Graph of the Dunning-Kruger effect on the confidence of medical students in their diagnostic ability.

Graph of the Dunning-Kruger effect on the confidence of medical students in their diagnostic ability.

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BACKGROUND Point-of-care ultrasound (POCUS) diagnosis, performed by a physician at the patient bedside, is routinely used in emergency medicine and critical care. Although training in ultrasonography has become part of the medical school curriculum, POCUS can be challenging for medical students. This study aimed to assess the effectiveness of a one...

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... Dunning-Kruger effect might partially explain this finding. The Dunning-Kruger effect of cognitive bias was described by social psychologists David Dunning and Justin Kruger (Figure 4) [20][21][22][23]. This effect is the inability to acknowledge the lack of individual competence. ...

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... Algumas instituições introduziram a US em suas avaliações de exame clínico estruturado, 8,14,15 e alguns programas de treinamento avançado inseriram a avaliação de imagens na nota final. 16 Houve também universidades que utilizaram a autoavaliação 12,17,18 ou o desempenho nas simulações práticas 19 como método avaliativo. ...
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... Pediatric trainees are interested in obtaining POCUS training during residency and view POCUS as an important skill for their future careers. Our finding is consistent with other needs assessment studies indicating that pediatric residents increasingly demonstrate an interest in POCUS [18,[20][21][22][23]. Upstream of residency training, medical schools are also incorporating ultrasound training into undergraduate medical education [14,[24][25][26][27][28][29][30][31]. As this trend continues, future pediatric residents will likely have more familiarity with POCUS and likely seek training for its clinical applications. ...
Article
Background Prior studies showed that point-of-care ultrasound (POCUS) training is not commonly offered in pediatric residency. We assessed the need for a pediatric POCUS curriculum by evaluating pediatric trainees' attitudes toward the use of POCUS and identifying barriers to training. We also aimed to evaluate the impact of a POCUS educational intervention on self-efficacy and behavior. Methods We conducted a cross-sectional survey of pediatric residents in a single large freestanding children's hospital distributed via an institutional listserv and administered online. The survey included opinion-rating of statements regarding POCUS and barriers to training. We also offered a two-week POCUS course with online modules and hands-on scanning. Participating residents completed pre- and post-course knowledge assessments and follow-up surveys up to 12 months following the course to assess POCUS use and self-report confidence on POCUS indications, acquisition, interpretation, and clinical application. Results Forty-nine respondents were included in the survey representing all three pediatric levels with 16 specialty interest areas. Ninety-six percent of trainees reported that POCUS is an important skill in pediatrics. Ninety-two percent of trainees reported that residency programs should teach residents how to use POCUS. The most important perceived barriers to POCUS training were scheduling availability for POCUS rotations and lack of access to an ultrasound machine. Fourteen participants completed the pre- and post-course knowledge tests, with eight and six participants also completing the six- and 12-month follow-up surveys, respectively. Self-ratings of confidence were significantly improved post-intervention in indications (P = 0.007), image acquisition (P = 0.002), interpretation (P = 0.002), and clinical application (P = 0.004). This confidence improvement was sustained up to 6-12 months (P = 0.004-0.032). Participants also reported higher categorical POCUS use after course completion (P = 0.031). Conclusions Pediatric trainees perceive POCUS as an important skill, hold favorable opinions towards the use of POCUS, and support POCUS training within a pediatric residency. A POCUS course can improve resident POCUS knowledge, instill confidence, and motivate higher POCUS use. Further study is needed to evaluate POCUS applications in pediatric medicine to develop a standardized POCUS curriculum and establish a training guideline for pediatric residency.
... Point of care ultrasound (POCUS), for example, offers the opportunity to quickly assess cardiac contractility and look for a pericardial effusion. These have become core skills in some medical school classes 14 . Yet, finding a way to convey the increased information and skills required within the same amount of curricular time is challenging, particularly in scenarios with rare or limited case exposures. ...
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... POCUS curricula have been developed in medical schools across the country in recognition of the increasingly important role POCUS has across disciplines [8][9][10][11]. Undergraduate medical education (UME) POCUS curricula include one-day simulation labs, electives, longitudinal preclinical and clinical courses but these different approaches of POCUS education have had unclear association with medical student performance [11][12][13]. ...
