Introduction
Resident feedback is a vital means by which to identify opportunities for program improvement . For many years at our institution, resident feedback highlighted the need for a formal curriculum to instruct radiology residents how to perform hands-on, diagnostic, quality ultrasound examinations. Although residents generally felt satisfied with their training regarding interpretation of diagnostic ultrasounds and performance of ultrasound-guided procedures, they felt ill-prepared for actually performing diagnostic ultrasound examinations themselves. This lack of training, they claimed, limited their abilities to offer helpful guidance to sonographers in challenging cases. Indeed, in speaking with educators from other institutions, a comprehensive curriculum for hands-on ultrasound instruction appeared to be a near-universal weakness for most medical schools and radiology residency programs nationwide .
To address this deficiency, we initially tried to integrate hands-on ultrasound education within the workflow of our clinical ultrasound services. The hope was that radiology faculty and ultrasound technologists would set aside time to teach residents basic ultrasound scanning techniques during the normal workday on actual patients. After only a short time, however, it became apparent that this model would not succeed, given the sheer volume of clinical work and the pressure that technologists felt to maintain patient throughput. Moreover, it did little to enhance residents’ understanding of ultrasound physics.
Learning from this early failure, we determined that hands-on scanning would need to be taught at dedicated times outside of clinical rotations. Also, busy clinical and research schedules made it unlikely that faculty radiologists could serve as primary course instructors. Thus, in the spirit of interdisciplinary education, we secured the time and interest of an experienced sonography faculty member already well-known in our institution’s radiographic technology program. With her expertise and dedicated educational time, we were able to develop a new year-long ultrasound course for our residents.
Normal clinical service obligations precluded all of our program’s residents from participating in the course simultaneously, so we chose to focus on second-year radiology residents. Second year residents seemed ideal because they would benefit from already having 1 year of clinical ultrasound exposure and yet still have two more years to put their scanning education to use. With time, then, every resident in our program would participate in this course as a second year. We hypothesized that in this way, a comprehensive hands-on ultrasound course could be successfully integrated into resident training and success measured by evaluating both resident feedback and performance before and after the course.
Methods
We chose as the principal instructor a sonographer with over 30 years of community-based clinical experience and over 10 years of teaching experience at the radiologic technology program located at our institution. She has a bachelor’s degree in radiologic technology and is registered in multiple modalities, including abdominal and Obstetrics/Gynecology (RDMS), adult echocardiography (RDCS), and vascular technology (RVT). The course syllabus was designed by faculty members from both the diagnostic radiology residency program and the radiologic technology program.
Our 15 second-year radiology residents were divided into four groups: three groups of four residents and one group of three. Each group met for weekly 2-hour teaching sessions beginning in mid-July and continued through the following June, essentially spanning the entire academic year. Accounting for holidays and breaks for large national radiology meetings, the total number of weekly class meetings was 43. To ensure protected time for the scanning sessions, residents were excused from their normal clinical responsibilities for their dedicated 2-hour classes. Teaching sessions took place in the ultrasound teaching facility of the radiologic technology program, which contains the necessary equipment, including three examination tables and three ultrasound machines.
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Table 1
Course Examinations
Examination 1 Gallbladder, biliary system, liver, kidneys, pancreas, spleen Examination 2 Doppler physics, Doppler imaging of liver, kidney, abdominal vessels Examination 3 Carotid and peripheral vascular imaging of lower and upper extremities Examination 4 Abdomen review, physics, thyroid, salivary, superficial parts, breast Examination 5 Pelvic, first and second trimester obstetric ultrasound Examination 6 Pediatric, echocardiography, musculoskeletal
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Table 2
Annual Costs of Hands-on Ultrasound Course
Course-specific Needs Cost Course instructor salary and benefits $31,000 Linen $500 Acoustic gel $12 Models for breast, OB, pelvis units $450 Other course needs already purchased Ultrasound machines (3) $132,000 Equipment service contracts (3) $2900 Scanning tables (3) $28,500 Scanning chairs (3) $2550 Room dividers (2) $300
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Results
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Table 3
Survey Results of Ultrasound Course: 2012–2014
Question Results 1. The course made a significant 60% Strongly agree contribution to my knowledge of 33% Agree ultrasound. 7% Neutral 2. The course significantly improved 53% Strongly agree my ability to perform hands-on 40% Agree ultrasound. 7% Neutral 3. The course significantly improved 20% Strongly agree my overall understanding of 67% Agree ultrasound physics. 13% Neutral 4. The course significantly contributed 33% Strongly agree to my performance on the ultrasound portion 40% Agree of the ABR Core examination. 27% Neutral 5. The course significantly contributed 13% Strongly agree to my performance on the ultrasound physics 67% Agree portion of the ABR Core examination. 7% Neutral 7% Disagree 7% Strongly disagree
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Discussion
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References
1. Naeger D.M., Jen A., Ahearn B., et. al.: Effectively acquiring and using feedback. J Am Coll Radiol 2015; 12: pp. 1320-1323.
2. Goldberg B.B., Schultz S.M., Baltarowich O., et. al.: Effectiveness of the “teaching the teachers” diagnostic US training program. Acad Radiol 2001; 8: pp. 1159-1167.
3. Goldberg B.B.: International arena of ultrasound education. J Ultrasound Med 2003; 22: pp. 549-551.
4. Webb E.M., Cotton J.B., Kane K., et. al.: Teaching point of care ultrasound skills in medical school: keeping radiology in the driver’s seat. Acad Radiol 2014; 21: pp. 893-901.
5. Hertzberg B.S., Middleton W.D.: Ultrasound, the requisites.Second ed.2004.MosbySt. Louis, MO