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The role for peer-assisted ultrasound teaching in medical school
Abstract
Background:
Bedside ultrasonography has an increasing role in medicine yet medical students have limited exposure. Although countless hours are devoted to plain radiograph and electrocardiogram (ECG) interpretation, ultrasound is frequently glossed over. Yet this imaging modality could enhance students' understanding of anatomy, physiology and pathology, and may increase their integration into hospital teams. We aimed to investigate whether a peer-assisted ultrasound course has a place within the undergraduate medical curriculum. We describe the implementation of a course and discuss its acceptability and utility in student education. Bedside ultrasonography has an increasing role in medicine yet medical students have limited exposure METHODS: Following consultation with the medical school, an improved ultrasonography course was developed with expert guidance from an ultrasonographer and with new equipment. Sessions involved peer-tutors teaching ultrasonography techniques to medical students during emergency medicine placements. Tutees completed questionnaires to assess the quality and perceived benefits of the course and of learning ultrasonography. Both quantitative and thematic analyses of the responses were conducted by the authors.
Results:
Over a period of 8 months, 105 medical students received teaching across four sessions. A total of 103 students (98%) returned questionnaires on their evaluation of the course and tutors, and on their confidence in using ultrasound. Ninety-eight per cent felt that the teaching was well delivered, 100 per cent felt that their knowledge of ultrasound had improved and 100 per cent would recommend the course.
Conclusions:
The peer-assisted ultrasound course described here enabled the majority of students to feel confident gaining elementary ultrasound views, and performing abdominal aneurysm screening and trauma assessments: techniques that they could hopefully put to use during their placements. The peer-assisted model has an acceptable role in teaching emerging clinical skills to medical students.
... Most studies focused on normal anatomy; however, five studies incorporated pathological features. 6,12,13,16,17 One study compared a group of students receiving an ultrasound anatomy demonstration with a control group taught via traditional cadaveric anatomy and found that both groups performed comparably well on a post-intervention assessment. 15 T A B L E 2 Overview of teaching approaches and ultrasound skills. ...
... Dickerson et al. 16 3 peer-taught stations, with hands-on ultrasound experience. AAA screening, FAST scanning Gogalniceanu et al. 17 Case-based discussions, problem-solving exercises, and a hands-on FAST scan of a volunteer. ...
... Four studies used real patients for their ultrasound teaching sessions, and these focused on specific pathologies. 6,8,13,19 Ten studies used volunteers as simulated patients, 7,12,[14][15][16][17]19,20,22,23 and of these, four studies explicitly stated that their volunteer participants were students 7,14-16 (Table 1). Three studies used manikin models, 18,20,23 and one study used a turkey breast model. ...
Background:
Sonography is increasingly integrated into medical curricula to prepare students for clinical practice. In 2022, we conducted a systematic review to explore the degree to which ultrasound skill acquisition is incorporated into undergraduate medial education in the United Kingdom.
Methods:
A search of Medline and Embase databases from 2003 to 2022 identified 15 relevant articles. Studies were included if they described ultrasound skills training in UK undergraduate medical education.
Findings:
A range of teaching methods were reported including didactic demonstrations, hands-on experience and combinations thereof. Portable machines were more common than cart-based machines, and most demonstrators were ultrasound-trained clinicians. Ultrasound teaching is well received, with improvements in confidence using ultrasound, motivation to learn anatomy and retention of knowledge.
Discussion:
Obstacles to integration were noted including training, cost, curriculum time constraints and the issue of incidental pathology. One study demonstrated that anatomists with appropriate training could provide ultrasound teaching, reducing the need for clinicians or sonographers. Costs may be reduced by renting machines or purchasing portable/hand-held devices. Allowing access to machines during student's free time may address scheduling difficulties. A final recommendation is to pre-scan volunteers prior to the teaching session.
Conclusion:
We have outlined approaches to ultrasound skills teaching and the inherent hurdles to this, as well as potential solutions. This may aid educators wishing to augment their curricula. Although there are relatively few studies from the United Kingdom, there is consensus that students enjoy the incorporation of ultrasound practice and believe it complements existing teaching, especially in a small group setting.
... Peer-led training was evaluated in 18 studies. 51,55,56,58,77,[102][103][104][105][106][107][108][109][110][111][112][113][114] Fifteen studies used medical students as teachers, 51,56,58,77,[102][103][104][105][106][107][108][109][111][112][113] two studies used residents, 55,110 and one study used a fellow. 114 Twelve studies did not use comparison groups, of which eleven found positive outcomes. ...
... Peer-led training was evaluated in 18 studies. 51,55,56,58,77,[102][103][104][105][106][107][108][109][110][111][112][113][114] Fifteen studies used medical students as teachers, 51,56,58,77,[102][103][104][105][106][107][108][109][111][112][113] two studies used residents, 55,110 and one study used a fellow. 114 Twelve studies did not use comparison groups, of which eleven found positive outcomes. ...
... 114 Twelve studies did not use comparison groups, of which eleven found positive outcomes. 58,77,[106][107][108][109][110][111][112][113][114] Six studies compared peer-led training to expert-led training. 55,56,[102][103][104][105] Of these, four studies found no difference between peer-led and expert-led education outcomes. ...
Point-of-care ultrasound (POCUS) is an important tool for diagnosis and management across medical specialties. This scoping review consolidates POCUS education literature, examining how curricula are developed, implemented, and assessed. We identify literature gaps, explore directions for further research, and provide recommendations for curriculum development, implementation, and improvement. Methods
We conducted a scoping review per the framework outlined by Arksey & O’Malley. A systematic search of the MEDLINE, EMBASE, Cochrane, ERIC, Web of Science, and Scopus databases was conducted to identify published, English language literature, on POCUS education in undergraduate or graduate medical training.ResultsOf 6,164 articles identified, 421 were analyzed in depth. Curricular content included diverse diagnostic and therapeutic applications, varying significantly by specialty. Teaching modalities included in-person didactics (74%), human models (58%), simulation (33%), and web-based didactics (18%). Several studies showed better outcomes for structured vs. apprenticeship curricula, hands-on teaching vs. didactic lectures, and human models vs. simulators. Web-based didactics were as effective as in-person didactics and conveyed benefits in reusability, cost, and instructor time. Dedicated electives and boot-camps were identified as effective. Few curricula assessed knowledge retention (5%), clinical decision making (3%), learner behavior (12%), or patient outcomes (6%). ConclusionScholarly POCUS education literature is expanding. Curricular content varies and should be tailored to specialty needs. Structured curricula utilizing hands-on learning, electives, and boot-camps can enhance educational outcomes. Higher-level outcomes such as knowledge retention, clinical decision making, learner behavior, and patient outcomes, are lacking and should be a focus of further researchResumeL’échographie au point de service (POCUS) est un outil important pour le diagnostic et la gestion dans toutes les spécialités médicales. Cette étude de portée consolide la littérature éducative POCUS, en examinant comment les programmes d’enseignement sont élaborés, mis en œuvre et évalués. Nous identifions les lacunes de la littérature, explorons les directions à prendre pour des recherches plus approfondies et fournissons des recommandations pour le développement, la mise en œuvre et l’amélioration des programmes d’enseignement. MéthodesNous avons procédé à un examen de portée conformément au cadre défini par Arksey & O’Malley. Une recherche systématique dans les bases de données MEDLINE, EMBASE, Cochrane, ERIC, Web of Science et Scopus a été effectuée afin d’identifier les publications en langue anglaise sur l’enseignement POCUS dans le cadre de la formation médicale de premier ou de deuxième cycle. RésultatsSur les 6 164 articles identifiés, 421 ont fait l’objet d’une analyse approfondie. Le contenu des programmes d’études comprenait diverses applications diagnostiques et thérapeutiques, variant considérablement selon les spécialités. Les modalités d’enseignement comprenaient la didactique en personne (74 %), les modèles humains (58 %), la simulation (33 %) et la didactique basée sur le web (18 %). Plusieurs études ont montré de meilleurs résultats pour les programmes structurés par rapport aux programmes d’apprentissage, l’enseignement pratique par rapport aux cours magistraux didactiques, et les modèles humains par rapport aux simulateurs. La didactique basée sur le web était aussi efficace que la didactique en personne et présentait des avantages en termes de réutilisation, de coût et de temps de l’instructeur. Les cours optionnels et les camps d’entraînement ont été jugés efficaces. Peu de programmes ont évalué la rétention des connaissances (5 %), la prise de décision clinique (3 %), le comportement des apprenants (12 %) ou les résultats pour les patients (6 %). Conclusion
La littérature éducative POCUS est en pleine expansion. Le contenu des programmes d’études varie et doit être adapté aux besoins spécifiques. Des programmes structurés utilisant un apprentissage pratique, des cours optionnels et des camps d’entraînement peuvent améliorer les résultats scolaires. Des résultats de plus haut niveau, tels que la rétention des connaissances, la prise de décision clinique, le comportement de l’apprenant et les résultats pour le patient, font défaut et devraient faire l’objet de recherches plus approfondies.
