Using Ultrasound To Assess Accuracy Of Liver Measurement And Palpation During Early Medical Training

Abstract

The changing nature of medicine requires the innovative use of new techniques and technologies in medical education. A specific learning objective in our Development of Clinical Skills (DOCS) course is that students develop proficiency in palpation of subcutaneous structures when performing physical examinations. Abdominal examination is a challenging skill for Year 1 medical students to master. Evaluation of the abdominal system with respect to the liver typically includes percussion, palpation and/or the scratch test to determine localization of the liver edge and measurement of liver span. Historically it has been difficult to assess the student's proficiency in performing this aspect of the physical examination. Moreover, studies show that clinicians routinely underestimate the liver span as compared to that measured by ultrasonography. Thus, more effective methods to enhance learning of abdominal examination techniques are needed. Accordingly, we have developed and evaluated an approach to teaching examination of the liver that incorporates real‐time ultrasound imaging to provide immediate feedback to improve diagnostic accuracy. The dimension of liver span and location of the liver edge along the right midclavicular line were first determined by percussion and palpation in a standardized patient. Students were not initially given feedback as to the accuracy of their perceived liver edge localization. The accuracy of the student's estimated measurement was then compared to the exact dimension of liver span and the edge visualized using ultrasound imaging (GE LOGIQ ultrasound using a 4C probe). A distinct advantage of utilizing this approach is the student can develop their palpation skills based on immediate feedback, thus improving their accuracy for times when ultrasound is not available. We found ultrasound‐assisted determination of liver edge localization and span to be a useful adjunct to traditional means of teaching abdominal examination skills resulting in improved student physical examination technique. Finally, it provides our students with a solid foundation in point‐of‐care ultrasonography.