Ultrasound Education Research Articles

Evaluation of Ultrasound Teaching Curriculum in Tanzania by First Year Medical Students: A Comparison of Language on Learning Outcomes

Introduction Advanced medical imaging is often lacking in rural countries, including Tanzania. Few studies have evaluated POCUS teaching to healthcare providers in Tanzania. Our objective was to determine if clinical officers could be taught POCUS by first-year medical students. A second objective was to determine if students learned better in English or Kiswahili. Methods Clinical officers were recruited from the Tandabui Institute of Health Sciences and Technology in Mwanza, Tanzania. Subjects took a pre-course, post-course, and practical exam. Between testing, students were taught an ultrasound course by first-year medical students. The students were randomly assigned into the Kiswahili or English group with identical examinations. Results 78 subjects were included in the final data collection. 42 were in the Kiswahili course and 36 in the English course. The median pre-course exam score was 26.9 (Min: 7.7, Max: 53.9) for the English group and 30.8 (Min: 0, Max: 61.5) for the Kiswahili group (All scores are in 0-100 scale). The median Post- course score rose to 93.3 (Min: 20.0, Max: 100.0) in English (P<0.001) and 80.0 (Min: 33.3, Max: 100.0) in Kiswahili (P<0.001). No significant score difference was found between the two groups (P= 0.19). Conclusions Our study found that POCUS can be taught to clinical officers in Tanzania using first-year medical students. There was no difference in the ability of students to learn ultrasound in English or Kiswahili. Future large scale studies are needed to validate these findings and evaluate long-term retention.

Teaching ultrasound-guided peripheral venous catheter placement through immersive virtual reality: An explorative pilot study.

Introduction:Immersive virtual reality (IVR)-based training is gaining ground as an educational tool in healthcare. When combined with well-established educational methods, IVR can potentially increase competency and autonomy in ultrasound (US)-guided peripheral venous cannulation.The aim of this study was to examine the impact of adding IVR training to a course in US-guided peripheral venous cannulation.Methods:Medical students (n = 19) from the University of Southern Denmark with no former standardized US education were recruited to voluntarily participate in a pilot study, designed as a randomized controlled trial. The primary outcome was the proportion of successful peripheral venous cannulations on a phantom. Secondary outcomes included the proportion of surface punctures on the phantom and procedure time. Participants received e-learning on the basic US before randomization to either IVR (n = 10) or no further training (n = 9). The additional IVR training comprised 10 virtual scenarios for US-guided peripheral venous catheter (PVC) placement. Students were subsequently evaluated in peripheral venous cannulation by a blinded assessor.Results:The proportion of successful peripheral venous cannulations was significantly higher in the IVR group (P ≤ .001). The proportions of successful cannulations were significantly higher in the IVR group compared to the control group for the 1st and 2nd PVC (P = .011, P = .023), but not for the 3rd PVC (P = .087). Similar results were found for the proportion of surface punctures (1st: P ≤ .001, 2nd: P = .001, and 3rd: P = .114). No significant differences in procedure times were found between the groups.Conclusion:This pilot study showed that adding an IVR-based training simulation to an existing e-learning curriculum significantly increased the learning efficacy of US-guided PVC placement for medical students.

Conception and Feasibility of a Digital Tele-Guided Abdomen, Thorax, and Thyroid Gland Ultrasound Course for Medical Students (TELUS study).

Medical education has been transformed during the COVID-19 pandemic, creating challenges regarding adequate training in ultrasound (US). Due to the discontinuation of traditional classroom teaching, the need to expand digital learning opportunities is undeniable. The aim of our study is to develop a tele-guided US course for undergraduate medical students and test the feasibility and efficacy of this digital US teaching method. A tele-guided US course was established for medical students. Students underwent seven US organ modules. Each module took place in a flipped classroom concept via the Amboss platform, providing supplementary e-learning material that was optional and included information on each of the US modules. An objective structured assessment of US skills (OSAUS) was implemented as the final exam. US images of the course and exam were rated by the Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET). Achieved points in image rating were compared to the OSAUS exam. A total of 15 medical students were enrolled. Students achieved an average score of 154.5 (SD ± 11.72) out of 175 points (88.29 %) in OSAUS, which corresponded to the image rating using B-QUIET. Interrater analysis of US images showed a favorable agreement with an ICC (2.1) of 0.895 (95 % confidence interval 0.858 < ICC < 0.924). US training via teleguidance should be considered in medical education. Our pilot study demonstrates the feasibility of a concept that can be used in the future to improve US training of medical students even during a pandemic.

