Ultrasound Education Research Articles

Evidence-based Ultrasound Education? - A Systematic Literature Review of Undergraduate Ultrasound Training Studies.

Despite a large number of studies previously conducted on educational concepts of ultrasound teaching in medical school, various controversial issues remain. Currently, recommendations for ultrasound curricula that aim to standardize ultrasound teaching are frequently based on expert panel advice instead of relying on valid evidence-based literature. In December 2022, a systematic literature review on the subject of undergraduate ultrasound education was conducted. All ultrasound studies listed in the PubMed and Google Scholar medical databases were filtered and analyzed with respect to various aspects of their methodological conduct and curricular implementation. A total of 259 publications were considered in the data synthesis, including 145 teaching studies in the field of undergraduate ultrasound education. The latter encompassed 58 (40%) studies that did not compare their ultrasound training to a control group. Furthermore, 84 (58%) of these studies did not assess knowledge prior to the applied ultrasound training, neglecting this factor's potential influence on study outcomes. Despite a great interest in the development and further implementation of ultrasound education during medical school, this process is still compromised by significant deficiencies in studies that have been conducted in the past. In order to provide a valid basis for curricular decisions, teaching studies should fulfill essential methodological requirements despite the multifactorial framework in which they are conducted. In the future, a guide for the design of ultrasound studies could be a useful aid for ultrasound enthusiasts and promote scientific knowledge gain.

A Comparison Between In-Person and Video Conference Lectures on Medical Student Ultrasound Education

A Comparison Between In-Person and Video Conference Lectures on Medical Student Ultrasound Education

Simulation-based education in ultrasound - diagnostic and interventional abdominal focus.

Simulation-based training (SBT) is increasingly acknowledged worldwide and has become a popular tool for ultrasound education. Ultrasound simulation involves the use of technology and software to create a virtual training setting. Simulation-based training allows healthcare professionals to learn, practice, and improve their ultrasound imaging skills in a safe learning-based environment. SBT can provide a realistic and focused learning experience that creates a deep and immersive understanding of the complexity of ultrasound, including enhancing knowledge and confidence in specific areas of interest. Abdominal ultrasound simulation is a tool to increase patient safety and can be a cost-efficient training method. In this paper, we provide an overview of various types of abdominal ultrasound simulators, and the benefits, and challenges of SBT. We also provide examples of how to develop SBT programs and learning strategies including mastery learning. In conclusion, the growing demand for medical imaging increases the need for healthcare professionals to start using ultrasound simulators in order to keep up with the rising standards.

Student ultrasound education - current views and controversies.

As an extension of the clinical examination and as a diagnostic and problem-solving tool, ultrasound has become an established technique for clinicians. A prerequisite for high-quality clinical ultrasound practice is adequate student ultrasound training. In light of the considerable heterogeneity of ultrasound curricula in medical studies worldwide, this review presents basic principles of modern medical student ultrasound education and advocates for the establishment of an ultrasound core curriculum embedded both horizontally and vertically in medical studies.

Novel Scoring Scale for Quality Assessment of Lung Ultrasound in the Emergency Department.

The use of a reliable scoring system for quality assessment (QA) is imperative to limit inconsistencies in measuring ultrasound acquisition skills. The current grading scale used for QA endorsed by the American College of Emergency Physicians (ACEP) is non-specific, applies irrespective of the type of study performed, and has not been rigorously validated. Our goal in this study was to determine whether a succinct, organ-specific grading scale designed for lung-specific QA would be more precise with better interobserver agreement. This was a prospective validation study of an objective QA scale for lung ultrasound (LUS) in the emergency department. We identified the first 100 LUS performed in normal clinical practice in the year 2020. Four reviewers at an urban academic center who were either emergency ultrasound fellowship-trained or current fellows with at least six months of QA experience scored each study, resulting in a total of 400. The primary outcome was the level of agreement between the reviewers. Our secondary outcome was the variability of the scores given to the studies. For the agreement between reviewers, we computed the intraclass correlation coefficient (ICC) based on a two-way random-effect model with a single rater for each grading scale. We generated 10,000 bootstrapped ICCs to construct 95% confidence intervals (CI) for both grading systems. A two-sided one-sample t-test was used to determine whether there were differences in the bootstrapped ICCs between the two grading systems. The ICC between reviewers was 0.552 (95% CI 0.40-0.68) for the ACEP grading scale and 0.703 (95% CI 0.59-0.79) for the novel grading scale (P < 0.001), indicating significantly more interobserver agreement using the novel scale compared to the ACEP scale. The variance of scores was similar (0.93 and 0.92 for the novel and ACEP scales, respectively). We found an increased interobserver agreement between reviewers when using the novel, organ-specific scale when compared with the ACEP grading scale. Increased consistency in feedback based on objective criteria directed to the specific, targeted organ provides an opportunity to enhance learner education and satisfaction with their ultrasound education.

