Original reportIs Basic Emergency Ultrasound Training Feasible as Part of Standard Undergraduate Medical Education?
Introduction
Medical training is experiencing a paradigm shift toward supraspecialization, where diagnostic imaging and interventional procedures are increasingly performed by physicians with no formal radiology training. This has led to the concept of “point-of-care ultrasonography” (PCUS) where limited, problem-directed bedside ultrasound is performed by hospital specialists.1 Currently, this has become an established practice in vascular access, abdominal aortic aneurysm screening, rheumatology, critical care, and emergency cardiac function assessment. The more liberal use of ultrasound by nonradiology specialists has been facilitated by the introduction of portable hand-held ultrasound devices, as well as the development of more affordable and user-friendly ultrasound equipment.
More recently surgeons and emergency physicians have adopted focused assessment with sonography in trauma (FAST) scanning to determine the presence or absence of free fluid in the abdomen, pelvis, or pericardium to guide further assessment with computed tomography or to expedite surgical exploration.
Trauma and Acute Care Surgery are developing specialties in the UK, whilst current postgraduate training of junior doctors focuses on the assessment and management of critically ill patients. In this setting, most newly-qualified doctors will encounter PCUS during their foundation or core training. Despite this however, the principles and practice of ultrasonography (US) are not integrated in UK medical undergraduate curricula. Preliminary pilot studies in the United States and Ireland have demonstrated that this might be both feasible and acceptable to medical students.2, 3, 4 In the UK no data exists to document whether teaching basic US to medical students is either acceptable, appropriate to an undergraduate level of training, or can be successfully taught within the constraints of an already crammed curriculum. In addition, the role of undergraduate US as an additional method of teaching clinically-oriented anatomy has not been thoroughly investigated.
The study aims to assess whether basic ultrasound training can be incorporated in undergraduate medical education. The study's objectives were to elicit students' opinion and motivation regarding PCUS skills teaching and determine the feasibility of teaching basic US skills in short time periods.
Section snippets
Methods
A pilot course was designed to teach FAST scanning to medical students (undergraduate years 3 and 5) at Imperial College London, UK. The course consisted of seminars on basic ultrasound physics and the principles of PCUS, benefits and limitations of FAST scanning, as well as the role of US in surgical decision-making. The course was taught by a multidisciplinary faculty consisting of radiologists, surgeons, and sonographers over a period of 5 hours. Teaching methods included a formal seminar,
Demographics
Twenty-six students participated in the study. Seventy-six percent were final year students (undergraduate year 5) and 24% were first year clinical students (undergraduate year 3). Seventy-nine percent of students had no previous experience of ultrasound whatsoever, while 21% had some prior informal encounter with US. No student had ever attended formal ultrasound training.
Assessment
All participants completed the formal 9-station OSCE. The mean average score achieved in the assessment was 11.2 out of 13
Discussion
Despite the experiential and constructivist methods used in the training sessions, the educational benefits of a half day course are modest without reinforcement through regular ultrasound practice. Nevertheless, the study suggests that in the absence of any prior experience most of the students achieved basic competency in FAST scanning after 5 hours of training. This indicates that US could be a vertically integrated curricular theme in medical school education, as well as provide immediate,
Conclusions
FAST scanning is a realistic undergraduate teaching goal that is considered advantageous and popular by medical students. US training should be integrated in undergraduate medical education in the UK and further consideration must be paid to its role in creating diagnostic and therapeutic competencies for junior doctors. These findings should inform faculty involved in undergraduate curriculum design.
Acknowledgments
The authors thank Mr. Declan Dunphy and Siemens Ultrasound for providing the ultrasonography equipment and technical expertise for the project. The authors also thank Dr. Joshua Markowitz (Albert Einstein Medical Center in Philadelphia, PA) for providing ultrasound images used in the assessment tool and Dr. Vicki Noble (Massachusetts General Hospital in Boston, MA) for her guidance with the project.
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