... In the preclinical semesters, sonography training focusses on providing an increased knowledge of anatomy and physiology [12][13][14], while in the clinical semesters, this knowledge is extended towards a sustained sonopathological competency [12,15,16]. Many training curricula rely on the use of peer tutors or peer-assisted learning (PAL) [17][18][19] and employ both theoretical and practical examination and evaluation formats to assess the learning process [20]. ...
... Irrespective of the course format, the defined course content, including teaching objectives, teaching media and script, as well as the trained peer tutors, was successfully implemented. The very positive evaluation of the tutors illustrated the central importance of the peer-assisted learning approach for the implementation of ultrasound training formats [18]. The significantly better evaluation of the tutors in the 2-day compact course could be explained by the more intensive social contacts in the context of the block courses. ...
Background
A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills.
Methods
Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed.
Results
A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor’s didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05).
Conclusion
These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.
... However, these models are costly, and the friability with repeated punctures remains a major limitation, resulting in the need for the frequent purchase of replacements given the large number of students involved in such training. Low-cost homemade gelatinbased phantoms facilitate the development and assessment of basic ultrasound skills, such as transducer movement, vessel cannulation, aspiration, and biopsies [84,92,93]. A cheap and interesting simulator using a Kunafa knife and playdough was developed to train students in hand movements with a probe and corresponding cross-sections or two-dimensional images [94]. ...
... In basic education, sonographic anatomy and a physical examination with ultrasound can be taught effectively by peer tutors with extensive training in ultrasound clerkship [116,117]. Peer teaching also proved effective in education concerning cardiac ultrasound [118][119][120][121], abdominal ultrasound [92,122], cardiac and abdominal ultrasound [123,124], obstetrical and gynecological ultrasound [72], musculoskeletal ultrasound [125], and comprehensive ultrasound [126,127]. Kühl et al. [118] showed in a randomized controlled study that hands-on training supervised by student tutors led to a significant gain in cardiac ultrasound skills among novices, although it was inferior to teaching by an expert sonographer. ...
The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.
... Die Lernkurve bezüglich der fokussierten Sonographie ist nachweislich steil [16]. [9]. ...
... B. die Medizinische Fakultät der Universität zu Köln (Kölner interprofessionelles Skills Lab und Simulationszentrum) -haben mittlerweile ein "peer to peer teaching" etabliert. Das "peer to peer teaching" hat sich im Rahmen der studentischen Ausbildung bewährt; die Zufriedenheit der Studierenden und die subjektive Sicherheit in der Anwendung waren hoch [9]. ...
Ultraschall ist ein wichtiges diagnostisches Mittel in der Notfall- und Intensivmedizin. Jederzeit am Patientenbett verfügbar verkürzt Ultraschall die Zeit bis zur Stellung der richtigen Diagnose. Daher ist Ultraschall in vielen Fachbereichen im Sinne einer erweiterten körperlichen Untersuchung in die diagnostischen Algorithmen eingebettet. Viele Differenzialdiagnosen lassen sich mittels einer fokussierten Sonographie schnell ausschließen und erlauben somit eine schnellere Einleitung einer zielgerichteten Therapie. Daher ist die fokussierte Sonographie von größter Bedeutung für den Notfall- und Intensivmediziner. Die Integration der Ausbildung in das Studium wird zunehmend häufiger, es existieren jedoch keine einheitlichen strukturierten oder universitätsübergreifenden Standards.
... Peer-mentoring [126][127][128][129][130][131][132] In the course of evaluating articles which integrate POCUS in a novel way, peer mentoring emerged as a major theme in ultrasound education. In the peer mentoring studies reviewed, medical students in clinical or clerkship years (typically third or fourth year) teach preclinical medical students (first or second year). ...
... Advantages for the education of medical students also extend to the peer tutors themselves [127,128]. There may, however, be a limit to the extent to which peer tutoring can replace faculty instruction, with Kühl [130] show that not all students find peer teaching as acceptable as that delivered by faculty. ...
Introduction: Increasingly, medical schools are integrating Point of Care Ultrasound (POCUS) into their curricula. This review investigated the available literature on how best to integrate POCUS in the teaching of medical students and the benefits of doing so. Methods: Given the heterogeneous literature that has emerged on POCUS education, a scoping review was conducted. Relevant medical databases, including PubMed, MEDLINE, PsycINFO, EMBASE and CINAHL, were searched between January 1980 and August 2016, using keywords identified by the authors. Inclusion criteria were as follows: prospective or retrospective studies, observational or intervention studies, and studies describing how medical students learn to use ultrasound. Results: The literature search yielded 593 articles, of which 128 met the inclusion criteria. Studies that met the inclusion criteria were sub-categorised under the following headings: those that described or evaluated an ultrasound curriculum, those that employed ultrasound as a means of teaching another topic in the curriculum (i.e., anatomy, physical examination, physiology, invasive procedures), those that investigated the learning curve of ultrasound education and those that employed adjuncts or peer mentoring to teach ultrasound. Conclusions: The reviewed literature indicates that the integration of ultrasound in undergraduate medical education is both feasible and beneficial to medical students. This article is intended to inform medical educators aiming to integrate ultrasound into their medical school curricula.
... Peer-mentoring [126][127][128][129][130][131][132] In the course of evaluating articles which integrate POCUS in a novel way, peer mentoring emerged as a major theme in ultrasound education. In the peer mentoring studies reviewed, medical students in clinical or clerkship years (typically third or fourth year) teach preclinical medical students (first or second year). ...
... Advantages for the education of medical students also extend to the peer tutors themselves [127,128]. There may, however, be a limit to the extent to which peer tutoring can replace faculty instruction, with Kühl [130] show that not all students find peer teaching as acceptable as that delivered by faculty. ...
... Irrespective of the above and in summary, interdisciplinary coordination of medical specialist disciplines should continuously create multiple contact points with ultrasound [10][11][12][13][14][15]25,31]. Bearing in mind the universal lack of resources and teaching staff, good strategic planning and the employment of medically supervised peer tutors are imperative [17,22,27,49]. Modern teaching methods (for example, simulator-based training) and adapted, validated test formats [26,[50][51][52] should also be included in future curriculum design [45,50]. ...
Introduction:
Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses.
Methods:
From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum".
Results:
Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills.
Conclusions:
Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.
... To make it possible to offer practical courses to as many students as possible, it is useful and essential to use peer-group tutors [21,22,49]. Since practical ultrasound courses work best in small groups [20] and are very time-consuming and resource-intensive, welltrained tutors could help to relieve the teaching loads of physicians and reduce group size. ...