Critical congenital heart disease: contemporary prenatal screening performance and outcomes in a multi-centre perinatology service

BackgroundPrenatal detection of critical congenital heart disease (CCHD) optimises perinatal decision-making and neonatal outcomes. The objective of this study was to determine the prenatal screening performance, care pathways and perinatal outcomes for prenatally and postnatally diagnosed cases of CCHD over a four-year period.Study designThis retrospective cohort study in a tertiary centre and its two affiliated secondary sites examined all cases of CCHD, including cases of pregnancy termination and in-utero fetal death, neonatal death and liveborn babies that underwent cardiac catheterization or surgery in the first six weeks of life. Prenatal and postnatal data were ascertained from the first trimester assessment for all patients diagnosed prenatally. Cases requiring intervention that were first identified in the postnatal period were included to determine prenatal detection rates. Follow-up for all cases of CCHD continued to one year of age.ResultsIn a consecutive cohort of 49,950 pregnancies in a 4-year period 01/2019 to 12/2022, a prenatal diagnosis of CCHD was made in 96 cases, yielding a prevalence of 1.9 per 1000 births. The prenatal detection for right duct-dependant heart pathology and congenital heart block was 100%, 85% for left duct-dependant pathology and 93% for transposition of the great arteries (TGA). In the prenatally diagnosed group, 37% of cases were complicated by extracardiac structural abnormalities, a genetic diagnosis or both. All cases of prenatal detection were identified in the context of routine anatomy screening rather than specialist Fetal Cardiac screening services. Almost half of all pregnancies complicated by CCHD did not undergo neonatal cardiac intervention, by virtue of parental choice determined either prenatally or after birth. An additional eight babies were diagnosed with CCHD in the neonatal period, such that the prenatal detection rate for CCHD was 92% (96/104, 95% CI = 84%-96%). Survival at 1-year for infants deemed suitable for CCHD surgery was 85%.ConclusionIn a large unselected population, optimal rates of prenatal detection of critical congenital heart disease can be achieved by a protocolised approach to mid-trimester fetal anatomy ultrasound, underpinned by a programme of sonographer education and training. The cardiac abnormalities most likely to evade prenatal detection are left-sided obstructive lesions.

Comparison of peer-assisted learning with expert-led learning in medical school ultrasound education: a systematic review and meta-analysis.

Teaching point-of-care ultrasonography (PoCUS) to medical students is resource intensive. Peer-assisted learning, where the teacher can be a medical student, may be a feasible alternative to expert-led learning. The objective of this systematic review and meta-analysis was to compare the PoCUS performance assessments of medical students receiving peer-assisted vs expert-led learning. This study was submitted to PROSPERO (CRD42023383915) and reported with PRISMA guidelines. MEDLINE, Embase, ERIC, Education Source, Scopus, and Web of Science were searched from inception to November 2022. Inclusion criteria were studies comparing peer-assisted vs expert-led PoCUS teaching for undergraduate medical students. The primary outcome was performance assessment of PoCUS skills. Two reviewers independently screened citations and extracted data. The Cochrane risk-of-bias tool for randomized trials was used to assess study quality. Studies were included in the meta-analysis if mean performance assessment scores with standard deviations and sample sizes were available. A random-effects meta-analysis was conducted to estimate the accuracy score of practical knowledge test for each group. A meta-regression evaluated difference in mean scores. The search yielded 2890 citations; 1417 unique citations remained after removing duplicates. Nine randomized-controlled studies conducted in Germany, USA, and Israel, with 593 participants, were included in the meta-analysis. The included studies assessed teaching of abdominal, cardiac, thoracic, musculoskeletal, and ocular PoCUS skills. Most studies had some risk-of-bias concerns. The estimate accuracy score after weighting is 0.56 (95% CI [0.47, 0.65]) for peer-assisted learning and 0.59 (95% CI [0.49, 0.69]) for expert-led learning. The regression coefficient estimate is 0.0281 (95% CI [-0.1121, 0.1683]); P value is 0.69. This meta-analysis found that peer-assisted learning was a reasonable alternative to expert-led learning for teaching PoCUS skills to medical students.

