Integration of ultrasound in the education programme in anatomy

Abstract

Context and setting Medical students invest a significant amount of time studying human structure using a variety of resources. They often find it challenging to visualise the functioning living human and to apply their learning clinically. Because ultrasound imaging provides a means of visualising structure and movement in a living person, it was proposed that it could be used to enhance and facilitate the learning of functional clinical anatomy. An ultrasound learning resource was located within the anatomy area to enable students to integrate their learning through ultrasound with the study of specimens and other resources. Why the idea was necessary The purpose of the study was to determine the effect on student learning of integrated ultrasound anatomy teaching sessions. These sessions included an introduction to the technology of ultrasound imaging and the hands-on experience of performing an examination in order to provide students with the opportunity to develop basic imaging skills, and to enhance their knowledge of surface and visceral anatomy. What was done Groups of 6 first-year medical students had an integrated clinical skills, anatomy and radiology session, followed by a series of 3 90-minute ultrasound anatomy sessions provided by a radiologist during the cardiovascular and renal subunits. The sessions included an introduction to the use of the ultrasound imaging, the setting of learning objectives, guidance on the location of landmarks and the visualisation of organs and tissues, a hands-on experience conducting an ultrasound examination on a living human, a discussion of its clinical relevance and an evaluation of the session. The objectives of the examinations were to use various approaches and scans to visualise and identify specific cardiac structures, major abdominal vessels, carotid arteries and the kidneys, as well as noting the relationships of adjacent structures. Videos of related pathologies were also discussed. The students were evaluated on their ability to perform an ultrasound examination at the end of the first and the last sessions, and received formative evaluation. For this study, a 5-point scale was used: from 1 = poor (inadequate identification of ‘acoustic window’ required for visualisation of prioritised structures) to 5 = excellent (ability to detect normal and pathological surface anatomy and functional morphology on reference standards). Approximately 490 medical students from 4 consecutive classes participated. The average score at the end of the first session was 3.25 ± 0.12, compared to the last session (4.15 ± 0.16; P < 0.005). The scores from this study were not provided to the students or incorporated into their formal evaluation. The student evaluations of the sessions were consistently excellent (score of 5/5), and included highly positive comments. Evaluation of results and impact The results of this study show that the small-group problem-based ultrasound anatomy sessions for students in the Medical Program at McMaster University, which focuses on small-group problem-based active learning, are a highly effective method for facilitating student learning and significantly enhance knowledge of living clinical anatomy. In addition, they provide students with a basic understanding of ultrasound imaging and its use in clinical practice. Finally, the students value these innovative sessions highly and find that this use of ultrasound is an exciting and engaging approach to stimulate the learning of ‘living’ clinical anatomy and enhance their clinical reasoning skills.