ITSUS: Integrated, Tiered, Self-Directed Ultrasound Scanning for Learning Anatomy.

Ultrasound is being introduced into many medical schools and incorporated into the anatomy curriculum; however, in most cases, this consists of proctored sessions which can be limited by faculty time and availability. Additionally, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has significantly impacted medical education, especially ultrasound education, which has traditionally depended on hands-on practice and instruction. A structured, independent, hands-on learning curriculum using ultrasound would have many benefits. In this study, eight self-guided system-based modules were developed mirroring the undergraduate anatomy curriculum. For each scan, a beginner, intermediate, and advanced component was designed. Each module contains clear, stepwise directions for image acquisition, optimization, and interpretation of the anatomical structures and suggestions for troubleshooting. Students save ultrasound images as part of their digital portfolios for review with ultrasound faculty. This design provides an educational model to increase medical student opportunities for independent, structured, self-directed anatomy learning with ultrasound that can be integrated with existing educational programs.

Ultrasound education improves safety for peripheral intravenous catheter insertion in critically ill children.

Difficulty in obtaining peripheral vascular access is a common problem in patients admitted to the pediatric intensive care unit (PICU). The use of ultrasound guidance can improve the overall success in obtaining vascular access. This study evaluated the success and longevity of PIV placement by nurses pre- and post-implementation of an USGPIV curriculum. PICU nurses participated in a prospective quality improvement study. Each participating nurse attempted 10 PIVs by using landmark (LM) methods. The same nurses then received individual instruction in an USGPIV placement curriculum. Following the educational intervention, each nurse attempted 10 USGPIVs. A total of 150 LM PIVs and 143 USGPIVs were attempted. The first stick success in the post-intervention (USGPIV) group was 85.9% compared to 47.3% in the pre-intervention (LM) group (p < 0.001). Overall success was also superior in the USGPIV group (94.3 versus 57.3%, respectively; p < 0.001). PIVs placed by US lasted longer with a median survival time of 4 ± 3.84 daysversus 3 ± 3.51 days for LM PIVs (p < 0.050, log-rank test). Successful implementation of a standardized curriculum for USGPIV placement for PICU nurses improves first stick, overall success, and longevity of PIV catheter placement. An ultrasound-guided IV curriculum can be successfully implemented resulting in increased first stick success and increased longevity. Registered nurses can be trained in placement of ultrasound-guided IV placement. This study provides a training curriculum for ultrasound-guided IV placement that can be applied to other settings or institutions.

Teaching emergency ultrasound to emergency medicine residents: a scoping review of structured training methods.

BackgroundOver the past 2 decades, emergency ultrasound has become essential to patient care, and is a mandated competency for emergency medicine residency graduation. However, the best evidence regarding emergency ultrasound education in residency training is not known. We performed a scoping review to determine the (1) characteristics and (2) outcomes of published structured training methods, (3) the quality of publications, and (4) the implications for research and training.MethodsWe searched broadly on multiple electronic databases and screened studies from the United States and Canada describing structured emergency ultrasound training methods for emergency medicine residents. We evaluated methodological quality with the Medical Education Research Study Quality Instrument (MERSQI), and qualitatively summarized study and intervention characteristics.ResultsA total of 109 studies were selected from 6712 identified publications. Publications mainly reported 1 group pretest–posttest interventions (38%) conducted at a single institution (83%), training in image acquisition (82%) and interpretation (94%) domains with assessment of knowledge (44%) and skill (77%) outcomes, and training in cardiac (18%) or vascular access (15%) applications. Innovative strategies, such as gamification, cadaver models, and hand motion assessment are described. The MERSQI scores of 48 articles ranged from 0 to 15.5 (median, 11.5; interquartile range, 9.6–13.0) out of 18. Low scores reflected the absence of reported valid assessment tools (73%) and higher level outcomes (90%).ConclusionsAlthough innovative strategies are illustrated, the overall quality of research could be improved. The use of standardized planning and assessment tools, intentionally mapped to targeted domains and outcomes, might provide valuable formative and summative information to optimize emergency ultrasound research and training.

Letter to the Editor: Comment on "Medical Student Ultrasound Education: The Radiology Chair Weighs in".

Letter to the Editor: Comment on "Medical Student Ultrasound Education: The Radiology Chair Weighs in".