Utility and challenges of ultrasound education for medical and allied health students in Asia.

Utility and challenges of ultrasound education for medical and allied health students in Asia.

Sonographic imaging education for sonographers versus health professionals: A literature review

AbstractBackgroundSonographers are tertiary qualified health professionals who acquire, measure, and interpret diagnostic ultrasound images. Ultrasound is also used by many health professionals other than sonographers. As the imaging objectives of these two groups differs, and in the interest of enhancing education, we performed a literature review.MethodResearch questions drove the literature search that initially yielded &gt;4,000 articles: subject and theme relevance checks reduced this to a final selection of 44. Based on dominant themes within articles, the final 44 were placed into 7 categories, 3 in ‘skills development’ and 4 in ‘educational methods’ domains. In each category, articles were grouped by research participant type: 1. Sonographer or 2. Health Professional, and citation frequency used to measure impact.ResultSix sonographer‐focused and 16 health professional focused articles were assigned to the skills development domain. The highest impact sonographer‐focused article emphasised psychomotor skills for optimal development, the highest impact health professional focused article centered on rapid image acquisition and interpretation. Six sonographer‐focused and 16 health professional focused articles were assigned to the educational methods domain. The highest impact sonographer‐focused article identified a limitation of high‐fidelity simulators, the highest impact health professional focused article cited a limitation of education delivery.ConclusionDifferent sonographic imaging skills and educational methods are used for sonographers and health professionals. Sonographers utilise a wide range of imaging skills: teaching methods should be tailored accordingly. Health professionals rely on condensed imaging skills and standardised protocols: this requires a customised approach and may be enhanced by sonographer involvement.

Insights Into Modern Undergraduate Ultrasound Education: Prospective Comparison of Digital and Analog Teaching Resources in a Flipped Classroom Concept - The DIvAN Study.

Purpose Sonography training has become an important part of university medicine courses. This study explores the impact of digital and analog teaching resources on learning outcomes, knowledge retention, and student preferences and motivation in a flipped classroom setting. Materials and Methods This prospective controlled study involving two groups of third-year medical students included a voluntary three-day compact ultrasound course given in a flipped classroom, comprising 26 teaching units of 45 minutes each. Hardcopy lecture notes (control group) and E-learning (study group) were used as teaching resources. Evaluations were conducted before (pre) and during the preparation phase (intermediate), and after (post) the face-to-face course. Likert scale responses, written theory tests with very short answer questions (Theorypre, Theoryinter, Theorypost), and practical examinations (Practiceinter, Practicepost) were used for student self-assessment and to measure attitude, motivation, as well as theoretical and practical skills. Results A total of N=236 complete data sets (study group n=136; control group n=100) were analyzed. Both groups showed an equivalent initial level of, and a continuous and significant (p<0.01) increase in, subjective and objective skills over the evaluated time frame. The study group achieved significantly (p<0.05) better results in Theoryinter, Theorypost, Practiceinter, and Practicepost. The study group evaluated their teaching resource and the training concept significantly (p<0.05) better. Conclusion The integration of digital resources into sonography education provides comparable learning outcomes to traditional analog materials, enhancing the preparatory phase. In the future, digitally supported training should be used more.

Validity of Using Still Images for Written Competency Assessments for Point-of-Care Ultrasound among Non-Radiologists-pilot study.

