Rationale and Objectives
Ultrasound is used increasingly in medical practice as a tool for focused bedside diagnosis and technical assistance during procedures. Widespread availability of small portable units has put this technology into the hands of many physicians and medical students who lack dedicated training, leaving the education and introduction of this key modality increasingly to physicians from other specialties. We developed a radiology-led program to teach ultrasound skills to preclinical medical students.
Materials and Methods
To develop this new ultrasound program we 1) established a program leader, 2) developed teaching materials, 3) created a hands-on interactive program, and 4) recruited the necessary instructors. The program was piloted with the first-year medical student class of 154 students. The introductory session was assessed by pre- and post-activity Likert scale–based surveys.
Results
Of 154 (68.8%) students, 106 completed a voluntary online survey before starting the program and 145 students (94.2%) completed a voluntary survey after the session. Students found the program educationally valuable (4.64 of 5) and reported that it improved their understanding of ultrasound imaging (4.7 of 5). Students’ reported confidence in identifying abdominal organs, intra-abdominal fluid, and Morison pouch that was significantly higher on the postactivity survey compared to the presurvey ( P < .001 for all).
Conclusions
We piloted a radiology-led program to teach ultrasound skills to preclinical medical students. Students found the experience enjoyable and educationally valuable.
Ultrasound has been a useful diagnostic imaging tool since the introduction of grayscale imaging in the 1970s. While originally the purview of radiologists, rapidly evolving technology, and smaller ultrasound units have put this imaging modality into the hands of a wider range of physicians including subspecialists closer to the point of service. Ultrasound is now used routinely by cardiologists, obstetricians and gynecologists, emergency medicine physicians, critical care physicians, surgeons, and hospitalists for point of care uses including focused diagnostics, as a physical examination adjunct, and for bedside procedure guidance . A portable ultrasound device is a far more accurate and powerful tool to identify a suspected pleural effusion, for example, rather than relying simply on a stethoscope. In 1988, ultrasound was called “the stethoscope of the future” in the Journal Radiology and that future has largely arrived.
Although ultrasound can be a powerful tool, it is a complex imaging modality, and skillful interpretation and mastery takes years of specialized training. Formal diagnostic examinations, as well as ideally focused examinations, should be performed by imaging experts with specialized training in residency or fellowship. That said, targeted limited ultrasound examinations are already being performed routinely at the bedside by a wide array of physicians, often with little or no formal imaging training.
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Materials and methods
Needs Assessment
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Implementation
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Program Leader
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Teaching Materials
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Creating a Hands-on Program
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Recruiting Instructors
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Assessment
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Table 1
Survey Questions, Answer Choices, and Responses from First-year Medical Students Before Beginning the Ultrasound Training