Quality Improvement Initiatives in Sonography Education: A Review of the Literature

Objective: Continuous improvement is vital to ensuring quality in sonography education. The aim of this literature review was to compile and summarize the current literature on accreditation, credentialing, and quality improvement initiatives in sonography education. Materials &amp; Methods: Four sonography-specific journals and six health science/academic databases were searched using the terms education, sonography, ultrasound, accreditation, credential, and quality. The search was limited to findings in the English language, from 2000 to 2020. Results: The search uncovered only 19 articles on this topic in sonography education. The vast majority of papers focused on quality improvement initiatives, while just a few concentrated on accreditation or credentialing. Conclusion: Much of the contemporary sonography educational literature focuses on clinical, lab, or didactic quality improvement initiatives. Overall, it is clear that more research is needed in the field of sonography education. This review provides examples of quality initiative research in other allied health fields that can be useful guides for future sonography educational research.

Acil hekimlerinin Yatakbaşı Ultrasonografi Kullanımlarının Değerlendirilmesi

Aim: Bedside ultrasonography (US) is a frequently used tool to facilitate diagnosis and treatment in emergency departments (EDs). The primary aim of our study was to evaluate the characteristics of emergency physicians’ use of bedside US. Our secondary aim was to analyze factors affecting the regular use of bedside US.&#x0D; Material and Methods: This was a descriptive cross-sectional survey study conducted with physicians working in EDs. The study was carried out using a 15-item questionnaire in 2020, and the results were analyzed with the Statistical Package for the Social Sciences software.&#x0D; Results: The questionnaire was sent to 965 physicians working in the EDs of 48 different hospitals, and the data of 684 (71.5%) that responded to all items in the questionnaire were included in the study. The EDs of the hospitals included in the study had at least one US device, and 82% of them were equipped with three probes. It was observed that 152 (22.2%) of the emergency physicians did not use US at all, and 532 (77.8%) used US regularly, albeit rarely. The most common area of use for US in the ED was focused assessment with sonography in trauma, followed by procedural guidance (432 [63.2%] and 308 [45%], respectively]. Of the physicians who did not use bedside US regularly, 33.3% (n=96) stated that they did not use it due to their lack of training. In addition, the interest of emergency physicians in US education was measured as 7±3 points. It was observed that the conditions associated with frequent use of bedside US were gender, inclusion of US training during residency, and duration of the availability of an US machine in the emergency clinic.&#x0D; Conclusion: This study showed that emergency physicians had a high interest in using bedside US. The greatest obstacle to the use of US was insufficient training. Therefore, emergency physicians should be offered regular US training programs sand those that have not received US training should be encouraged to participate in such programs.

A randomized controlled trial of simulation-based mastery learning to teach the extended focused assessment with sonography in trauma.

Mastery learning has gained popularity for training residents in procedural skills due to its demonstrated superiority over traditional methods. However, no studies have compared the efficacy of traditional versus mastery learning methods in residency point-of-care ultrasound education. We hypothesized that mastery learning would improve residents' skills in performing the extended focused assessment with sonography in trauma (eFAST). All first-year emergency medicine (EM) resident physicians at a single university hospital underwent a crossover randomized controlled trial to receive mastery-learning eFAST training either at the beginning of the academic year or 6months into intern year. Participants were taught using a checklist validated by a panel of experts using Mastery Angoff methods and were given feedback on missed tasks until each trainee completed the eFAST with a minimum passing standard (MPS). Our primary outcome was technical proficiency between the two groups for eFAST examinations performed in the emergency department during the academic year. Sixteen interns were enrolled; eight were randomized to each group. The group that received mastery training at the beginning of the year had mean clinical eFAST proficiency scores above the MPS in the first two quarters of the academic year, while the control group did not. Once the control group underwent eFAST mastery training at the midpoint of the year, both groups had mean proficiency scores above the MPS for the remainder of the year. Simulation-based mastery learning is an effective method of teaching the eFAST examination. This training during intern orientation conferred early proficiency in clinical performance of eFAST among EM residents. This difference in proficiency was no longer present after the control group received mastery learning education halfway through the academic year.

Clinical Ultrasound Education for Medical Students: Virtual Reality Versus e-Learning, a Randomized Controlled Pilot Trial.