Background and Objective: Point-of-care ultrasound (POCUS) has become an integral part of the curricula of various spe-cialty residency programs. POCUS education requires learners to be proficient in image acqui-sition, image interpretation, and integration into clinical practice. The assessment of POCUS skills and competency is variable. This study aimed to assess the validity and reliability of us-ing still ultrasound images as examination test items without providing clinical vignettes or anatomical locations. Methods: This is a proof-of-concept survey pilot study, residents from the Middle East who had com-pleted their training in emergency medicine were surveyed during their competency assess-ment examination. They were provided with a single ultrasound image of an abdominal aortic aneurysm in both print and PowerPoint slide format. The task was to identify the diagnosis based on this image, which was taken from a reference emergency medicine textbook. Results: The study showed that only 50% of the residents correctly identified the diagnoses based on the still images. Many of the incorrect answers included diagnoses that were not related to the anatomical structure that was scanned, indicating that the residents were not able to identify the anatomical locations, which highlighted the challenges of interpreting a single still image without clinical context and emphasized the need for valid and reliable test items in point-of-care ultrasound (POCUS) education and assessment. Conclusions: National and international emergency medicine societies should establish standards for writ-ing POCUS examination test items to ensure their validity and reliability.

Validity of Using Still Images for Written Competency Assessments for Point-of-Care Ultrasound among Non-Radiologists-pilot study.

Background and Objective: Point-of-care ultrasound (POCUS) has become an integral part of the curricula of various spe-cialty residency programs. POCUS education requires learners to be proficient in image acqui-sition, image interpretation, and integration into clinical practice. The assessment of POCUS skills and competency is variable. This study aimed to assess the validity and reliability of us-ing still ultrasound images as examination test items without providing clinical vignettes or anatomical locations. Methods: This is a proof-of-concept survey pilot study, residents from the Middle East who had com-pleted their training in emergency medicine were surveyed during their competency assess-ment examination. They were provided with a single ultrasound image of an abdominal aortic aneurysm in both print and PowerPoint slide format. The task was to identify the diagnosis based on this image, which was taken from a reference emergency medicine textbook. Results: The study showed that only 50% of the residents correctly identified the diagnoses based on the still images. Many of the incorrect answers included diagnoses that were not related to the anatomical structure that was scanned, indicating that the residents were not able to identify the anatomical locations, which highlighted the challenges of interpreting a single still image without clinical context and emphasized the need for valid and reliable test items in point-of-care ultrasound (POCUS) education and assessment. Conclusions: National and international emergency medicine societies should establish standards for writ-ing POCUS examination test items to ensure their validity and reliability.

Guidance for clinical practice using emergency and point-of-care ultrasonography.

Owing to the miniaturization of diagnostic ultrasound scanners and their spread of their bedside use, ultrasonography has been actively utilized in emergency situations. Ultrasonography performed by medical personnel with focused approaches at the bedside for clinical decision-making and improving the quality of invasive procedures is now called point-of-care ultrasonography (POCUS). The concept of POCUS has spread worldwide; however, in Japan, formal clinical guidance concerning POCUS is lacking, except for the application of focused assessment with sonography for trauma (FAST) and ultrasound-guided central venous cannulation. The Committee for the Promotion of POCUS in the Japanese Association for Acute Medicine (JAAM) has often discussed improving the quality of acute care using POCUS, and the "Clinical Guidance for Emergency and Point-of-Care Ultrasonography" was finally established with the endorsement of JAAM. The background, targets for acute care physicians, rationale based on published articles, and integrated application were mentioned in this guidance. The core points include the fundamental principles of ultrasound, airway, chest, cardiac, abdominal, and deep venous ultrasound, ultrasound-guided procedures, and the usage of ultrasound based on symptoms. Additional points, which are currently being considered as potential core points in the future, have also been widely mentioned. This guidance describes the overview and future direction of ultrasonography for acute care physicians and can be utilized for emergency ultrasound education. We hope this guidance will contribute to the effective use of ultrasonography in acute care settings in Japan.

Point-of-care-ultrasound for the assessment of post-renal transplant recipients.

