ACOG) and the American Institute of Ultrasound in Medicine (AIUM). First trimester reports from obstetric offices (n = 20) had complete compliance with ACOG guidelines in 35% and AIUM standards in 15% of the cases (p = NS). Radiological reports (n = 26) had complete compliance with ACOG guidelines in 11.5% and AIUM standards in 3.9% of the cases (p = NS). None of the second/third trimester reports from either the obstetrical offices (n = 35) or from radiological facilities (n = 94) had complete compliance with either ACOG or AIUM standards/guidelines. Ultrasound reports generated by community-based obstetricians and radiologists from our referral sources demonstrate significant omissions in documentation of components suggested by AIUM and ACOG for minimum standards of basic ultrasound examinations. © 1996 John Wiley & Sons, Inc.     

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

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

Practice‐based education for medical students: The doctor's office as classroom

The University of Rochester School of Medicine and Dentistry has developed the Practice‐Based Experience (PBE) program in which third‐year students spend the entire second half of the 12‐week Medicine Clerkship in the offices of practicing internists. This program began in 1989–1990 and has now concluded its fourth full year of operation. An extensive evaluation component has convinced the course organizers that medical student education in physicians’ offices is feasible, academically effective, and acceptable to students and faculty. This article describes the design and implementation of PBE.     

Nonmedical fetal ultrasound: knowledge and opinions of Maine obstetricians and radiologists.

OBJECTIVE: The purpose of this study was to evaluate knowledge and opinions regarding nonmedical fetal ultrasound (NMFU) in obstetricians (OB) and radiologists (R). METHODS: A questionnaire was sent to all Maine fellows of the American College of Obstetricians and Gynecologists practicing obstetrics and members of the Maine Society of Radiology in April 2005. RESULTS: Among OB, 52 (81.2%), 24 (37.5%), 45 (75.0%), and 56 (87.5%) did not know whether the American College of Radiology, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, or US Food and Drug Administration held positions on NMFU. Among R, 11 (37.9%), 27 (93.1%), 19 (65.5%), and 24 (82.7%) did not know whether the organizations held positions. More R than OB agreed that women might forego medical ultrasound after NMFU (62.1% versus 49.2%; P = .05), whereas more OB than R believed fetal anomalies would go undetected during NMFU (79.4% versus 62.1%; P = .04). OB and R had concerns for false-positive NMFU diagnoses (41.9% and 31.0%), false reassurance by NMFU (76.2% and 62.1%), poor imaging causing anxiety (39.7% and 51.7%), and lack of physician availability to review suspected abnormalities on NMFU (73.0% and 65.5%). Sizable minorities of OB and R believed NMFU providers should be disciplined by licensing boards (33.9% and 44.8%), excluded from society memberships (22.9% and 37.9%), or reported to the Food and Drug Administration (21.3% and 31.0%). CONCLUSIONS: Most Maine OB and R are aware of their own but not each other's professional or regulatory NMFU positions yet practice within these guidelines. Most respondents do not favor sanctioning colleagues performing NMFU.     

Integration of a Low‐Cost Introductory Ultrasound Curriculum Into Existing Procedural Skills Education for Preclinical Medical Students

We evaluated integration of an introductory ultrasound curriculum into our existing mandatory procedural skills program for preclinical medical students. Phantoms consisting of olives, pimento olives, and grapes embedded in opaque gelatin were developed. Four classes encouraged progressive refinement of phantom‐scanning and object identification skills. Students improved their ability to identify hidden objects, although each object type achieved a statistically significant improvement in correct identification at different time points. The total phantom cost per student was $0.76. Our results suggest that short repeated experiences scanning simple, low‐cost ultrasound phantoms confer basic ultrasound skills.     

Integrated Obstetric Curriculum for Obstetrics and Gynecology Residency, Radiology Residency and Maternal-Fetal Medicine Fellowship program at an accredited American Institute of Ultrasound in Medicine Diagnostic Ultrasound Center.

OBJECTIVE: The purpose of this work was to demonstrate the approach to developing an integrated curriculum for obstetric ultrasound training by utilizing an accredited American Institute of Ultrasound in Medicine teaching platform. METHODS: During the 1996-98 academic years, the American College of Obstetricians and Gynecologists and American Institute of Ultrasound in Medicine guidelines for ultrasound performance and training were integrated into a multifaceted training program for obstetric and radiological residents and maternal-fetal medicine fellows consisting of a structured reading program, self study of a 35-mm slide program of normal/abnormal anatomy, a basic ultrasound and fetal echocardiography interactive CD program, hands-on supervised scanning program and practical and certificate-bearing fetal echocardiography courses for fellows. All obstetric residents were given pretests and post-tests to measure learning performance in the program. The results from these tests were analyzed for statistical significance. RESULTS: Thirteen obstetric residents completed the training program. The locally developed pretest showed a mean of 16/40 correct questions with an SD of 1.85. After completing the training, the mean obstetric resident scores on the post-test were 32/40 with an SD of 5.9. This difference was statistically significantly different, P < 0.009. Radiology residents showed an improvement from no residents passing the obstetric ultrasound portion on the 1996 Radiology Boards to 100% pass rate in 1997 (four residents per year) after completing the course. Maternal-fetal medicine fellows progressed from inability to perform acceptable fetal echocardiography to full ability to perform fetal echocardiographic examinations. CONCLUSION: An integrated approach to obstetric ultrasound training for obstetric and radiologic residents and maternal-fetal medicine fellows with multifaceted learning methods is easily achieved with available guidance from the American College of Obstetricians and Gynecologists and American Institute of Ultrasound in Medicine.