The primary aim was to evaluate the effect of immersive virtual reality learning for training medical students in basic clinical ultrasound. Secondary outcomes were to explore if virtual reality learning had an effect on hand-eye coordination skills and if the medical students wanted more virtual reality learning.This pilot study was a double-blind, parallel-group, block-randomized, controlled trial. Participants (n = 20) were blinded and randomized to virtual reality or e-learning for basic ultrasound education. Medical students with no previous ultrasound education were recruited voluntarily from the University of Southern Denmark. Data were collected during introductory courses on ultrasound from March to May 2019. Participants were assessed with Objective Structured Assessment on Ultrasound Skills. Assessing supervisors were blinded.The virtual reality group (n = 11) scored a significantly higher Objective Structured Assessment on Ultrasound Skills score (143 [95% confidence interval {CI}, 135 to 151]) compared with the e-learning group (n = 9; 126 [95% CI, 113 to 138]; mean difference, 17 points [95% CI, 4 to 30]; P < 0.01). No significant effect on the hand-eye score was found (mean difference, 3 points [95 % CI, -3 to 9]; P = 0.32). Ninety-one percent of the virtual reality group wanted more virtual reality learning.Immersive virtual reality learning improved medical students' ultrasound skills significantly compared with e-learning. The hand-eye score was higher in the virtual reality group, although not at a significant level. Students wanted more virtual reality learning. Further research is needed to clarify immersive virtual reality's educational role in the future.

Online Competency‐Based Assessment for Ultrasound Training

Introduction Competency assessment and quality assurance are significant aspects of point-of-care ultrasound (POCUS) training for residents and medical students. However, due to the COVID-19 pandemic, alterations in programs have caused a need to develop new models of online assessments for students. While novel alterations in the curriculum have been made, clear learning outcomes and strategies must still teach the best practices. At the California University of Science and Medicine, School of Medicine (CUSM-SOM), we aim to adapt training and assessment tools that include SonoSim LiveScan experiences. Sonosim, Inc. has developed a tool that students can use remotely to mimic the clinical applications traditionally done in person. This would allow students to familiarize themselves with normal and pathologic scans remotely and hone their diagnostic abilities without requiring in-person faculty-led sessions. There have already been multiple medical schools that have added SonoSim to supplement their curriculum and assess students’ competencies. This study aims to develop an online system of reliable competency-based assessments for medical students in the teaching of POCUS. Methods After completing each ultrasound module on SonoSim LiveScan alongside the schools’ corresponding system-based courses, students will be assessed for achievement of competencies and learning outcomes. Students will take an online quiz and submit sonographic images that they obtained on their own time using provided standardized patients. The students will submit the images taken according to the guidelines mapped by the courses’ learning outcomes. Submissions will be through a secured online system. Quizzes will be graded with a predetermined grading system. Using a standardized rubric, three faculty members/instructors will assess scans for competency and quality. Results Assessment will be completed in two steps. The first step will include an assessment of medical knowledge and concepts via an online quiz. The quiz will have still images and short video clips from SonoSim LiveScan to gauge the mastery of knowledge. The second step of the assessment will include a review of the ultrasound images obtained by the student. They will complete this part of the assessment on their own, asynchronously, and within a defined period of time. Then, three faculty members will score the images independently. To maintain the quality of the assessment, all instructors must agree that the required competencies have been achieved. All major discrepancies between the instructors regarding the results and assessment will be addressed according to the predetermined guidelines. Conclusion This competency-based assessment and training identifies students’ areas of weakness and makes review and remediation easy and straightforward. Clear objectives, teaching modalities, and assessments set the foundation for a successful ultrasound program. Competency-based assessment as outlined above could be the best possible method to ensure students are involved and learning accurately during primarily remote learning times. By outlining a program that is easily implementable and accessible, ultrasound education will be made more available and widespread to medical students who would otherwise not be exposed.

An Evidence‐Based Template to Incorporate Ultrasound in the Undergraduate Medical Curriculum