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Introduction Point-of-care ultrasound (US) is used in clinical practice across many specialties. Ultrasound (US) curricula for medical students are increasingly common. Optimal timing, structure, and effect of ultrasound education during medical school remains poorly understood. This study aims to retrospectively determine the association between participation in a preclinical, longitudinal US curriculum and medical student academic performance. Methods All first-year medical students at a medical school in the Midwest region of the United States were offered a voluntary longitudinal US curriculum. Participants were selected by random lottery. The curriculum consisted of five three-hour hands on-sessions with matching asynchronous content covering anatomy and pathologic findings. Content was paired with organ system blocks in the standard first year curriculum at our medical school. Exam scores between the participating and non-participating students were compared to evaluate the objective impact of US education on performance in an existing curriculum. We hypothesized that there would be an association between participation in the curriculum and improved medical student performance. Secondary outcomes included shelf exam scores for the surgery, internal medicine, neurology clerkships and USMLE Step 1. A multivariable linear regression model was used to evaluate the association of US curriculum participation with student performance. Scores were adjusted for age, gender, MCAT percentile, and science or engineering degree. Results 76 of 178 students applied to participate in the curriculum, of which 51 were accepted. US curriculum students were compared to non-participating students (n = 127) from the same class. The US curriculum students performed better in cardiovascular anatomy (mean score 92.1 vs. 88.7, p = 0.048 after adjustment for multiple comparisons). There were no significant differences in cumulative cardiovascular exam scores, or in anatomy and cumulative exam scores for the gastroenterology and neurology blocks. The effect of US curriculum participation on cardiovascular anatomy scores was estimated to be an improvement of 3.48 points (95% CI 0.78-6.18). No significant differences were observed for USMLE Step 1 or clerkship shelf exams. There were no significant differences in either preclinical, clerkship or Step 1 score for the 25 students who applied and were not accepted and the 102 who did not apply. Conclusions Participation in a preclinical longitudinal US curriculum was associated with improved exam performance in cardiovascular anatomy but not examination of other cardiovascular system concepts. Neither anatomy or comprehensive exam scores for neurology and gastrointestinal organ system blocks were improved.
... Participants experienced a statistically lower self-efficacy (p=0.044) and higher ease of use perception (p=0.034) in e-learning. Compatible with the literature, higher selfefficacy results with decreased experience can be explained by the Dunning Kruger effect (16). This effect is called the inability to acknowledge the individual lack of competence. ...
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... Only a handful of schools reported the impact of ultrasound education UGME in measurable formats like enhanced performance on standardized tests, enhanced physical exam skills by providing real time visual feedback on examination finding, improving the diagnostic accuracy of pathological exam findings, enhancing critical thinking skills by providing real time information corroborating or refuting differential diagnosis [5,[18][19][20][21]. One school conducted a retrospective analysis of the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) level 1 scores in anatomy, diagnostic technology, and osteopathic principals and practice. ...
... Published programs have demonstrated the feasibility of integrating a POCUS curriculum into UGME and emerging data suggests that students perceive value in this effort. Focused ultrasonography can be used as a useful aid in teaching anatomy to medical students, learning physical exam skills; and has been received quite positively by medical students at several institutions [8,21]. A national survey of 82 medical schools, where 51 report some ultrasound integration into UGME, found that > 90% of students preferred ultrasound incorporated into their program, > 80% Fig. 2 The Wake Ready! ...
... Curriculum is divided into three phases to better prepare medical students for the next step in their training. Phases are divided into requisite focuses as Foundations, Clinical Immersion and Career Exploration felt that ultrasound sessions enhanced training in both pre-clinical and clinical courses, and 60-90% students reported increased confidence in physical exam skills after visualizing anatomy by ultrasound [1,5,11,14,21]. In 2014, fewer than 60% of medical schools reported some level of ultrasound training in UGME; and almost 80% agreed that it should be included in UGME but fewer than 20% prioritized it [22]. The American Institute of Ultrasound in Medicine hosts a self-reported list of all medical schools with UGME ultrasound curricula and reports 66 of 222 LCME accredited schools have some level of structured ultrasound instruction. ...
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Background Hands-on ultrasound experience has become a desirable component for undergraduate medical education (UGME) curricula throughout medical schools in the United States (US) to enhance readiness for future training. Ultrasound integration can be a useful assistive educational method in undergraduate medical education to improve anatomy and physiology skills. Relatively few medical schools have integrated ultrasound experiences formally into their 4-year medical school curriculum due to limitations of a resource intensive set up. Methods We undertook a scoping review of published UGME ultrasound curricula integrated into all four years in peer-reviewed as well online literature. In addition, we provide a narrative review of our institutional experience in conceptualization, design and implementation of UGME ultrasound curriculum driven by need to address the fading knowledge in anatomy and physiology concepts beyond pre-clinical years. Results Integrated ultrasound curriculum at WFSOM utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science concepts taught in the medical school curriculum. We found 18 medical schools with ultrasound curricula published in peer-reviewed literature with a total of 33 ultrasound programs discovered by adding Google search and personal communication Conclusions The results of the review and our institutional experience can help inform future educators interested in developing similar curricula in their undergraduate programs. Common standards, milestones and standardized competency-based assessments would be helpful in more widespread application of ultrasound in UGME curricula.