Introduction:
In emergency and critical-care medicine, focused cardiac ultrasound (FoCUS) is indispensable for assessing a patient's cardiac status. The aim of this study was to establish and validate a peer-to-peer-supported ultrasound course for learning FoCUS-specific skills during undergraduate studies at a German university.
Methods:
A 1-day, 12 teaching units training course was developed for students in the clinical section of medical college, with content based on the current national guidelines. A total of 217 students participated in the study (97 in the course group and 120 in the control group). The course and the participants' subjective assessment of improved skills were evaluated using a questionnaire (7-point Likert scale; 7 = complete agreement and 1 = no agreement at all). Objective learning gains were assessed by tests before and after the course. These consisted of a test of figural intelligence (eight items) and a test of technical knowledge (13 items).
Results:
The course participants experienced significant improvement (P < 0.001) from before to after the course, with a large effect size of η2part = 0.26. In addition, the course group had significantly better results (P < 0.001) than the control group in the post-test, with a medium to large effect size of η2part = 0.14. No significant differences (P = 0.27) were detected in the test section on figural intelligence. The evaluations showed that the participants had a high degree of satisfaction with the course approach, teaching materials, and tutors. There was also a positive increase in their subjective assessment of their own skills, including areas such as technical knowledge, ultrasound anatomy, and performance of the examination.
Conclusion:
The results of both the objective learning assessment and the subjective evaluations suggest that a FoCUS course originally intended for qualified physicians is equally suitable for students. With the development and provision of modern digital teaching media, even more students will be able to benefit from this approach in the future.
... However, studies have shown the efficacy of using student tutors (STs) as a way to combat the lack of faculty resources in teaching ultrasound at the preclinical level [8]. Furthermore, studies supported that trained STs can teach their peers effectively [9]. ...
Background
Ultrasound is a vital part in many medical schools’ curriculum. Although there is strong support for the use of student tutors (STs), there is a lack in gauging their effectiveness with more difficult organ systems such as the musculoskeletal (MSK) system. We aim to determine the effectiveness of using STs versus expert ultrasound instructors (UIs) when teaching MSK ultrasound.
Methodology
Medical students were recruited to participate in an MSK workshop to identify superficial volar arm structures (radial nerve, radial artery, median nerve, ulnar artery, ulnar nerve) using Butterfly iQ. In total, 14 participants were taught by STs and 10 participants were taught by UIs. Participants imaged the five structures and answered surveys gauging their confidence via five-point Likert scales.
Results
There was no significant difference in confidence or identification accuracy for all five structures between the two groups. However, there was a significant difference in confidence in the understanding of basic ultrasound concepts in favor of the UI group (p < 0.05). A greater number of students were more confident in identifying all five structures when taught by STs, but more students correctly identified the structures when taught by UIs.
Conclusions
The results on confidence could be due to positive peer perception. Both groups scored relatively high in their identification accuracies, promoting the successful use of STs. The successful use of STs in teaching MSK ultrasound opens the possibility to developing peer-led ultrasound curriculum on more complex ultrasound topics in the future.
... Peer-assisted learning (PAL) is a small-group teaching strategy in which students are responsible for teaching, learning, and active participation to optimize their learning opportunities. 6 This style of education is a multifaceted, learner-centered model that encourages social interactions to benefit both students and teachers. 7 Social cognitive theory (SCT) is a promising framework to study POCUS education while using PAL. ...
Purpose:
The aim of this study was to understand how peer-assisted learning (PAL) could be utilized by physician assistant (PA) students in an ultrasound student interest group (USIG) as a means of developing cognitive confidence and practical competence with the imaging modality.
Methods:
An observational study that included 3 USIG workshops was designed. Pre- and postworkshop surveys were administered. All first-year PA students, regardless of participation in the USIG workshops, were asked to complete the voluntary and anonymous surveys.
Results:
A statistically significant difference between those who attended at least one workshop and those who did not attend any workshops on their postworkshop scores (p = 0.02) was seen. There was a statistically significant association between the number of workshops attended and the postworkshop difference (p = 0.03).
Conclusion:
Results show that, in the context of social cognitive theory, PAL is an efficacious learning modality that enhances learner and tutor performance in ultrasound.
... The literature has shown that instructors of various types and backgrounds, including trained senior medical students, nonclinical anatomists, and electronic programs, can effectively teach POCUS. 2,[26][27][28][29] Thus, it is possible for individuals to have learned POCUS and to teach it to medical students without having formal advanced training such as radiology residency or ultrasound fellowship. For example, residents learn basic skills in POCUS as part of routine training in EM and other disciplines. ...
Introduction:
Point-of-care ultrasound (POCUS) is a valuable asset in bedside clinical care. Undergraduate medical education is increasingly using POCUS as an adjunct tool for teaching anatomy, pathophysiology, and physical exam in an integrated manner. Many medical schools teach content in an organ systems-based format in the preclerkship years. POCUS teaching can be very effectively tailored to specific organ systems. Though pilot curricula for generalized ultrasound education exist, few teach organ systems-based content using POCUS. To address this gap, we designed and implemented an integrated POCUS module to supplement anatomy, pathophysiology, and physical exam teaching in the renal course.
Methods:
The module consisted of (1) a 30-minute didactic lecture introducing students to renal ultrasound technique and image interpretation and (2) a practical hands-on skills session. Pre- and postmodule surveys assessed the efficacy and impact of the curriculum.
Results:
A total of 31 first-year medical students completed the POCUS renal curriculum. A majority reported that the module positively affected their understanding of renal pathophysiology and the physical exam. They also reported increased confidence in using POCUS to detect renal pathology and make clinical decisions.
Discussion:
It was feasible to implement a POCUS curriculum to supplement integrated teaching of renal system concepts in the first year of medical school, and students found POCUS teaching valuable. POCUS provides educators with another tool to integrate basic and clinical sciences with hands-on relevant clinical skills practice in early medical school years.
... Among the students, 98% mentioned that they had received a qualified education, and 100% mentioned that their education on USG had improved and that they would recommend the training. [20] In another study, 5 th -year students of the medical faculty were given theoretical and practical education on USG, and they were examined on actual patients. Values of obtaining acceptable correct images were 73.8% for the cardiovascular region and 93.5% for the whole abdomen. ...
Background:
The present study aims to investigate the efficacy of ultrasound simulators in the training of the health staff working in the emergency department of a university hospital on Focused Assessment with Sonography for Trauma (FAST).
Methods:
This study was conducted on emergency medicine residents, medical interns and paramedics of the emergency department of Selçuk University Medical Faculty, prospectively. The participants were given theoretical and practical training on FAST using the SonoSim® USG simulator. At the end of the training, all participants were requested to perform FAST for the pre-selected scenarios for five patients to find the ideal diagnostic window for each patient and declare the diagnosis.
Results:
This study included 60 participants, including emergency medicine residents, medical interns and paramedics, each having 20 members. The rate of obtaining the correct image was 99.5%, and the rate of diagnosing correctly was 94% among resident physicians. For interns, these rates were 98.5% and 88%, respectively. For paramedics, the rates were 98% and 81.5%, respectively.
Conclusion:
It was observed that the theoretical knowledge level of the trainees did not affect the ability to obtain a correct image in the simulator. However, the skills of the trainees for correctly diagnosing via FAST were directly proportional to their theoretical knowledge levels. Our findings suggest that a short theoretical training followed by a simulator-guided practice would easily provide a sufficiency for FAST for the health workers.