Bedside ultrasonography, also known as Point of Care Ultrasound (POCUS) is becoming increasingly prevalent in medical practice1 with some calling it the modern stethoscope2. As a result, a number of medical schools across the United States3–5, Canada6–8, Germany9, France10, Australia11, and the United Kingdom12 have incorporated POCUS into their curriculums. However, none of these countries exhibit any form of standardization or general guidelines surrounding their POCUS curriculums. This can pose difficulties for instructors who are willing to include ultrasound education in their curriculum but unsure of how to approach teaching it. Of the curriculums analyzed, we found that the majority of schools that included ultrasound teaching in the pre-clinical years incorporated it into the anatomy curriculum. However, number of students, content covered, and time allotted to POCUS education varies from school to school. Of the published data, it was found that on average students received about 6 hours of ultrasound experience over the course of the year. Moreover, the topics taught using ultrasound technology differed but the most common were cardiovascular and abdomen anatomy. In addition, the structure of the classroom varied from one program to the next depending on the size of the cohort and number of machines available. During hands-on practice, students were divided into groups with an average of 10.45 students per group. Thus, the question of which curriculum (or combination of curricular components) is feasible and most effective arises. By conducting an analysis of the pre-existing literature on POCUS education, we collected information regarding how medical schools have incorporated it into their own curriculums in the past. With this information, we hope to form a template or foundation to aid instructors and course developers in implementing their own POCUS curriculums. 1. Tarique, U. et al., J. Ultrasound Med. 2018; 37:1. 2. Feilchenfeld, Z. et al., Med. Educ. 2018; 52:12. 3. Rempell, J.S. et al., West J. Emerg. 2016; 17:6. 4. Rao, S. et al., J. Ultrasound Med. 2008; 27:5. 5. Hoppmann, RA. et al., Crit. Ultrasound J. 2015; 7:8. 6. Steinmetz, P. et al., J. Ultrasound Med. 2016; 35: 9. 7. Mohialdin, V. et al., FASEB J. 2018; 32. 8. Stone-McLean, J. et al., Cureus. 2017; 9:9. 9. Teichgräber, U.K.M. et al., Med. Educ. 1996; 30:4. 10. Hammoudi, N. et al., Arch. Cardiovasc. Dis. 2013; 106:10. 11. Moscova, M. et al., Anat. Sci. Educ. 2014; 8:3. 12. Wakefield, R.J. et al., Med. Teach. 2018; 40:6.

The PEGASUS Games: Physical Exam, Gross Anatomy, phySiology and UltraSound Games for Preclinical Medical Education.

Introduction: Gamification engages learners and has successfully taught point-of-care ultrasound (POCUS) to residents and fellows. Yet ultrasound (US) curricula in undergraduate medical education remains limited. This study assessed a gamification model integrating US, anatomy, physiology, physical examination, and radiology created for preclinical medical students as compared with traditional didactic education. Methods: Twenty first-year medical students participated in a session on neck and thyroid material. Students were randomly assigned to a game or non-game group. Game students participated in games incorporating thyroid US with exam maneuvers, other imaging modalities, physiology, and pathology. Non-game students were taught the same material with an instructor. Students were assessed with a pretest and immediate and delayed post-tests. Group differences and scores were assessed using t-tests. A Likert scale evaluated learners' opinions of the educational experience. Results: The game group performed better than the non-game group on the immediate post-test (p = 0.007, CI = [0.0305, ∞]). There was no significant difference between the groups on the delayed post-test (p = 0.726, CI = [-0.120, ∞]). Students in both groups felt more confident in their knowledge of the material, and all students in the game group agreed that the games encouraged teamwork. Most (9/10) stated the games allowed them to learn the material more effectively and would like to see more gamification (8/10). Conclusion: This US education model incorporating gamification for preclinical medical students promotes teamwork and is as effective for learning material than a traditional learning model. Students additionally convey a positive attitude towards gamification.

Evaluation of Diagnostic Imaging Capacity and the Role for Point-of-Care Ultrasound (POCUS) within the Zanzibar Health System.

Background: The Zanzibar Ministry of Health identified access to ultrasound (US) as a system priority due to limited diagnostic imaging capacity and consequent impact on patient care and requested a needs assessment in this regard. As a result, the objective of this study was to assess diagnostic imaging capacity focusing on ultrasound in Zanzibar, including health care providers’ (HCPs) current training, use, and barriers to implementation. Methods: A previously published ultrasound needs assessment survey was modified and administered on-site at the eight public hospitals in Zanzibar among a convenience sample of HCPs. Demographics, perceived US needs, current training and practice, and availability of specialty support were assessed. HCPs also completed focused personal interviews (FPIs) to explore experience with training, interests, and barriers to ultrasound. On-site diagnostic imaging modalities were assessed. Results: There were nine ultrasound machines present at six of the eight public hospitals assessed. All had x-ray, but only one had a CT scanner and a radiologist. There was no MRI capacity at the hospitals assessed at the time of the study. Survey data among 40 participants revealed that prior experience with POCUS was limited with only 10% reporting any prior ultrasound training or experience. The majority of those surveyed (72%), indicated a ‘high’ interest in learning ultrasound. Of those reporting interest in POCUS applications, obstetrics was the most often cited (70%). Lack of ultrasound machines (40%) and educators (28%) were identified as the greatest barriers. Conclusion: HCPs in Zanzibar have limited access to diagnostic imaging, including ultrasound, and expressed a high level of interest in learning point-of-care ultrasound. A shortage of machines and educators are the main barriers to widespread use. Obstetrics is the application for which ultrasound is currently most used and is the application HCPs are most interested in learning. Equipment and educational support for a POCUS program could improve care by increasing access to diagnostic imaging.

