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  • 1. Using Hand-Held Ultrasound to Enhance Pre-Clinical Medical School Curricula
    Mary Beth Poston, MD, MSCR
    University of South Carolina School of Medicine
    Columbia, SC
  • 2. Workshop Outline
    Background – Ultrasound in medical education
    integrated UltraSound Curriculum (iUSC)– Ultrasound Vertical Curriculum
    Ultrasound in the Pre-Clinical Years
    Curriculum Content
  • 3. Learning Objectives
    To discuss the new role of hands-on learning in medical education
    To demonstrate how one medical school has implemented a vertical curriculum in ultrasound technology
    To demonstrate specifically how this complements learning in the Pre-Clinical curriculum
    To demonstrate the ease with which these techniques can be taught and learned
  • 4. Why Ultrasound?
  • 5. Ultrasound in Medical Education
    Expansion of hands-on learning, simulation in education
    Using ultrasound as an adjunct to physical exam skills has been shown to be an acquirable skill for medical students
    Identification of cardiac pathology
    Abdominal ultrasound
    Ultrasound technology as part of some residency training programs
    FAST exam in Emergency Medicine training
  • 6. Comparison of Hand-Carried Ultrasound to Bedside Cardiovascular Physical ExaminationKopalSL, et al. Am J Cardiol2005
    Two first year medical students
    4 hrs of lecture and 14 hrs of hands-on experience
    Students outperformed 5 board-certified cardiologists in identifying cardiac pathology in 61 cardiac patients
    Students identified 75% of the pathologies and cardiologists identified 49%
  • 7. British Medical Journal May 2008 – Feature Article on Ultrasound Education
    Dr Giles Maskell, radiologist at the Royal Cornwall Hospital in Truro, believes ultrasonography should be taught to everyone in medical school: "It is a fantastic tool and every medical student should be taught to use ultrasound like they are taught to use a stethoscope”.
    “This is already happening at one medical school in the United States. The University of South Carolina is pioneering a project to train all medical students in ultrasonography.”
  • 8. iUSC
    Class of 2010, first fully trained in ultrasound vertical curriculum
    In 2006, USCSM introduced the ultrasound curriculum in the basic science years
    In 2007, this was expanded to the clinical years
  • 9. USC-SOM Vertical Curricula
    Ethics and Professionalism
    Substance Abuse
  • 10. Vertical Curriculum
    Defined as “the interdepartmental integration, in basic science courses and clinical rotations over the course of the four-year curriculum, of topical subject matters that transcend the purview of an individual USC-SOM department”
    Distinguishable from “horizontal integration” in that the latter attempts to teach similar preclinical topics simultaneously even if in different required courses
  • 11. Vertical Curriculum - Oversight
    Overseen by individual VC directors
    Also overseen by the Interdepartmental/ Interdisciplinary Integration Subcommittee of the Curriculum Committee, which
    Conducts periodic reviews and updates of vertical curricula
    Ensures the integration of interdepartmental and interdisciplinary educational efforts
    Oversees initiation and maintenance of a curricular tracking system
  • 12. Vertical Curriculum - Tracking
    Mapping within curriculum data base helps with oversight
    Overarching and course specific objectives for each of the vertical curricula are included in the curriculum data base
    Methods of assessment are outlined in the curriculum data base
  • 13. Vertical Curriculum - Ultrasound
    M1 – taught in conjunction with Gross Anatomy and Physiology
    M2 – expansion of M1 curriculum, coordinated with lecture topics in Pathology/Pathophysiology and Physical Diagnosis
    M3 – most core clerkships have an ultrasound learning component and OSCE
    IM – thyroid, central line placement
    OB/Gyn – pregnancy with bleeding
    Surgery – FAST exam
    Family Medicine – AAA
    Pediatrics - HOCM, situsinversus, dehydration
    Review of essential skills
    Elective in emergency bedside ultrasound
    Capstone workshop
  • 14. Ultrasound in the Pre-Clinical Curriculum
  • 15. M1 Curriculum
    Fall Semester – Gross Anatomy
    Introductory lecture during Orientation
    Cardiac ultrasound
    Neck ultrasound (carotid artery, internal jugular vein, thyroid)
    Pelvic ultrasound (urinary bladder)
    Abdominal (hepatic, spleen, renal) ultrasound
    Evaluated with Objective Structured Clinical Examination (OSCE)
  • 16. M1 Curriculum
    Spring Semester – Physiology