... There is growing interest in ultrasound use in medical education, exemplified by the integration of point-ofcare ultrasound courses in some undergraduate medical school curricula. 21,22 Ultrasound use has grown in many medical specialties. Nevertheless, medical students still learn their anatomy from cadaver dissections. ...
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Interest in Doppler ultrasound (DUS) analysis of the face has grown in cosmetic medicine, in particular for injectable fillers. When dealing with complications, DUS has the advantage of easily visualizing the filler and identifying the problem in relation to the patient’s anatomy. When working with hyaluronic acid filler, ultrasound-guided injections with hyaluronidase can precisely target the problem. In addition, DUS can be used to study the anatomy of a patient, specifically to prevent intravascular injections. We predict that in a few years’ time DUS will become standard equipment in the offices of cosmetic doctors. We discuss the basics of ultrasound imaging of different tissues with the concomitant terminology. With the use of 7 basic DUS probe positions, key anatomic reference points can be easily found. From these, all relevant anatomic structures in the face can be observed and analyzed. With some practice, physicians will ultimately be able to acquire a complete 3-dimensional mental image of a patient’s face.
... Previous studies in medical education, which have addressed global health issues, have focused on stand-alone ultrasound courses (12) or on stand-alone international EM elective rotations (13,14) . However, in this study, we conducted the POCUS training during an international elective rotation. ...
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Background: International rotations for EM residents are becoming increasingly popular. However, there is a dearth of evidence to demonstrate that these rotations can be performed utilizing the POCUS training and that residents have appropriate training, which could assist them in improving their point-of-care ultrasound (POCUS) knowledge. Objective: The researchers aimed at evaluating the POCUS knowledge of the international EM residents after the POCUS training during an international elective rotation. Materials and Methods: A curriculum was developed in the form of a 4-week rotation in the Laos EM residency program at the Department of Emergency Medicine at Khon Kaen University’s Srinagarind Hospital. It consisted of didactic lectures, bedside ultrasound trainings, the journal club, and the process of reviewing the images. Tools were developed, which included a knowledge exam, which was designed to test the residents’ image interpretation abilities and their clinical decision-making processes. The assessments were administered before and after each resident’s rotation. Results: Eight Laos EM residents completed their rotations and the tests. The average Pre-training scores and Post-training scores were 11.13+1.27 and 17.75+1.30, respectively. The average knowledge test score was found to have significantly improved from 55.63% to 88.75%. Conclusion: A POCUS training for the Laos EM residency program in the international elective rotation was able to be developed. Through participating in this training, the residents had been able to improve their basic POCUS knowledge, which will aid the emergency physicians to better care for their patients.
... US is now being incorporated in medical school, residency, fellowship, and postgraduate training, and is quickly becoming an important tool across medical settings. Skill and confidence with POCUS can be quickly acquired following a 1-d course (50,51). Physicians across the spectrum of medicine can incorporate US into their clinical practice, improving diagnostic sensitivity and specificity, reducing radiation exposure, lowering costs, and decreasing time to diagnosis without an increase in adverse events or missed diagnoses. ...
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The availability of handheld ultrasound offers physicians an opportunity to better define anatomy and pathophysiology, thus enhancing the diagnostic capabilities of a standard physical examination. The medical community increasingly embraces the potential for point-of-care ultrasound across medical specialties. The primary aim of this review was to identify and compile information on the current clinical utility of point-of-care ultrasound for musculoskeletal examination. This information will enable health care providers to understand the current utility and potential of musculoskeletal point-of-care ultrasound, thus facilitating its appropriate adoption into clinical practice.
... 15 competence and self-confidence with time has also been demonstrated in medical students and academic physician faculty. 9,[16][17][18] The utility of recognizing the Dunning-Kruger Effect is helping junior physicians navigate their professional development, clinical expertise, and sense of self-confidence. It encourages physicians to be introspective, recognize their weaknesses, and beware of the limitations of self-confidence as a measure of clinical competency. ...