Postoperative imaging for deceased donor renal transplants is often delayed, as these surgeries occur after-hours. These delays can be critical in identifying immediate complications. To our knowledge, there are no formal training programs for point-of-care ultrasound (POCUS) in this setting; therefore, we aimed to develop and evaluate a feasible and practical POCUS curriculum for the assessment of a renal transplant graft. Urology and nephrology transplant physicians completed a three-hour online course, followed by a five-hour hands-on seminar for sonographic scanning. Simulated patients with transplanted kidneys were used. Course material was developed with licensed ultrasound technologists based on Sonography Canada national competency profiles. Pre- and post-course surveys focused on user confidence, while pre- and post-course multiple-choice questionnaires assessed theoretical knowledge. Twelve participants were included, six of whom were urologists. Theoretical knowledge in POCUS improved significantly (p<0.001). Confidence in manipulation of ultrasound controls, Doppler imaging, and POCUS of the transplant kidney also improved (all p<0.001, d>2.0). Participants indicated an increased likelihood of POCUS use in clinical practice and that training should be integrated into a transplant fellowship. We introduced a novel and guideline-based POCUS curriculum that leveraged local ultrasound educators and found improved theoretical knowledge and skill confidence in our cohort of transplant physicians. This course will serve as the first step toward a validated competency-based training system for POCUS use in the immediate post-renal transplant setting, and likely will be incorporated into the training of the modern transplant physician.

Effectiveness of Lung Ultrasound Training Utilizing a High-Fidelity Simulator.

The usefulness of lung ultrasound (LUS) has been demonstrated. However, it is unclear whether diagnostic techniques using LUS are accepted by all physicians. A simple simulation-based educational program may improve the LUS skills of beginners, but it has not been fully assessed. This prospective study was conducted to assess the educational outcomes of LUS training using a high-fidelity simulator. A simulator-based program for LUS was conducted. All clerkship students at the Department of Respirology at Chiba University Hospital participated in the program from December 2022 to April 2023. The participants watched a 30 minute teaching video on demand before a hands-on session lasting for 1 hour during the first week of the clinical clerkship. The readiness of the participants to learn LUS and the usefulness of the program were assessed using questionnaires administered before and after the program. The LUS skills were assessed using simulator-based tests during Weeks 1 and 4. Data on the accuracy and time required to answer the questions were collected during the tests. Forty clerkship students participated in this study. Thirty-three (82.5%) had received other ultrasound education; however, only two (5.0%) had experience with LUS. Based on the questionnaire responses, the participants perceived LUS as useful (preprogram: 4.6 vs. postprogram: 4.8; P = 0.010; a 5-point Likert scale was used [1: not useful to 5: useful]). The simulator-based tests showed comparable accuracies at Weeks 1 and 4 for pneumothorax (Week 1: 47.5% vs. Week 4: 52.5%; P = 0.623), pulmonary edema (Week 1: 100% vs. Week 4: 100%; P = 1.000), and pleural effusion (Week 1: 37.5% vs. Week 4: 40.0%; P = 0.800). The time required for scanning was the same for each question. In addition, the test results did not differ with prior learning, previous knowledge, or experience during clinical clerkships on LUS. A short educational program consisting of on-demand learning and hands-on sessions with a high-fidelity simulator would be effective in equipping clerkship students with basic LUS skills. However, to increase its educational effectiveness to a practical degree, the program should be improved, and more opportunities for training using simulators should be provided.

Wireless handheld focused ultrasound in student teaching during the COVID-19 pandemic: Initial results of a pilot study1.

The study aim was to investigate the use of a novel device, the Vscan Air™, for rapidly and effectively performing ultrasound in student teaching during the COVID-19 pandemic. As part of the ultrasound practical course with integrated hands-on activity required by the regular medical curriculum, 100 medical students were instructed in the use of the Vscan Air™, including duplex mode. They then evaluated the quality of the ultrasound images obtained by the Vscan Air™ from previously selected organs. 100 students were interviewed (female n = 68, male n = 32; age >18 years n = 100). The rated image quality never fell below a mean of 3 for the examined organs and portal vein flow (liver 4,58; spleen 3,99; kidneys 4,29; aorta 4,16; Douglas/rectovesical space 4,14; portal vein 4,43; pancreas 3,53; Focused Assessment with Sonography for Trauma 4,38). Scores below 3 were found sporadically in ultrasounds of the spleen (n = 4), kidneys (n = 3), Douglas/rectovesical space (n = 2), and pancreas (n = 15). The liver was rated the lowest for 59 ratings. The portal vein was evaluated in 68 cases. The hepatic artery and hepatic veins could be also visualized in all 68 examinations. The aorta was evaluated in 62 cases. The Vscan Air™ technology offered adequate image quality and provided a new, fast and patient-oriented technique to support continuous ultrasound examinations and education of students, especially during a pandemic. Particularly noteworthy is the uncomplicated compliance with the required high level of hygiene.