    Vascular hemodynamics (introduces concepts of color flow and doppler to demonstrate direction of flow and measurement of velocity, recognition of arterial and venous wave forms)
    Cardiac hemodynamics (normal function) Wall and valve motion, flow through cardiac chambers
    Evaluating for cardiogenic shock: gross LV/RV function and size, gross valve function
    Evaluated with the addition of case-based multiple choice test questions to standard Physiology quizzes and tests
  • 17. M2 Curriculum
    Coordinated with Introduction to Clinical Medicine (ICM)
    Fall Semester: Physical Diagnosis
    All standard cardiac views
    General abdominal ultrasound
    Abdominal aorta (AAA screen)
    Lower extremity vascular (DVT screen)
    Evaluating based on Web-based modules with multiple choice questions, “open book” multiple choice quiz
  • 18. M2 Curriculum (ICM)
    Spring Semester – Pathophysiology
    Pelvic ultrasound (female gynecology)
    Vascular ultrasound (inferior vena cava for volume status estimation)
    Cardiogenic shock
    Ultrasound guided procedures
    (uses ultrasound phantoms)
    Evaluated with OSCE
  • 19. Delivery of Course ContentUltrasound Labs
    Primarily hands-on labs: 1 hour groups
    May have brief (max 30 minutes, usually less than 10 minutes) pre-lab lecture/demonstration
    Occasional (usually no more than 1/semester) longer classroom lecture for complex topics
    Group size of ~ 20 students, 4 faculty preceptors, 4-5 standardized patients
    2-4 “open lab sessions”/semester, 2 hours each, staffed by iUSC faculty (1 or 2 faculty per session)
  • 20. Web-based Modules
    Cover a wide range of topics from ultrasound physics to specific clinical indications
    Demonstrate relevant technique plus discuss evidence based guidelines for use of ultrasound in the clinical setting
    Include ultrasound images and loops
    Generally 12-15 minutes in length
  • 21. Web-based Module:Demonstration
  • 22. Pre-Clinical Ultrasound Curriculum Assessment of Skills
    OSCE is standard testing format with standardized patients, M1-M4
    Must demonstrate
    Understanding of technology (M1-M4)
    Ability to acquire images (M1-M4)
    Ability to interpret findings in context of patient history and physical exam (M3-M4)
    Ability to use findings appropriately in planning patient care (M3-M4)
  • 23. Additional Measures in Pre-clinical Curriculum: Standard Multiple Choice Questions
    May be incorporated into quizzes and tests for the course with which the curriculum is paired
    Can create “stand-alone” quizzes
    Can incorporate questions with other learning materials (web-based modules)
    Questions usually include cases and/or images
  • 24. Pre-Clinical Ultrasound CurriculumAssessment of Impact
    Student surveys/Focus Groups
    Controlled studies
  • 25.
  • 26. Controlled Study of Comparative Performance on Gross Anatomy Multiple Choice Quiz
    3 predefined dissection groups:
    Group A: Anterior wall
    Group B: Viscera
    Group C: Posterior wall
    Half of each group randomly assigned to additional abdominal ultrasound exposure during abdominal dissection
  • 27. Controlled Study of Comparative Performance on Gross Anatomy Multiple Choice Quiz
    Performance on 25 question quiz compared
    Questions from pre-existing test bank utilized in the usual fashion
    Prior to test administration, Ultrasound and Gross Anatomy faculty reviewed quiz and identified 6 questions thought to be related to Ultrasound Concepts
  • 28. Controlled Study of Comparative Performance on Gross Anatomy Multiple Choice Quiz: Results
    Intervention group (n=53)
    Control group (n=50)
    Multiple comparisons explored (US vs no US within and across dissection groups) without a clear pattern of significant differences (though in most comparisons US scores slightly higher)
    Additional comparisons planned controlling for overall Gross Anatomy grade
  • 29. Resources: Faculty Recruitment and Development
    Faculty are across many clinical specialties:
    Emergency Medicine
    Internal Medicine and related subspecialties
    Family Medicine
    Recruited on the basis of interest
    Offered brief course in basic US (via our EM department or iUSC), additional training sessions occur sporadically
    Most learning is “on the job”
  • 30. Learning Objectives - Revisited
    You should now
    Understand the new role of hands-on learning in medical education
    Know how one medical school has implemented a vertical curriculum in ultrasound technology
    And have the confidence to consider such at your own institution
    See the ease with which these techniques can be taught and learned
  • 31. Thank You!
    Ultrasound Demonstration Available
    Many thanks to Victor Rao, Lance Paulman, Erika Blanck, Duncan Howe, Stanley Fowler and Richard Hoppmann