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Vertical Curriculum

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    Vertical Curriculum Vertical Curriculum Presentation Transcript

    • 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
    • Workshop Outline
      Background – Ultrasound in medical education
      integrated UltraSound Curriculum (iUSC)– Ultrasound Vertical Curriculum
      Ultrasound in the Pre-Clinical Years
      Curriculum Content
      Evaluation
      Resources
    • 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
    • Why Ultrasound?
    • 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
    • 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%
    • 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.”
    • 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
    • USC-SOM Vertical Curricula
      Ethics and Professionalism
      Genetics
      Geriatrics
      Nutrition
      Substance Abuse
      Ultrasound
    • 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
    • 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
    • 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
    • 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
      M4
      Review of essential skills
      Elective in emergency bedside ultrasound
      Capstone workshop
    • Ultrasound in the Pre-Clinical Curriculum
    • M1 Curriculum
      Fall Semester – Gross Anatomy
      Introductory lecture during Orientation
      “Knobology”
      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)
    • 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
    • M2 Curriculum
      Coordinated with Introduction to Clinical Medicine (ICM)
      Fall Semester: Physical Diagnosis
      All standard cardiac views
      General abdominal ultrasound
      Pathophysiology
      Abdominal aorta (AAA screen)
      Lower extremity vascular (DVT screen)
      Evaluating based on Web-based modules with multiple choice questions, “open book” multiple choice quiz
    • 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
    • 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)
    • 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
    • Web-based Module:Demonstration
      http://media.med.sc.edu/ultrasound_institute/M2/11B/player.html
    • 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)
    • 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
    • Pre-Clinical Ultrasound CurriculumAssessment of Impact
      Student surveys/Focus Groups
      Controlled studies
    • 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
    • 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
    • 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
    • Resources: Faculty Recruitment and Development
      Faculty are across many clinical specialties:
      Emergency Medicine
      Internal Medicine and related subspecialties
      Family Medicine
      Pediatrics
      Radiology
      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”
    • 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
    • Thank You!
      Ultrasound Demonstration Available
      Many thanks to Victor Rao, Lance Paulman, Erika Blanck, Duncan Howe, Stanley Fowler and Richard Hoppmann