Rationale and Objectives
This study aimed to determine the degree of involvement of radiologists in ultrasound education in medical schools in the United States.
Materials and Methods
An online survey was sent to 129 directors of medical student education in radiology, identified by the Alliance of Medical Student Educators in Radiology. Each survey recipient represented a unique medical school.
Results
There was a 31% survey completion rate. Radiology education was incorporated into the majority of respondents’ medical school curricula (95%). Ultrasound images were used in preclinical education in the majority of schools (76%). Students were trained to perform hands-on ultrasound examinations in half of schools (49%), and a minority of schools offered a dedicated point-of-care ultrasound elective (14%). Radiology and emergency medicine were the most involved departments in teaching ultrasound to medical students (88% and 75% of medical schools, respectively).
Conclusions
Ultrasound imaging was incorporated into the curricula of most of the responding medical schools, although actual hands-on training was less widespread.
Introduction
Point-of-care ultrasound is widely used by non–radiology physicians for both diagnosis and therapeutic guidance . The defining features of point-of-care ultrasound are as follows: it is a well-defined purpose linked to improving patient outcomes, findings are easy to identify, study is easy to learn, study is quick to perform, and study is performed at patient’s bedside . The rise of point-of-care ultrasound was anticipated decades ago , but has only recently come to fruition because of improved image quality from lower cost units. Although radiologists still perform the majority of noncardiac ultrasound, nonradiologists performed 42% of noncardiac ultrasound in 2009, and that percentage only included studies that were billed to Medicare . It is conceivable that in the near future, portable wireless ultrasound transducers will replace stethoscopes for the basic physical examination.
How are physicians getting trained in ultrasound? Physicians who have already completed residency can pay to take multiday crash courses. Resident physicians may receive hands-on training through their residency; however, the training availability depends on the specialty and individual residency. For example, emergency medicine residency programs are required to provide hands-on ultrasound training to their residents, and the published requirements do not specify who should be doing the teaching . Medical students receive ultrasound education through radiology as well as multiple non–radiology departments, in particular emergency medicine and internal medicine . If ultrasound is truly the new stethoscope, then point-of-care ultrasound training really should begin in medical school, and there should be a standardized approach . Formal training at an early stage allows for better standardization and competency assessment .
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Materials and Methods
Survey
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TABLE 1
Survey questions and responses. The most frequent responses for each question are indicated in bold
1. What is your area of expertise? Anatomy 0/55 (0%)Radiology49/55(89%) Surgery 0/55 (0%) Emergency medicine 1/55 (2%) Other (free-form response): 5/55 (9%) Neurology 1/55 (2%) Rheumatology 1/55 (2%) Internal medicine 1/55 (2%) Family medicine 1/55 (2%) Student affairs 1/55 (2%) 2. Is radiology incorporated into the medical school curriculum at your institution? No 3/54 (5%)Yes (for all students)35/54(65%) Yes (for just some students) 16/54 (30%) 3. Are ultrasound images used to help teach anatomy, physiology, or any other preclinical topic? No 13/53 (24%)Yes40/53(76%) 4. Does the medical school, or any department within the school, own ultrasound machines that are solely for educational use?No24/52(46%)Yes24/52(46%) Don’t know 4/52 (8%) 5. To your knowledge, who teaches ultrasound to the medical students? (see Fig 1 ) 6. Are students trained to perform hands-on ultrasound examinations?No18/51(35%) Yes, during their preclinical years 10/51 (20%) Yes, during their clinical years 14/51 (27%) Other (free-form response): 9/51 (18%) Yes, preclinical and clinical years 1/51 (2%) Variable exposure 3/51 (6%) Planned in the future 1/51 (2%) Don’t know 4/51 (8%) 7. If yes to question 6, is hands-on ultrasound training required of all students?No14/24(58%) Yes 10/24 (42%) 8. Are radiology electives offered to your medical students? No 0/51 (0%)Yes51/51(100%) 9. If yes to question 8, is a dedicated point-of-care ultrasound elective one of these options?No (We offer radiology electives but not one involving experience with point-of-care ultrasound.)28/51(55%) Yes (We do offer a radiology elective that gives medical students experience with point-of-care ultrasound.) 7/51 (14%) Unsure (There may be an elective in a different department such as ED or ICU offering point-of-care ultrasound experience.) 16/51 (31%) 10. If no or unsure to question 9, are there plans of incorporating experiences with point-of-care ultrasound to the undergraduate medical education at your institution?No12/33(36%) Yes 10/33 (30%) Unsure 11/33 (33%)
ED, emergency department; ICU, intensive care unit.
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Survey Participants
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Results
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Survey Participants
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Ultrasound Education for Medical Students
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Departments Responsible for Ultrasound Education
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Free-form Comments From Respondents
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Discussion
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Conclusion
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Acknowledgments
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Appendix
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“It is the way of the future in medicine. Ultrasound will be the additional tool in the physician’s toolbox.” “With 270 medical students per class, it is a massive undertaking.” “[Teaching medical students ultrasound] is a bad idea.” “Make sure [ultrasound] is done by the right people who know how to teach it correctly!” “Obviously, because of philosophy, money, and politics, we don’t work as a united group to offer radiology education.” “I think there is too much emphasis too early in teaching students how to perform ultrasound rather than understanding anatomy and appropriate ordering indications (which more of the students will utilize in their future careers).” “Consider strong regulatory policies regarding ultrasound examinations to deter performance by the inexperienced.” “I am a radiologist in the Society for Radiologists in Ultrasound, and yet I still believe that although we need to have a presence teaching students about the basics of ultrasound imaging and when to order a great ultrasound with us, the appropriate place for them to learn about point-of-care ultrasound is at the point-of-care, and radiologists can’t really do that in our department. We don’t have time to teach all of them in our ultrasound clinic anyway. When they are with us, we need to show them what we do is very high quality and adds to their clinical exam when the patient may be getting surgery. We also need to emphasize when they are with us that if a patient is being billed for an imaging study and interpretation, that it is important to store and share images of that imaging procedure in the patient’s chart.”
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“We teach ultrasound using high-end ultrasound machines.” “We have four Sonosite machines and fifteen Siemens handheld machines dedicated to medical student education.” “Our medical students’ exposure to radiology is in the form of a two-week elective in 3rd or 4th year. As such, they spend 1 day in ultrasound, but they see ultrasound used in other sections too, like musculoskeletal, pediatrics, genitourinary, etc, where they also spend a day.” “The department of emergency medicine offers a two-week elective to teach point-of-care ultrasound.” “We are undergoing a curriculum renewal and plan to incorporate point-of-care ultrasound from the start of the first year.” “We are in the process of incorporating ultrasound education, started by the emergency room; I added myself to the mix!”
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