Keep up with progress-Ultrasound education requires change.

Abstract

Despite increasing use of ultrasound imaging even beyond the circle of radiologists, low priority is given to student training. Until today, integration of ultrasound into clinical education at medical schools still lags far behind, and a curricular structure is oftentimes missing or implemented half-heartedly on a voluntary basis. Main reasons for not having ultrasound integrated are lack of time and poor funding. Finally, residents feel inadequately prepared for daily professional practice. For patient safety and satisfaction, however, it is highly desirable that ultrasound becomes second nature to the next generations of physicians, as the stethoscope already is.1 At our university hospital, we recently developed and implemented a multidisciplinary curriculum that integrates ultrasound as a compulsory part into medical education directly from start to finish. The curriculum follows a spiral course with four levels of training in which learning activities are repeated with continuously growing complexity. Competency-centred “probe-in-the-hand” courses are held in small groups of maximum six learners. Students start to practice ultrasonography by scanning each other, attending training in skills labs and, finally, deepen experience in clinical settings. Students should prepare self-determinedly for courses using learning videos available on the university's in-house network and on publicly available e-learning platforms. On the first training level, during preclinical education, ultrasonography is closely linked to anatomy dissection- and physiology courses. With this vertical integration, basic sciences are put into context and vice versa, clinical aspects are introduced into early medical training. At the same time, specific psychomotor skills are introduced. On the second level, in the third year of medical education, students apply point-of-care ultrasound in peers, skills lab simulations and ultrasound phantoms. The skills lab will be available during semester breaks to provide the opportunity to practice outside scheduled courses. On the third level, during advanced clinical education, students select a compulsory elective ultrasound course in a specialty of their choice, held at five consecutive dates following the concept of work-based learning. This allows students to direct their own learning and to focus on their preferred specialty. From then on, they conduct ultrasound examinations in patients. During the final year, students successively adapt skills and knowledge to growing medical experience. Now they are expected to use ultrasound with a large degree of independence and confidence. Entrustable professional activities are specified and assessed concomitantly. The longitudinal curriculum might serve as an inspiring example, however, with built-in flexibility according to requirements of each medical school and changing conditions. Incidental effects including enhancement of self-determined learning and mutual benefits regarding learning success in involved disciplines are expected. Costs and time can be saved by e-learning and appointment of student tutors. As participating departments share benefits arising from integration of ultrasound, they may contribute to the costs proportionally. In the interest of both patients and students, with an eye to the future, medical schools are encouraged to remove initial obstacles and tackle full and early integration of ultrasound into their curricula.