... PAL is a great means to encourage interaction among students, and evaluations of such courses have shown a high degree of student satisfaction [18]. This confirms the feasibility of peer teachers in medical education, and more specifically in teaching sonography skills [30,31]. Expert teachers can be supported and to a certain extent replaced by student teachers, thus saving resources. ...
Objective:
The aim of this prospective randomised trial was to assess the impact of the team-based learning approach on basic musculoskeletal ultrasound skills in comparison to both peer-assisted and conventional teaching and to examine the influence of gender and learning style on learning outcomes.
Methods:
In this prospective randomised trial, we randomly assigned 88 students to 3 groups: team-based learning (n = 19), peer-assisted learning (n = 36) and conventional teaching (n = 33). Pre-existing knowledge was assessed using a multiple-choice (MC) exam. Student performance after completing the course was measured using an Objective Structured Clinical Examination (OSCE) and a second MC exam. Students were asked to complete Kolb's Learning Style Inventory and to evaluate the course.
Results:
There was a significant gain in theoretical knowledge for all students (p < 0.001). The team-based learning groups' performance proved to be significantly superior on the OSCE (p = 0.001). As gender had no significant effect on practical or theoretical performance, learning style was linked to differences in the practical outcome. An evaluation showed overall satisfaction with the course and with the respective teaching methods.
Conclusion:
Team-based learning proved to be superior to peer-assisted and conventional teaching of musculoskeletal ultrasound skills.
... Consequently, the majority of the POCUS teaching was done in an extracurricular manner, with the newly created POCUS interest group that employed a peerteaching approach. A recent scoping review evaluating the novel integration of POCUS in medical education found seven studies (8,(10)(11)(12)(13)(14)(15) which revealed that the majority of designs consisted of clerkship (near-peer) students teaching pre-clerkship students. To our knowledge, studies evaluating pre-clerkship students teaching POCUS to other pre-clerkship students are very limited. ...
Objectives
Point of care ultrasound (POCUS) is increasingly used in rural settings where it’s portability,and imaging capabilities make it effective clinically. POCUS teaching has traditionally relied on faculty instruction, which is limited by the small number of certified faculty members. The UOttawa POCUS interest group deployed peer-teaching since 2018, which overcomes the instructor barrier by employing experienced medical students to train preclerkship students. This paper will evaluate the efficacy of the peer-led POCUS workshops as a learning format.
Methods
3-hour POCUS workshops were held for Cardiac, MSK, Aorta, and eFAST scans from October 2018 to June 2019. Students with prior experience in POCUS were identified as peer-teachers, and were trained by an expert physician prior to the workshop. Peer-teachers taught a small group, with physician experts rotating through groups for technical support.
Surveys were sent out to students who participated in the workshops assessing the following categories:utility, learning experience,workshop efficacy, tutor competence, and interest. Descriptive statistics and thematic analysis was reported for the quantitative and qualitative data, respectively.
Results
45 participants completed the survey. The surveys showed positive support for the aforementioned categories, with the average score being greater than 4. From the thematic analysis, the four main strengths of the peer-led format are: Trainer competence, learner comfort, situational teaching, and opportunity to practice.
Conclusion
Peer-led workshops are an effective format for POCUS training in instructor-constrained settings. These workshops can be translated to rural settings in lieu of a formal POCUS training program.
... A voluntary laboratory practical that is provided by peer instructors may increase medical students' sonographic performance in a sustainable matter. Dickerson et al. 17 also concluded that the peer teaching method has an important place in sonographic training of students. By offering a small group format, this may help improve a student's sonographic skills. ...
Objectives
Worldwide medical schools that provide sonography training appear to be very heterogeneous in their offerings. A medical school has developed a training program with limited resources, which used a peer teaching method, to provide sonography training. The implemented courses consist of a voluntary laboratory practical and a required didactic seminar.
Methods
To analyze this concept, the effects on knowledge, skills, and attitudes were examined by using surveys, multiple-choice tests, and practical tests.
Results
The teaching concept demonstrated a positive effect on theoretical knowledge, practical skills, and attitudes. Nevertheless, some practical skills such as conducting gallbladder sonography deteriorated over the time of the study.
Discussion
The peer-teaching approach with well-trained students as instructors and tutorials in smaller groups appeared to be a key element for success. This cohort study underlines the need to provide both theoretical and practical mandatory training.
Conclusion
Peer teaching may be a cost-effective way to teach sonography skills to medical students during their training.
... While the instructor could deliver didactic content using the flipped classroom and demonstrate scanning skills to the group, it was difficult for her to provide direct feedback and guidance at each station. To this end, we are developing a peer instructor model for future sessions that allows upper-level students to assist with instruction in the hands-on scanning sessions to produce a smaller instructor-to-student ratio.Peer-assisted course models have been effective in delivering undergraduate ultrasonography education15 and would allow us to increase available instructors while maintaining a single-instructor model. Other studies have also shown that POCUS skills and understanding did not differ between students taught by faculty or peer instructors.[16][17][18] ...
Context:
Ultrasonography is becoming more prevalent in clinical practice, but medical schools looking to implement preclinical training are limited by financial and faculty resources.
Objective:
To design a single-instructor model to save faculty resources and to determine whether this model is effective at teaching ultrasonography to preclinical medical students.
Methods:
This single-instructor model included 3 components: (1) flipped classroom, where students watched an online lecture covering examination techniques; (2) in-person scanning sessions, where students scanned each other after the instructor went through lecture content and pathologic images, a video camera to show probe placement and examination technique, and a live feed from an ultrasonography demonstration; and (3) feedback on written examination questions and course evaluations.
Results:
When compared with a traditional ultrasonography curriculum, which requires approximately 600 instruction hours annually, this program required 96 hours. Students reported appreciation of exposure to ultrasonography but expressed desire for smaller group sizes and greater individual instruction. Students performed well on written test questions, with the first-year class answering 88% correctly and the second-year class answering 90.6% correctly.
Conclusions:
Although this educational format was used successfully to teach introductory ultrasonography to preclinical students, feedback suggested that students would prefer more individual instruction. The authors look toward implementing a peer-instructor format, forming smaller laboratory groups, and improving skill assessment.
... 7 One study of peerinstructed US found that 100% of the 105 medical student respondents felt that their emerging clinical skills improved after an 8-month US course. 8 In a similar study, researchers concluded that students' perceptions of peer instructors' teaching competency was equivalent to their perceived competence of faculty instructors. 9 These data offer a possible solution to one of the more prevalent limitations in medical school education: the limited availability of skilled instructors. ...
Background:
The importance of medical ultrasonography (US) is well established, but given an already dense curriculum, integration of US into preclinical training can be difficult. Although there is no clear consensus on the best practice for integrating US into medical school curricula, growing student interest in US training demands investigation of potential solutions.
Objective:
To investigate whether US integration through peer-assisted learning (PAL) and extracurricular activities during preclinical training is perceived to be valuable by student participants.
Methods:
First- and second-year students at the West Virginia School of Osteopathic Medicine (WVSOM) were invited via email to attend 4 monthly PAL extracurricular US sessions on the following point-of-care US topics: (1) basic lung examination to assess pleural sliding, (2) extended focused assessment with sonography for trauma, (3) right upper quadrant biliary examination, and (4) US-guided central venous catheter placement. A brief survey using Likert-style questions inquired about participants' level of agreement with whether the given session was appropriately complex, increased comfort with US, was informative and interactive, and improved confidence in identifying anatomic structures (sessions 2 and 3 only). A final question asked participants whether they would attend more extracurricular US sessions.
Results:
Fifty-eight students (36 unique students) attended the peer-led sessions. Of the 58 students, 50 responded to the survey for a response rate of 86.2%. Responses were overwhelmingly positive. All respondents strongly agreed or agreed that these sessions improved their confidence in identifying anatomic structures using US, and 49 (98%) strongly agreed or agreed that they would attend more US sessions.
