Point-of-Care Clinical Ultrasound for Medical Students

Abstract

Purpose:

Our institution has recently implemented a point-of-care (POC) ultrasound training program, consisting of an e-learning course and systematic practical hands-on training. The aim of this prospective study was to evaluate the learning outcome of this curriculum.

Materials and Methods:

16 medical students with no previous ultrasound experience comprised the study group. The program covered a combination of 4 well-described point-of-care (POC) ultrasound protocols (focus assessed transthoracic echocardiography, focused assessment with sonography in trauma, lung ultrasound, and dynamic needle tip positioning for ultrasound-guided vascular access) and it consisted of an e-learning course followed by 4 h of practical hands-on training. Practical skills and image quality were tested 3 times during the study: at baseline, after e-learning, and after hands-on training.

Results:

Practical skills improved for all 4 protocols; after e-learning as well as after hands-on training. The number of students who were able to perform at least one interpretable image of the heart increased from 7 at baseline to 12 after e-learning, p<0.01, and to all 16 students after hands-on-training, p<0.01. The number of students able to cannulate an artificial vessel increased from 3 to 8 after e-learning and to 15 after hands-on training.

Conclusion:

Medical students with no previous ultrasound experience demonstrated a considerable improvement in practical skill after interactive e-learning and 4 h of hands-on training.

Key words

abdomen - heart - vascular - ultrasound

• References

• 1 Moore CL, Copel JA. Point-of-care ultrasonography. The New England Journal of Medicine 2011; 364: 749-757
• 2 Labovitz AJ, Noble VE, Bierig M et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. Journal of the American Society of Echocardiography 2010; 23: 1225-1230
• 3 Spencer KT, Kimura BJ, Korcarz CE et al. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography 2013; 26: 567-581
• 4 Neskovic AN, Hagendorff A, Lancellotti P et al. Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. European Heart Journal Cardiovascular Imaging 2013; 14: 1-11
• 5 Neskovic AN, Edvardsen T, Galderisi M et al. Focus cardiac ultrasound: the European Association of Cardiovascular Imaging viewpoint. European Heart Journal Cardiovascular Imaging. 2014
• 6 Laursen CB, Sloth E, Lambrechtsen J et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2013; 144: 1868-1875
• 7 Laursen CB, Sloth E, Lassen AT et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. The lancet Respiratory Medicine 2014;
• 8 Melniker LA, Leibner E, McKenney MG et al. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Annals of Emergency Medicine 2006; 48: 227-235
• 9 Hansen MA, Juhl-Olsen P, Thorn S et al. Ultrasonography-guided radial artery catheterization is superior compared with the traditional palpation technique: a prospective, randomized, blinded, crossover study. Acta Anaesthesiologica Scandinavica 2014; 58: 446-452
• 10 Verghese ST, McGill WA, Patel RI et al. Comparison of three techniques for internal jugular vein cannulation in infants. Paediatric Anaesthesia 2000; 10: 505-511
• 11 Neri L, Storti E, Lichtenstein D. Toward an ultrasound curriculum for critical care medicine. Critical Care Medicine 2007; 35 (5 Suppl) 290-304
• 12 Randolph AG, Cook DJ, Gonzales CA et al. Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Critical Care Medicine 1996; 24: 2053-2058
• 13 Solomon SD, Saldana F. Point-of-care ultrasound in medical education – stop listening and look. The New England Journal of Medicine 2014; 370: 1083-1085
• 14 Hoppmann RA, Rao VV, Poston MB et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Critical Ultrasound Journal 2011; 3: 1-12
• 15 Bahner DP, Royall NA. Advanced ultrasound training for fourth-year medical students: a novel training program at The Ohio State University College of Medicine. Academic Medicine 2013; 88: 206-213
• 16 Rao S, van Holsbeeck L, Musial JL et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. Journal of Ultrasound in Medicine 2008; 27: 745-749
• 17 Brunner M, Moeslinger T, Spieckermann PG. Echocardiography for teaching cardiac physiology in practical student courses. The American Journal of Physiology 1995; 268: 2-9
• 18 Teichgraber UK, Meyer JM, Poulsen Nautrup C et al. Ultrasound anatomy: a practical teaching system in human gross anatomy. Medical Education 1996; 30: 296-298
• 19 Wicke W, Brugger PC, Firbas W. Teaching ultrasound of the abdomen and the pelvic organs in the medicine curriculum in Vienna. Medical Education 2003; 37: 476
• 20 Lamperti M, Bodenham AR, Pittiruti M et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Medicine 2012; 38: 1105-1117
• 21 Via G, Hussain A, Wells M et al. International evidence-based recommendations for focused cardiac ultrasound. Journal of the American Society of Echocardiography 2014; 27: 683.e1-683.e33
• 22 Volpicelli G, Elbarbary M, Blaivas M et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Medicine 2012; 38: 577-591
• 23 Jensen MB, Sloth E, Larsen KM et al. Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. European Journal of Anaesthesiology 2004; 21: 700-707
• 24 Scalea TM, Rodriguez A, Chiu WC et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. The Journal of Trauma 1999; 46: 466-472
• 25 Tso P, Rodriguez A, Cooper C et al. Sonography in blunt abdominal trauma: a preliminary progress report. The Journal of Trauma 1992; 33: 39-43
• 26 Clemmesen L, Knudsen L, Sloth E et al. Dynamic needle tip positioning – ultrasound guidance for peripheral vascular access. A randomized, controlled and blinded study in phantoms performed by ultrasound novices. Ultraschall in der Medizin 2012; 33: 321-325
• 27 Jakobsen CJ, Torp P, Sloth E. Perioperative feasibility of imaging the heart and pleura in patients with aortic stenosis undergoing aortic valve replacement. European Journal of Anaesthesiology 2007; 24: 589-595
• 28 Fernandez-Frackelton M, Peterson M, Lewis RJ et al. A bedside ultrasound curriculum for medical students: prospective evaluation of skill acquisition. Teaching and Learning in Medicine 2007; 19: 14-19
• 29 Gogalniceanu P, Sheena Y, Kashef E et al. Is basic emergency ultrasound training feasible as part of standard undergraduate medical education?. Journal of Surgical Education 2010; 67: 152-156
• 30 Breitkreutz R, Price S, Steiger HV et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 2010; 81: 1527-1533