Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review

The clinical applications of point‐of‐care ultrasound (US) have expanded rapidly over the past decade. To promote early exposure to point‐of‐care US, there is widespread support for the integration of US curricula within undergraduate medical education. However, despite growing evidence and enthusiasm for point‐of‐care US education in undergraduate medical education, the curricular design and delivery across undergraduate medical education programs remain variable without widely adopted national standards and guidelines. This article highlights the educational and teaching applications of point‐of‐care US with a focus on outcomes. We then review the evidence on curricular design, delivery, and integration and the assessment of competency for point‐of‐care US in undergraduate medical education.     

Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools

Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.     

Children's nursing and future directions: learning from 'memorable events'

At present, the UK provides pre-registration education in four distinct branches, including child, but this is under threat with calls for a single generalist register in line with most of the developed world. Debate about this may be understood by placing 'memorable events' associated with this in their historical context. Analysis of quantitative data, obtained from the Nursing and Midwifery Council identifies a clear correlation between the numbers of registered children's nurses and changes in child health and welfare policies as well as nurse education over the last century. This interpretation of 'memorable events,' showing the growth and influence of this branch of the profession, should enable present day reformers of nurse education to make a rational and informed decision as they debate and decide upon the future of children's (and young people's) nursing in the UK.     

Critical care ultrasound training: A survey of US fellowship directors

Purpose

The purpose of this study is to describe the current state of bedside ultrasound use and training among critical care (CC) training programs in the United States.

Materials and methods

This was a cross-sectional survey of all program directors for Accreditation Council for Graduate Medical Education accredited programs during the 2012 to 2013 academic year in CC medicine, surgical CC, pulmonary and critical care, and anesthesia CC. Availability, current use, and barriers to training in CC ultrasound were assessed.

Results

Sixty of 195 (31%; 95% confidence interval [CI], 24%-38%) program directors responded. Most of the responding programs had an ultrasound system available for use (54/60, 90%; 95% CI, 79%-96%) and identified ultrasound training as useful (59/60, 98%; 95% CI, 91%-100%) but lacked a formal curriculum (25/60, 42%; 95% CI, 29%-55%) or trained faculty (mean percentage of faculty trained in ultrasound: pulmonary and critical care, 25%; surgical CC, 33%; anesthesia CC, 20%; CC medicine, 7%), and relied on informal teaching (45/60, 77%; 95% CI, 62%-85%). Faculty with expertise (53/60, 88%; 95% CI, 77%-95%), simulation training (60/60, 100%; 95% CI, 94%-100%), establishing and meeting required number of examinations (47/60, 78%; 95% CI, 66%-88%), and regular review sessions (49/60, 82%; 95% CI, 70%-90%) were identified as necessary to improve ultrasound training. Most responding programs (32/35 91%; 95% CI, 77%-98%) without a formal curriculum plan to create one in the next 5 years.

Conclusions

This study identified deficiencies in current training, suggesting a need for a formal curriculum for bedside ultrasound training in CC fellowship programs.     

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

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

Seeing Is Believing: Evaluating a Point-of-Care Ultrasound Curriculum for 1st-Year Medical Students

Problem: Point-of-care ultrasound has been a novel addition to undergraduate medical education at a few medical schools. The impact is not fully understood, and few rigorous assessments of educational outcomes exist. This study assessed the impact of a point-of-care ultrasound curriculum on image acquisition, interpretation, and student and faculty perceptions of the course. Intervention: All 142 first-year medical students completed a curriculum on ultrasound physics and instrumentation, cardiac, thoracic, and abdominal imaging. A flipped classroom model of preclass tutorials and tests augmenting live, hands-on scanning sessions was incorporated into the physical examination course. Students and faculty completed surveys on impressions of the curriculum, and all students under-went competency assessments with standardized patients. Context: The curriculum was a mandatory part of the physical examination course and was taught by experienced clinician-sonographers as well as faculty who do not routinely perform sonography in their clinical practice. Outcome: Students and faculty agreed that the physical examination course was the right time to introduce ultrasound (87% and 80%). Students demonstrated proper use of the ultrasound machine functions (M score = 91.55), and cardiac, thoracic, and abdominal system assessments (M score = 80.35, 79.58, and 71.57, respectively). Students and faculty valued the curriculum, and students demonstrated basic competency in performance and interpretation of ultrasound. Further study is needed to determine how to best incorporate this emerging technology into a robust learning experience for medical students.     

Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation

Problem: The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment. Intervention: All 133 final-year students completed a 2-week anesthesia rotation, which began with a half-day session consisting of a lecture and hands-on practice session during which they learned 9 basic transthoracic echocardiography views using 4 basic ultrasound probe positions. Context: Each student was required to perform a transthoracic echocardiography-examine under supervision of 1 patient/week for 2 weeks, and their results were compared against that of the supervisor's. Most patients were elective cardiac surgery patients. One long question on transthoracic echocardiography was included in their end-of-year surgery examination paper. Students provided feedback on their experience. Outcome: Most students learned the basic transthoracic echocardiography views fairly efficiently and had variable, though generally favorable, success rates in identifying obvious cardiac anomalies, including use of color Doppler. A few common mistakes were identified but were easily correctable. Logistics for mobilizing enough bedside supervision were challenging. Students reported positive feedback on the teaching initiative. Lessons Learned: We were able to execute a successful short training course on transthoracic echocardiography during the final-year medical degree anesthesia rotation. Our initiative may set an example for other clinical departments to design similar courses pertinent to their specialties and syllabuses.     

Call to Publish in an Undergraduate Medical Course: Dissemination of the Final-Year Research Project

Problem: Today's medical doctors must not only have the clinical skills to treat patients effectively but also keep current with new advances in medicine and critically analyze evidence to choose the best treatments and explain the risks and benefits of different options. In this article, we aim to share the approach taken at a Portuguese medical school to promote a close connection between research and learning. Intervention: In a blended-learning approach, students studied research and scientific methods and undertook one of three faculty-supervised research and dissemination projects. To support immediate application of new research knowledge, students were offered optional short lectures and problem sets. All course information was featured on a website that also supported a discussion forum. We analyzed 1,350 theses leading to the medical degree, defended in six consecutive academic years (2007–2013). Our aim was to estimate the publication rates and factors associated with publication of the final-year undergraduate research projects. Context: The present research curriculum was developed at the University of Porto Faculty of Medicine as part of the Bologna process curriculum implemented in the 2007–2008 academic year. From May to June 2014 we looked for corresponding articles published over the period of September 2007 to April 2014. We searched PubMed, Scielo, Scopus, and IndexRMP databases to locate publications resulting from student theses. Outcomes: Over 6 years, the diffusion of knowledge produced by medical students, who engaged in clinical practice concurrently with research projects, was fairly low (10.4%). Program modifications that increased student accountability and engagement allowed for an increased rate of publication from 1.0% to 23.9%. Factors associated with publication were research area, publication as a performance assessment criterion, and publication language. Lessons Learned: The results of this study suggest that it is helpful to provide research opportunities that allow aspiring future medical doctors to begin their research careers. Further research is needed to understand difficulties students and supervisors face in project development and to achieve greater balance in topic coverage among projects and, consequently, in departmental involvement in the program.