Survey Question Answer Choices Number of Responses, n (%) Mean Response (Standard Deviation) I have used ultrasound prior to medical school 5 Strongly agree 2 (1.9) 1.22 (0.77) 4 Agree 3 (2.8) 3 Neutral 1 (0.9) 2 Disagree 4 (3.8) 1 Strongly disagree 96 (90.6) I am excited to learn more about ultrasound 5 Strongly agree 45 (42.5) 4.24 (0.79) 4 Agree 44 (41.5) 3 Neutral 14 (13.2) 2 Disagree 3 (2.8) 1 Strongly disagree 0 (0) I am familiar with how ultrasound works 5 Strongly agree 3 (2.8) 2.34 (1.07) 4 Agree 13 (12.3) 3 Neutral 27 (25.5) 2 Disagree 37 (34.9) 1 Strongly disagree 26 (24.5) I am familiar with the concept of gain 5 Strongly agree 1 (0.9) 1.56 (0.92) 4 Agree 6 (5.7) 3 Neutral 7 (6.6) 2 Disagree 23 (21.7) 1 Strongly disagree 69 (65.1) I am familiar with the appearance of fluid on ultrasound 5 Strongly agree 1 (0.9) 1.82 (1.04) 4 Agree 10 (9.4) 3 Neutral 13 (12.3) 2 Disagree 27 (25.5) 1 Strongly disagree 55 (51.9) I can confidently identify the liver, kidneys, spleen, and diaphragm with ultrasound 5 Strongly agree 0 (0) 1.54 (0.82) 4 Agree 3 (2.8) 3 Neutral 13 (12.3) 2 Disagree 22 (20.8) 1 Strongly disagree 68 (64.1) I feel confident identifying Morison’s Pouch with ultrasound 5 Strongly agree 0 (0) 1.27 (0.66) 4 Agree 3 (2.8) 3 Neutral 3 (2.8) 2 Disagree 14 (13.2) 1 Strongly disagree 86 (81.1) I feel ultrasound can facilitate learning of anatomy 5 Strongly agree 44 (41.5) 4.17 (0.93) 4 Agree 45 (42.5) 3 Neutral 11 (10.4) 2 Disagree 3 (2.8) 1 Strongly disagree 3 (2.8)
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Statistical Analysis
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Results
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Table 2
Survey Questions, Answer Choices, and Responses from First-year Medical Students After Completing the Introductory Training Session
Survey Question Answer Choices Number of Responses, n (%) Mean Response (Standard Deviation) The Introductory Module was educationally valuable 5 Strongly agree 85 (59.4) 4.59 (0.51) 4 Agree 57 (39.9) 3 Neutral 1 (0.7) 2 Disagree 0 (0) 1 Strongly disagree 0 (0) The Introductory Module ‘s length was 5 Far too long 1 (0.7) 3.12 (0.43) 4 Too long 20 (14) 3 About right 117 (81.8) 2 Too short 5 (3.5) 1 Far too short 0 (0) The In-person Instruction was educationally valuable 5 Strongly agree 115 (79.9) 4.79 (0.42) 4 Agree 28 (19.4) 3 Neutral 1 (0.7) 2 Disagree 0 (0) 1 Strongly disagree 0 (0) The In-person Instruction length was 5 Far too long 0 (0) 2.94 (0.36) 4 Too long 4 (2.8) 3 About right 128 (88.9) 2 Too short 11 (7.6) 1 Far too short 1 (0.7) Overall, this program of Ultrasound Instruction was educationally valuable: 5 Strongly agree 93 (64.1) 4.64 (0.48) 4 Agree 52 (35.9) 3 Neutral 0 (0) 2 Disagree 0 (0) 1 Strongly disagree 0 (0) This program improved my understanding of ultrasound imaging 5 Strongly agree 102 (70.3) 4.7 (0.48) 4 Agree 42 (29) 3 Neutral 1 (0.7) 2 Disagree 0 (0) 1 Strongly disagree 0 (0) I can confidently identify fluid at ultrasound 5 Strongly agree 28 (19.3) 4.03 (0.62) 4 Agree 96 (66.2) 3 Neutral 19 (13.1) 2 Disagree 2 (1.4) 1 Strongly disagree 0 (0) I can confidently identify the liver, spleen, and kidneys at ultrasound 5 Strongly agree 14 (9.7) 3.67 (0.77) 4 Agree 82 (56.5) 3 Neutral 38 (26.2) 2 Disagree 10 (6.9) 1 Strongly disagree 1 (0.7) I can confidently identify Morison’s pouch at ultrasound 5 Strongly agree 16 (11) 3.68 (0.79) 4 Agree 81 (55.9) 3 Neutral 34 (23.4) 2 Disagree 14 (9.7) 1 Strongly disagree 0 (0) This program improved my knowledge of anatomy: 5 Strongly agree 38 (26.2) 4.19 (0.55) 4 Agree 96 (66.2) 3 Neutral 11 (7.6) 2 Disagree 0 (0) 1 Strongly disagree 0 (0) The overall amount of time allotted for this program was 5 Far too long 0 (0) 2.86 (0.43) 4 Too long 4 (2.8) 3 About right 118 (81.9) 2 Too short 21 (14.6) 1 Far too short 1 (0.7) This program is appropriate for the 1st year (as opposed to later in medical school) 5 Strongly agree 71 (49) 4.42 (0.64) 4 Agree 66 (45.5) 3 Neutral 6 (4.1) 2 Disagree 2 (1.4) 1 Strongly disagree 0 (0)
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Discussion
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Conclusions
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