Teaching ultrasound in osteopathic medical schools.

An important diagnostic tool, ultrasound (US) has been incorporated into the curriculum of medical schools for more than 20 years. In the last decade, the interest in US educational research has experienced exponential growth but mostly from Medical Doctor (MD)-granted schools. Theextent to which US is embedded in the curricula of the colleges of osteopathic medicine (COM) still requires a comprehensive evaluation. This survey is designed to evaluate the current status of US teaching in COMs with an emphasis on the inclusion of the US in osteopathic manipulative medicine (OMM) training. An anonymous, voluntary, 22-question online survey was created and administered to all COMs to collect data about the current state of US teaching. A descriptive analysis was performed to describe and summarize the final data. Fisher's exact test was utilized for the comparison of study variables. We received responses from 36 of the 43 (83.7 %) COMs invited to participate in the survey, all of which had US training within their curriculum, most commonly integrated into the year 1 curriculum (86.1 %). Focused US training is incorporated into 83.3 % of these schools (30 of 36). Focused US training is covered in 83.3 % of schools (30 of 36). US is mostly taught in the anatomy course (38.8 %). US is incorporated in the OMM course in 12 of 36 schools (33.3 %). The majority of respondents feel that US training will make osteopathic students more competitive in the job market (88.9 %) and want more US in their curriculum (86.1 %). The idea that US is useful for a better understanding of the key OMM concepts is believed by 62.9 % of respondents. The major obstacle to the implementation of US in the curriculum is having appropriately trained faculty (86.1 %). The majority of the respondents did not feel that an adequate budget is a handicap to implementing US in the curriculum. US is included within the curriculum of all respondents to our survey, a third of whom included US within their OMM curriculum. US is treated as a useful and important skill for future osteopathic physicians. The majority of COMs desire more US training in the curriculum. The main barrier to implementing US in the curriculum is the lack of appropriately trained faculty.

Current Utilization and Perceptions of Formal Education of Point-of-care Ultrasound in Urology

ObjectiveTo assess the extent of formal POCUS training, current utilization of POCUS, and contemporary perceptions of POCUS amongst urologists. MethodsA survey including questions regarding demographics, prior ultrasound education, current ultrasound utilization in practice/training, perceived optimal POCUS utilization, and the perception of formal ultrasound training was developed. The survey was disseminated to residency program directors (PDs) via the SAU and members of AUA sub-section organizations. Data was collected via Redcap. ResultsA total of 40 PDs and 159 other respondents completed the survey with approximately half (51%) in an academic practice and two-thirds (68%) with more than 10 years in practice. PD response rate was 28%, and general response rate was 2%. Among all respondents, 95% (186/196) and 82% (160/194) agreed/strongly agreed formal POCUS training would be worthwhile during and after residency. Among urology residency program directors, 93% (37/40) agreed/strongly agreed that formal POCUS training is worthwhile in residency. The majority of respondents used some form of ultrasound in practice (77%, 154/199). However, only 37% (72/199) of all respondents had prior formal POCUS training, and 19% (5/26) of program directors reported formal training in their programs. Of respondents without formal training, 63% (80/127) reported interest in pursuing formal training. ConclusionsPOCUS is widely utilized in many practices. Yet, most urologists have not participated in formal POCUS training and most programs do not have curricula. Urologists have favorable opinions of the utility, safety, and efficacy of POCUS and desire training.

MUSIG: An Example Highlighting the Value of Student Led POCUS Education, Influenced by the COVID-19 Pandemic.

There has been a recent push for more formal ultrasound teaching in medical school curricula. Faculty availability, however, presents a significant barrier to its implementation. Medical student interest groups such as the McGill Ultrasound Interest Group (MUSIG), aimed to address this barrier by using near-peer instruction (NPI) to teach ultrasound to other students. MUSIG has helped teach hundreds of students about the fundamentals of ultrasound and its applicability in clinical practice by creating ultrasound conferences, friendly ultrasound competitions, virtual lectures, and educational resources. This paper aims to use MUSIG as an example to highlight the important role students can play in changing the landscape of medical education.

Perceived Importance of Ultrasound Vascular Access Education among Residents

Perceived Importance of Ultrasound Vascular Access Education among Residents