Conclusion:
Respondents strongly endorsed the peer-led US sessions, which has facilitated the formal integration of an elective US course at WVSOM. The peer-led sessions introduced at WVSOM could provide the framework and motivation for similar courses at osteopathic medical schools across the country.
... [5,6,[15][16][17] While there are some studies that illustrate the use of peer-to-peer educational programs in medical school, there are relatively few studies on medical students teaching ultrasound to other medical students. [18,19] Further investigation is needed into this concept. Potential future studies could include an assessment of long-term retention of the skills and knowledge obtained, to find differences between students of different levels of experience. ...
Context:
As the utility of point-of-care ultrasound (POCUS) continues to expand in the medical field, there is a need for effective educational methods. In Switzerland, medical education follows the European model and lasts 6 years, focusing on preclinical training during the first 2 years. No previous studies have evaluated the optimal time for teaching ultrasound in European medical education.
Aims:
The aim of this study is to provide ultrasound training to medical students in Switzerland at varying times during their clinical training to determine if the level of training plays a role in their ability to comprehend and to apply basic POCUS skills.
Methods:
We performed an observational study utilizing a convenience sample of Swiss medical students between July 11, 2016 and August 6, 2016. They were taught a 2-day POCUS course by five American-trained 1st-year medical students. Following this course, students were evaluated with written and clinical examination.
Results:
100 Swiss medical students were enrolled in the study. A total of 59 of these students were early clinical students, and 41 students were late clinical students. A two-tailed t-test was performed and demonstrated that the late clinical students performed better than the early clinical students on the written assessment; however, no difference was found in clinical skill.
Conclusion:
Our data suggest that Swiss medical students can learn and perform POCUS after a 2-day instructional taught by trained 1st-year American medical students. No difference was found between students in early clinical training and late clinical training for the ability to perform POCUS.
... Fourteen studies (15% [14 of 95]) reported training senior medical students to teach their peers. 33,54,56,57,59,64,67,69,84,85,87,88,98,108 Regarding novel technology, 3 studies used hand-carried US devices, 38 ...
Objectives
The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students.
Methods
A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full‐text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors.
Results
Ninety‐five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US‐related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non‐US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed.
Conclusions
There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.
... Der Bedarf für eine Intensivierung der praktischen Ausbildung zur Durchführung der Sonografie wurde bereits in früheren Studien aufgegriffen. Neben reinen Tutor-geführten Kursen [4] gab es insbesondere im Bereich der Anästhesiologie und Intensivmedizin Trainingsansätze mit dem Schwerpunkt sonografisch gestützter Interventionen. Hier existiert eine Untersuchung mit 75 Teilnehmern zu einem Trainingsmodul, das aus einer 40-minütigen didaktischen Einführung und einer anschließenden supervidierten, 80-minütigen "Hands-on-Übung" an Modellen und anatomischen Präparaten aufgebaut ist [8]. ...
Physicians in education often have poor experience in practice and assessment of ultrasonography on entering their profession, due to a deficiency of training offers during their study of medicine. Hence, a multimedia device for stepwise learning and training ultrasonography of the thyroid was developed. A software for a portable ultrasonography system was used to design a multimedia device for ultrasonography of the thyroid. It allows the user to illustrate texts and pictorial material simultaneously with ultrasound examination in order to compare own findings with examples from a database. The device was evaluated by 8 medical students and compared to a tutor-guided training. A structured, stepwise manual for ultrasonography of the thyroid with a large content of examples in different sectional images was designed for simultaneous reconstruction with the ultrasonography device. The informative content of the device and the replicability of the examination procedure were evaluated positively. Assessment respecting clarity, eligibility for users without experience and learning success was varying. The tutorial to learn and train ultrasonography of the thyroid is an instrument for self-learning and improving practical education in ultrasonography in medical education. In the next version, the manual for the examination will be structured in greater detail.
© Georg Thieme Verlag KG Stuttgart · New York.
Sra. Editora: El ultrasonido es la modalidad de imagen de primera línea establecida en todo el mundo1 y el espectro de su utilidad ha sido ampliamente demostrado en el ámbito hospitalario, áreas clínicas y medicina de emergencia.La ecografía tiene un rol cada vez más importante en la medicina, pese a esto los estudiantes tienen poca o nula formación específica sobre ultrasonido en el pregrado. Sin embargo, la educación en técnicas de ultrasonido permitiría a los estudiantes de medicina tanto a aprender, como a reforzar el conocimiento de anatomía, fisiología y patología, así como a mejorar sus habilidades en la evaluación física del paciente2. Adicionalmente la evidencia demuestra que la mayoría de los cursos de formación en habilidades prácticas, mejoran la confianza de los estudiantes y su rendimiento académico3.La introducción de la formación en ecografía es relativamente reciente y se remonta a hace más de 30 años en Alemania4. Actualmente, varias facultades de medicina en el mundo han integrado la formación en ultrasonido en sus planes de estudio de pregrado y los simuladores, los dispositivos portátiles y otros avances tecnológicos relacionados a la inteligencia artificial pueden facilitar dicha formación4.Como herramienta pedagógica, merece la pena considerar por su versatilidad y aplicabilidad, Point-of-care ultrasound (POCUS) (Ultrasonido en el punto de atención). Esta Modalidad de ultrasonido está adquiriendo cada vez más importancia en la atención de los pacientes a pie de cama, por ejemplo en las unidades de cuidados intensivos, emergencias y recientemente en atención prehospitalaria5.Point-of-care ultrasound se puede realizar con un equipo de ecografía convencional o con dispositivos portátiles o de mano. Estos últimos han mejorado notablemente su resolución siendo cada vez más comparables con los sistemas modernos convencionales, por tanto es razonable pensar que en algún momento las brechas actuales en las capacidades entre los sistemas convencionales y los portátiles desaparecerán por completo1, esto sin duda será a futuro un factor que contribuirá a los programas de enseñanza universitaria de Ecografía.A más del componente central de la Ecografía, representado por las modalidades mencionadas, los componentes clave de la integración del ultrasonido en la educación de los estudiantes de medicina requiere un enfoque multidisciplinario que incluyen entre otras medidas: la búsqueda del espacio e infraestructura idóneos, el establecimiento de metas apropiadas, una pedagogía adecuada de la enseñanza del ultrasonido, el establecimiento de responsables cualificados, la definición de de un plan de estudios estructurado, así como los materiales y medios de evaluación correctos1.Un concepto a considerar actualmente es el de Peer-to-peer learning (aprendizaje asistido por pares) que consiste en la interacción de estudiantes con otros estudiantes cualificados para enseñar habilidades, en este caso el uso de imágenes mediante ultrasonido6.Si bien el aprendizaje asistido por pares requiere de estrategias educativas sostenidas como capacitaciones prácticas y un reclutamiento continuo de nuevos estudiantes tutores, en situaciones complejas como la Pandemia de Covid 19, donde los recursos humanos y materiales se vieron trastocados, este concepto puede ajustarse a las circunstancias cambiantes de la enseñanza6.En América latina, área geográfica con multitud de variables geográficas como regiones de difícil acceso, así como sus determinantes sociales marcadas muchas veces por la pobreza, la falta de personal especializado en regiones remotas entre otros factores, se hace cada vez más urgente que el personal médico de atención primaria posea habilidades en Ultrasonido.Por su importancia trascendental, podemos concluir que la ultrasonografía debe ser considerada, como prioridad en los curriculums de enseñanza de pregrado. Esto facilitará el aprendizaje clínicamente relevante y por tanto la eficiencia de la atención médica. La consecución de estos objetivos, plantea reflexiones en materia de política educativa y de salud que requieren una urgente atención gubernamental de cada país.Animamos a los profesionales y estudiantes de la salud, así como a la comunidad de las ciencias médicas a mantenerse atentos al cumplimiento de dicha meta imprescindible. Conflictos de interés: Los autores de este artículo declaran no tener conflictos de interés.