Benefits to utilising ultrasound in examining the eye.

Ocular ultrasound (US) is not one of ACEMs 'big 5' in terms of US capability that is expected of a trainee or FACEM. Most texts have a small chapter dedicated to ocular US but it is usually at the back or a subsection of a chapter where it is rarely seen or appreciated. However, it is a straightforward scan to perform with many benefits which will be discussed in this article. The eye offers an excellent medium for US beam penetration, making good quality images of the retina easy and quick to acquire. This has the added benefit of being able to share images with an ophthalmologist remotely, improving time to definitive treatment. It can also be used in patients who cannot cooperate with sitting at a slitlamp, for example moribund or trauma patients. The authors propose that ocular US teaching should be incorporated into the ACEM syllabus, being a vital adjunct to a comprehensive eye examination.

Analysis of an obstetrics point-of-care ultrasound training program for healthcare practitioners in Zanzibar, Tanzania

BackgroundA point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at least 75 proctored ultrasounds. The objective of this study was prospectively to analyze the success of a longitudinal point-of-care ultrasound training program for antepartum obstetrical care providers in Zanzibar.ResultsDuring the 6-month course, trainees completed 1338 ultrasound exams (average 99 exams per trainee with a range of 42–128 and median of 109). Written exam scores improved from a mean of 33.7% (95% CI 28.6–38.8%) at pre-course assessment to 77.5% (95% CI 71–84%) at course completion (P < 0.0001). Practical exam mean scores improved from 71.2% at course midpoint (95% CI 62.3–80.1%) to 84.7% at course completion (95% Cl 78.5–90.8%) (P < 0.0005). Eight of the 13 trainees completed all training requirements including 75 proctored ultrasound exams.ConclusionTrainees improved significantly on all measures after the training program. 62% of the participants completed all requirements. This relatively low completion rate reflects the challenges of establishing ultrasound capacity in this type of setting. Further study is needed to determine trainees’ long-term retention of ultrasound skills and the impact of the program on clinical practice and health outcomes.

Team‐Based Ultrasound Objective Structured Practice Examination (OSPE) in the Anatomy Course

The clinical use of ultrasound has dramatically increased, necessitating early ultrasound education and the development of new tools in ultrasound training and assessment. The goal of this study was to devise a novel low-resource examination that tested the anatomical knowledge and technical skill of early undergraduate medical students in a gross anatomy course. The team-based ultrasound objective structured practice examination (OSPE) was created as a method for assessing practical ultrasound competencies, anatomical knowledge, and non-technical skills such as teamwork and professionalism. The examination utilized a rotation of students through four team roles as they scanned different areas of the body. This station-based examination required four models and four instructors, and tested ultrasound skills in the heart, abdominal vessels, abdominal organs, and neck regions. A Likert scale survey assessed student attitudes toward the examination. Survey data from participants (n=46) were examined along with OSPE examination grades (n=52). Mean and standard deviations were calculated for examination items and survey responses. Student grades were high in both technical (96.5%). and professional (96.5%) competencies with structure identification scoring the lowest (93.8%). There were no statistical differences between performances in each of the body regions being scanned. The survey showed that students deemed the examination to be fair and effective. In addition, students agreed that the examination motivated them to practice ultrasound. The team-based OSPE was found to be an efficient and student-favored method for evaluating integrated ultrasound competencies, anatomical knowledge, team-work, and professional attributes.

North American musculoskeletal ultrasound scanning protocol of the hip, knee, ankle, and foot: update of a Delphi consensus study.

A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs. Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics™) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar's chi-square test. Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation. Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound. Key Points • The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely. • The transverse sacroiliac joint view was suggested to be performed based on practice focus.

Integration of Point-of-Care Ultrasound Education Into the Internal Medicine Core Clerkship Experience.

Point-of-care ultrasound (POCUS) is becoming an essential skill for internists. To date, there are no professional guidelines for how POCUS skills should be taught to medical students. A panel of POCUS experts from seven academic medical centers in the United States was convened to describe the components of independently developed IM clerkship POCUS training programs, identify areas of similarity and difference, and propose recommendations for alignment.