Objectives:
Undergraduate ultrasound education is becoming increasingly important, but its expansion is limited by time, space and the availability of trained faculty. In order to validate an alternative and more accessible teaching model, our aim was to assess whether combining teleguidance and peer-assisted learning to teach ultrasound is as effective as traditional in-person methods.
Methods:
Peer instructors taught 47 second-year medical students ocular ultrasound via either teleguidance or traditional in-person methods. Proficiency was assessed using a multiple-choice knowledge test and objective structured clinical examination (OSCE). Confidence, overall experience, and experience with a peer instructor were measured using a 5-point Likert scale. Two one-sided t-tests were used to measure equivalency between the two groups. The null hypothesis that the two groups were not different was rejected when P < 0.05.
Results:
The teleguidance group performed as well as the traditional in-person group in terms of knowledge change, confidence change, OSCE time and OSCE score (p = 0.011, p = 0.006, p = 0.005 and = 0.004, respectively, indicating the two groups are statistically equivalent). The teleguidance group rated the experience highly overall (4.06/5), but less than the traditional group (4.47/5; P = 0.448, indicating statistical difference). Peer instruction was rated 4.35/5 overall.
Conclusion:
Peer-instructed teleguidance was equivalent to in-person instruction with respect to knowledge change, confidence gain and OSCE performance in basic ocular ultrasound.
Introduction:
Approximately 45% of paediatric deaths in the United Kingdom (UK) were as a result of trauma. Computed tomography (CT) provides time efficient and accurate diagnosis, increasing chances of survival. Whilst use of CT in evaluating paediatric trauma has been invaluable it carries significant radiation risks, largely because children have greater radiation sensitivity than adults. Although national paediatric trauma workload in the UK is proportionately low, the majority of paediatric patients are conveyed to hospitals which predominantly undertake CT scans on adult patients. This research aimed to determine the confidence levels of radiographers when performing paediatric CT trauma scans in three public hospitals in the UK, and whether a teaching intervention improved their perceived self-confidence.
Methods:
Individual questionnaires containing eight qualitative and quantitative questions were used to ascertain radiographers' perceived confidence levels. A teaching intervention was developed based on responses. A post-intervention questionnaire was used to determine whether radiographers' confidence levels had improved.
Results:
Radiographers (n = 45) reported a mean confidence score of 5.6 (standard deviation 2.2) and 8.0 (standard deviation 1.7) scanning paediatric trauma patients pre- and post-intervention respectively. A paired two group t-test found this difference to be statistically significant at p < .00001. Radiographers reported several factors which negatively influenced confidence levels, including limited experience and postgraduate education.
Conclusion:
Radiographers reported to be less confident scanning paediatric CT trauma patients compared to adults, pre- and post-intervention, however this research does not clarify whether this is as a result of an increase in competence. Further research regarding this concept warrants investigation.
Implications for practice:
Results suggest further training based on negative factors reported by radiographers can increase confidence when performing this type of scan, assisting radiographers in optimising paediatric patient doses.
O objetivo deste estudo foi analisar o histórico e os fatores associados ao ensino da ultrassonografia point-of-care na graduação de medicina. Trata-se de uma revisão sistemática da literatura, conduzida nas bases de dados PubMed®, Cochrane Library, Portal de Periódicos Capes e Biblioteca Virtual em Saúde, utilizando descritores controlados. Foram inclusos artigos que abordassem os benefícios e/ou entraves do uso da ultrassonografia point-of-care no currículo da graduação de medicina. Foram encontradas 959 referências, sendo que, destas, 42 foram incluídas na análise final; 64,3% eram estudos norte-americanos. Na maioria, os currículos foram implementados do primeiro ao quarto ano (28,6%), no primeiro e segundo ano (17,1%) ou no sexto ano (17,1%) da faculdade. Mostrou-se principalmente que a integração do ensino da ultrassonografia point-of-care na graduação de medicina é viável, já que a ultrassonografia é uma ferramenta de ensino valiosa e bem recebida pelos discentes. Além disso, esse ensino aumenta o conforto dos alunos e a capacidade de obter imagens de ultrassonografia precisas para fins diagnósticos e procedimentais. A incorporação da ultrassonografia point-of-care nos currículos e programas de ensino médico ainda está em desenvolvimento, mas os dados existentes já apontam que a inserção dessa ferramenta no processo de educação médica é possível e apreciada pelos discentes.
Background:
Extended focused assessment with sonography for trauma (eFAST) is now an essential part of the primary survey of an emergency patient. The discrepancy between an increasing number of medical students and growing clinical commitments of lecturers is a major challenge in student teaching that needs to be resolved. The practice of using peers in the clinical education of medical students is a well-established tradition and commonly practiced but lacks definition in its implementation. Therefore, we aimed to investigate whether the level of experience of the tutor affects the effectiveness of learning among students using eFAST during a clinical scenario.
Methods:
A prospective randomized single-blinded controlled trial, where 168 medical students in the eighth semester were randomized into control and intervention groups. The control group received the 4-h standard ultrasound (US) tutorial from various resident doctors. All residents were at least stage-1-certified in ultrasound. The intervention group received the tutorial from trained peer teachers (TPTs). These TPTs were medical students who were qualified to teach the procedure. All students received an initial tutorial on basic ultrasound principles and a final lecture on recognizing pathological images. Students completed basic questionnaires requesting pre-existing US experience, theoretical and clinical application questions based on eFAST one day later and at the end of the semester. Students also completed a 6-min OSCE (Objective-Structured-Clinical-Exam) station involving clinical emergency scenarios.
Results:
Eighty-five percent of participants had no previous eFAST experience. Early and later evaluation of the participants show no significant differences between both groups regarding the theoretical and the clinical application examinations, except the early phase OSCE results, which was not repeated in the late-stage results.
Conclusions:
Peer-teaching can be utilized to teach practical skills such as eFAST without a loss of clinical application skills. This relieves the burden of removing doctors from patient care situations and maintains teaching standards.
Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation. Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4). Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching. Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.
Objectives:
The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students.
Methods:
64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting.
Results:
A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care.
Conclusions:
The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
Background
Point-of-care ultrasound (POCUS) training has been increasing among internal medicine (IM) residency programs, but few programs can provide longitudinal training due to barriers such as lack of trained faculty.
Aim
Describe the development of a longitudinal POCUS track for IM residents using local and external resources, including a national POCUS certificate program.
Setting
University-based IM residency program affiliated with a public and veterans affairs hospital.
Participants
Twelve IM residents from 2018 to 2021.
Program Description
Residents complete a national POCUS certificate program by attending live courses and completing online modules, an image portfolio, and final knowledge/skills assessments. Locally, residents participate in 1-month procedure and diagnostic POCUS rotations and provide peer-to-peer POCUS teaching of residents and medical students.
Program Evaluation
The POCUS track increased residents’ use and comfort with diagnostic and procedural applications. All residents rated being satisfied or very satisfied with the track and would recommend it to prospective applicants (100%). The most commonly reported barriers to utilizing POCUS per residents were time constraints (83%), lack of available ultrasound equipment (83%), and lack of trained faculty (58%).
Discussion
IM residency programs with limited faculty expertise in POCUS can leverage external resources to provide longitudinal POCUS training to its residents.
Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation.
Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4).
Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching.
Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.
In response to mounting concerns regarding a perceived shortage of genetic counselors, the Genetic Counselor Workforce Working Group (WFWG) was established in 2013 to identify barriers to growth of the genetic counseling workforce. After completing a workforce analysis and confirming a shortage, the WFWG convened a strategic planning session in 2017 to identify goals and strategies that would increase the number of certified counselors to meet the current and future workforce demands and ensure access to genetic counselor services. Subcommittees were formed and charged with achieving assigned goals; one such subcommittee included a curriculum working group to build a dynamic and effective educational infrastructure to increase the number of genetic counselors graduated from accredited training program. This paper reports of progress of the WFWG Curriculum Subcommittee toward achieving this goal through a narrative literature review that identifies innovative education methods that help to increase capacity of fieldwork training, both in genetic counseling training programs and in other health professions. Of the five thematic areas identified in this study, four are analyzed for insight into building clinical capacity: systems/infrastructure, rotation structure/models, skill building, and novel techniques. While additional studies are needed to establish best practices in these thematic areas, there are several take‐aways that training programs can begin to utilize as they look to expand training opportunities. While growth of the genetic counseling workforce will continue to be a long‐term issue, programs should begin to think creatively and innovatively about how to reach beyond traditional fieldwork training formats to build capacity. The strategies explored in this paper offer feasible and untapped solutions that can help support efforts to establish a sustainable genetic counseling workforce.
Introduction
Ultrasound (US) imaging has rapidly increased its application in almost every medical field. Many universities worldwide provide teaching of US for undergraduates in their curricula. Emerging evidence is supporting the use of ultrasonography to improve also non-US skills and knowledge of medical students.
Objectives
The purpose of this review is to understand if the integration of US lessons into medical students’ curriculum improves their learning of physical examination and enhances their skills when performing it.
Methods
We performed a systematic review of literature by searching three electronic medical databases. We included studies of any level of evidence published in peer-reviewed journals. Evaluated data were extracted using the PICO framework and critically analyzed. PRISMA guidelines were applied; we excluded all the articles evaluated with serious risk of bias and/or low methodological quality.
Results
We included 15 articles, accounting for more than 1643 medical students involved from five different countries and 14 various academical institutions. Eight out of nine studies (88.9%) reported an improvement of practical physical examination scores by students exposed to ultrasound lectures. Eleven out of eleven studies (100%), which administered self-assessment questionnaires, reported strong agreement among students that ultrasound lectures helped them learning and understanding the physical exam and improved their confidence and skills.
Conclusions
Increasing evidence shows that incorporating ultrasound in medical students’ curriculum might improve their ability and confidence when learning and performing a physical exam. This significant tendency needs to be corroborated at a deeper level by further studies.
While peer-assisted (PAL) learning strategies have been successful in K-12 programs, such practices are used less commonly at the college level. In addition, PAL programs are aimed largely at student populations who are struggling (for example, learning disabled students) or in topics where many students encounter difficulty (for example, math and natural sciences). This means that while PAL strategies have shown their effectiveness, the view from the academy is that this help is largely remedial.
This paper surveys the literature and analyzes the use of PAL programs in freshman-level general education classes at a large, diverse public university with particular focus on the humanities. We conclude that using peer-assisted learning is a vibrant addition to university education, with promising possibilities for humanities education.
This article explores the assessment of professionalism within a cohort of medical students during a sequential 13‐week medical school histology and anatomy course. Across seven data points, students were asked to identify a professionalism role model from amongst their peers and to score Likert‐structured rationales for their decision. Based on density scores, an initial social network analysis identified six peer‐nomination “stars.” However, analysis of these stars revealed considerable variability and random‐like “noise” in both the nomination and explanation data sets. Subsequent analyses of both data sets explored the possibility of underlying patterns in this noise using tests of reliability, principal components factor analysis, and fixed‐effects regression analysis. These explorations revealed the presence of two dimensions (professional vs. supportive) in how students sought to explain their nomination decisions. Although data variability remained quite high, significantly less variability was present in the professional than in the supportive dimension, suggesting that academic helpfulness rationales are both empirically distinct and more mutable than rationales grounded in professionalism‐related factors. In addition, data showed that the greater the stability in one's choice of a professionalism role model nomination over the T1–T7 data periods, the more stable one's reasons for that nomination—both for professionalism and supportive dimensions. Results indicate that while peer assessment of professionalism by first‐year medical students may not be very reliable, students can differentiate between more personal and professional factors, even at this early stage in their professional development. Formal instruction within the pre‐clinical curriculum should recognize and address this distinction. Anat Sci Educ. © 2018 American Association of Anatomists.
This article was migrated. The article was not marked as recommended. Background
Use of ultrasound (US) to guide invasive procedures is steadily growing. The increased accuracy, decreased complications and overall patient and clinician satisfaction of ultrasound-guided procedures makes it a useful skill to acquire. In this study, we explored whether basic procedural ultrasound training, specifically addressing vascular access, can be taught to medical students by focusing on generic skills that could be individually assessed.Methods215 5th year medical students were enrolled in the session. The session involved 70 minutes of didactic teaching and 140 minutes of supervised scanning followed by an assessment. The training was on ultrasound compatible phantoms and simulated human patients using a linear transducer.Results 93% (n=199) of students were able to optimize the image and visualize the relevant structures independently. 86% (n = 184) were able to insert the needle into the vessel of the training block independently using transverse view while 89% (n=198) were able perform the same independently with longitudinal view. Discussion The majority of students were able to demonstrate this skill with limited training. This study suggests that ultrasound skills requiring hand-eye co-ordination such as probe stabilization and real time needle insertion can be more intensively targeted in procedural ultrasound training programs designed for all medical students.
Background
Point-of-care ultrasound performed by clinicians is a useful supplement in the treatment and assessment of patients. We aimed to investigate whether medical students with minimal training were able to successfully acquire and interpret ultrasound images using a pocket-size imaging device (PSID) as a supplement to their clinical practice.
Methods
Thirty 5th year (of six) medical students volunteered to participate. They were each given a personal PSID device to use as a supplement to their physical examination during their allocated hospital terms. Prior to clinical placement the students were given three evenings of hands-on training with PSID by a board certified radiologist/cardiologist, including three short lectures (<20 min). The students were shown basic ultrasound techniques and taught to assess for basic, clinically relevant pathology. They were specifically instructed to assess for the presence or absence of reduced left ventricular function (assessed as mitral annular excursion < 10 mm), pericardial effusion, pleural effusion, lung comets, hydronephrosis, bladder distension, gallstones, abdominal free-fluid, cholecystitis, and estimate the diameter of abdominal aorta and inferior vena cava.
Results
A total of 211 patients were examined creating 1151 ultrasound recordings. Acceptable organ presentation was 73.8% (95% CI 63.1-82.6) for cardiovascular and 88.4% (95% CI: 80.6-93.6) for radiological structures. Diagnostic accuracy was 93.5% (95% CI: 89.0-96.2) and 93.2% (95% CI: 87.4-96.5) respectively.
Conclusion
Medical students with minimal training were able to use PSID as a supplement to standard physical examination and successfully acquire acceptable relevant organ recordings for presentation and correctly interpret these with great accuracy.
As a non-invasive and readily available diagnostic tool, ultrasound is one of the most important imaging techniques in medicine. Ultrasound is usually trained during residency preferable according to German Society of Ultrasound in Medicine (DEGUM) standards. Our curriculum calls for undergraduate training in ultrasound of medical students in their 4th year of undergraduate education. An explorative pilot study evaluated the acceptance of this teaching method, and compared it to other practical activities in medical education at Muenster University.
240 medical students in their 4th year of undergraduate medical education participated in the training and completed a pre- and post-questionnaire for self-assessment of technical knowledge, self-assurance of the procedure, and motivation in performing ultrasound using a Likert scale. Moreover, students were asked about their interest in pursuing a career in internal medicine. To compare this training to other educational activities a standardized online evaluation tool was used. A direct observation of procedural skills assessment (DOPS) for the first time applied on ultrasound aimed to independently assess the success of our teaching method.
There was a significant increase in technical knowledge and self-assurance (p < 0.001) of the students’ self-assessments. The clinical relevance and self-motivation of the teaching were evaluated positively. The students’ DOPS results demonstrated proficiency in the understanding of anatomic structures shown in ultrasonographic images, including terminology, machine settings, and transducer frequencies.
Training ultrasound according to certified DEGUM standards was successful and should be offered in undergraduate medical education. The evaluation of the course affirmed the necessity, quality and clinical relevance of the course with a top ranking score of hands-on training courses within the educational activities of the Medical Faculty of Muenster.
International interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice.
To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students.
A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of "Kirkpatrick's Levels of Learning" were used to grade the impact size of study outcomes.
From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective contexts, achieves short-term learner outcomes that are comparable with those produced by faculty-based teaching. Furthermore, peer-teaching has beneficial effects on student-teacher learning outcomes.
Peer-teaching in undergraduate medical programs is comparable to conventional teaching when utilized in selected contexts. There is evidence to suggest that participating student-teachers benefit academically and professionally. Long-term effects of peer-teaching during medical school remain poorly understood and future research should aim to address this.
A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.
Bedside ultrasonography is regularly used by surgeons and emergency physicians to perform focused assessment with sonography in trauma (FAST) in acutely-injured patients. Despite this, there is no formal ultrasound training in UK undergraduate curricula and postgraduate accreditation remains difficult to achieve. This study aims to assess the feasibility of teaching basic ultrasound skills to undergraduates using FAST scanning as a model module.
Students were enrolled in a 5-hour theoretical and practical FAST scanning course. Ultrasound scanning competencies were ascertained using a 1-hour formal objective structured clinical examination (OSCE) assessment consisting of case-based discussions, problem-solving exercises, a complete FAST scan on a human volunteer, and free fluid detection exercises in organic simulators. A questionnaire was used to ascertain students' opinion on ultrasonography in undergraduate training.
Twenty-five volunteer medical students (years 3 and 5) from a London medical school.
Students did not have prior experience of formal ultrasound training. The mean score achieved in the summative assessment was 86%. Eighty-five percent of students completed a full FAST scan at an adequate level of performance in under 6 minutes. The feedback survey indicated that all students felt confident in operating the ultrasound apparatus and were able to obtain good quality images at the end of the 5-hour course. Eighty-eight percent of students thought ultrasonography was relevant to their training; all students intended to seek formal ultrasound accreditation; 92% believed ultrasound training should be a regular component of the curriculum; and 96% of students preferred using cart-based ultrasound machines rather than hand-held devices.
Undergraduate ultrasound tuition is an achievable educational goal which is well received by medical students. Medical schools need to consider the formal introduction of ultrasound teaching in their curricula to equip future doctors with relevant skill sets. The role of handheld ultrasound machines requires further investigation.
Libro de metodología cualitativo para investigación en las ciencias sociales. La utilización de la computadora, el uso de datos y la recolección de los mismos. Se describen detalladamente numerosos métodos de datos y análisis.
To assemble an international panel of experts to develop consensus recommendations on selected important issues on the use of ultrasonography (US) in trauma care.
R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Md. The conference was held on December 4, 1997.
A committee of two co-directors and eight faculty members, in the disciplines of surgery and emergency medicine, representing four nations. Each faculty member had made significant contributions to the current understanding of US in trauma.
Six broad topics felt to be controversial or to have wide variation in practice were discussed using the ad hoc process: (1) US nomenclature and technique; (2) US for organ-specific injury; (3) US scoring systems; (4) the meaning of positive and negative US studies; (5) US credentialing issues; and (6) future applications of US. Consensus recommendations were made when unanimous agreement was reached. Majority viewpoints and minority opinions are presented for unresolved issues.
The consensus conference process fostered an international sharing of ideas. Continued communication is needed to advance the science and technology of US in trauma care.
The focused abdominal sonogram for trauma (FAST) has been used by surgeons and emergency physicians (CLIN) to screen reliably for hemoperitoneum after trauma. Despite recommendations for "appropriate training," ranging from 50 to 400 proctored examinations, there are no supporting data.
We prospectively examined the initial FAST experience of CLIN in detecting hemoperitoneum by using diagnostic peritoneal lavage, computed tomography, and clinical findings as the diagnostic "gold standard."
241 patients had FAST performed by 12 CLIN (average, 20/CLIN; range, 2-43); 51 patients (21.2%) had hemoperitoneum and 17 patients (7.1%) required laparotomy. Initial experience with FAST by CLIN produced 35 true positives, 180 true negatives, 16 false negatives, and 3 false positives; sensitivity, 68%; specificity, 98%. Initial error rate was 17%, which fell to 5% after 10 examinations (chi2; p < 0.05).
Previous recommendations for the number of proctored examinations for individual nonradiologist clinician sonographers to develop competence are excessive.
This study was conducted to determine whether emergency physicians with relatively limited training and experience can accurately identify the presence or absence of abdominal aortic aneurysms (AAAs) by performing bedside ultrasound scanning, and to assess the potential impact of ultrasound scanning on clinical management.
Patients in whom AAAs were suspected, including those patients older than 50 years presenting with abdominal/back pain of unclear origin or presumed renal colic, were eligible for study entry. Consenting adults had ultrasound scanning by an emergency physician who was not responsible for their primary care. Treating physicians remained blinded to the results unless an unexpected AAAs was discovered. Scan accuracy was ascertained by comparing our ultrasound results with preselected gold standards. The clinical impact of the ultrasound studies was determined by comparing the preultrasound and postultrasound assessment sheets that detailed the presumed diagnosis, proposed investigations and therapies, and patient disposition.
Our convenience sample includes 68 scans for AAAs; findings of 26 scans were positive, 40 scans yielded negative findings, and 2 scans were indeterminate. Scan interpretations were 100% accurate. The ultrasound results would have improved the care of 46 patients without adverse sequelae. Ultrasound scanning served primarily to exclude AAA in patients who proved not to have aneurysms; however, scans also provided significant benefits for those with AAAs and improved patient management plans.
Relative neophytes can perform aortic ultrasound scans accurately. These scans appear useful as a screening measure in high-risk emergency department patients; they may also aid in rapidly verifying the diagnosis in patients who require immediate surgical intervention.
This study aimed to determine whether peer-assisted learning (PAL) can enhance clinical examination skills training.
Three student trainers studied small-group theory and clinical examination and provided PAL as extra tuition for 86 trainees. Trainees watched an examination video, were videotaped practising the examination and, after constructive feedback, repeated the examination. Responses to PAL were evaluated to attain an overview of trainee and trainer performance using visual analogue and Likert scale analyses. Year-group review was undertaken using questionnaires.
Trainees evaluated all aspects of PAL highly, including their post-training confidence in examination skills (mean > 7.7 on a 10-cm scale), indicating that the PAL was effective. Written comments confirmed the students perceived the sessions as well structured and of high quality. Compared with trainees in the first groups, those from later groups gave all parameters similar or higher gradings. Those for interest (P = 0.03) and appropriateness (P = 0.01) were significantly higher, suggesting that trainers may improve their technique with time. Students with previous degrees gave similar or lower gradings than standard entry students, with answers about post-training confidence and recommendation to friends being statistically lower (P < 0.006). Six months later, year-group analysis showed that 90% of trainees rated PAL highly, and 86% wished to become trainers. Of the trainers' year group, 79% perceived that PAL training could improve examination skills.
In the context of clinical skills training, PAL was highly evaluated across many parameters, including confidence after training. Student interest and enthusiasm supports suggestions that PAL could be a useful adjunct to clinical skills training.