Virtual Dissection by Ultrasound: Probe Handling in the First Year of Medical Education

Abstract

Objectives The aim of the present study was to assess the educational plan of first-year students of medicine by analyzing their scores in ultrasound body scanning.

Methods Since 2009, the San Paolo Medical School (Milan, Italy) has vertically integrated the study of anatomy with ultrasound-assisted virtual body dissection. Three modules were supplied: musculoskeletal system, heart and abdomen pelvis. 653 first-year students were trained. The students alternated as mutual model and operator. A skillfulness score was assigned to each student. The scores were consequently listed. Nonparametric exact multiple contrast tests were employed to determine relative group effects.

Results Statistical analysis showed that: no gender-related differences were found (0:49; p=0.769); peer learners performed less well than peer tutors (0.677; p=0); between modules, scores in the musculoskeletal system (pMS=0.726) tend to be higher (p<0.001) than those obtained in the heart and abdomen pelvis (pH=0.398; pAP=0.375 p=0.270); significant differences were found compared to the beginning of the project’s academic year.

Conclusion The students considered this didactic course an engaging and exciting approach. Acceptance of peer teaching was extraordinarily high. Autonomous exercitation allowed the students to improve self-criticism and enhance their own skills. The level of expertise obtained by peer tutors and by peer learners can be considered satisfactory. The main objective of training future physicians on personal stethoechoscope with the necessary competence seems to have been successfully started.

Key words

ultrasound - interdisciplinary medical education - curriculum development - living anatomy - peer tutor

• References

• 1 Swamy M, Searle RF. Anatomy teaching with portable ultrasound to medical students. BMC Med Educ 2012; 22: 12-99
• 2 Teichgräber UK, Meyer JM, Poulson Nautrup C, von Rautenfeld DB. Ultrasound anatomy: A practical teaching system in human gross anatomy. Med Educ 1996; 30: 296-298
• 3 Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, Jackson M, Dulchavsky SA. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: A pioneer year review. J Ultrasound Med 2008; 27: 745-749
• 4 Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of ultrasound into gross anatomy curriculum: Perceptions of medical students. J Emerg Med 2012; 43: 1098-1102
• 5 Serrao G, Costa G, Cecchini F, Ormas M, Turci MC. Ultrasonic anatomy: A professionalizing activity. Ital J Anat Embryol 2009; 114 1 Suppl 197
• 6 Badea R. Medical education of students and residents a new paradigm?. Med Ultrason 2012; 14: 175-176
• 7 Mircea PA, Badea R, Fodor D, Buzoianu AD. Using ultrasonography as a teaching support tool in undergraduate medical education – time to reach a decision. Med Ultrason 2012; 14: 211-216
• 8 Syperda VA, Trivedi PN, Melo LC, Freeman ML, Ledermann EJ, Smith TM, Alben JO. Ultrasonography in preclinical education: a pilot study. J Am Osteopath Assoc 2008; 108: 601-605
• 9 Fowlkes JB. Bioeffects Committee of the American Institute of Ultrasound in Medicine. American Institute of Ultrasound in Medicine consensus report on potential bioeffects of diagnostic ultrasound: executive summary. J Ultrasound Med 2008; 27: 503-515
• 10 Miller DL. Safety assurance in obstetrical ultrasound. Semin Ultrasound CT MR 2008; 29: 156-164
• 11 McLachlan JC, Patten D. Anatomy teaching: Ghosts of the past, present and future. Med Educ Mar 2006; 40: 243-253
• 12 Syperda VA, Trivedi PN, Melo LC, Freeman ML, Ledermann EJ, Smith TM, Alben JO. Ultrasonography in preclinical education: a pilot study. J Am Osteopath Assoc 2008; 108: 601-605
• 13 Weyrich P, Schrauth M, Kraus B, Habermehl D, Netzhammer N, Zipfel S, Jünger J, Riessen R, Nikendei C. Undergraduate technical skills training guided by student tutor – Analysis of tutors’ attitude, tutees’ acceptance and learning progress in an innovative teaching model. BMC Med Educ 2008; 8: 18-27
• 14 Glynn LG, MacFarlane A, Kelly M, Cantillon P, Murphy AW. Helping each other to learn a process evaluation of peer assisted learning. BMC Med Educ 2006; 6: 18-27
• 15 Knobe M, Münker R, Sellei RM, Holschen M, Mooij SC, Schmidt-Rohlfing B, Niethard FU, Pape HC. Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound. Med Educ 2010; 44: 148-155
• 16 Butter J, Grant TH, Egan M, Kaye M, Wayne DB, Carrión-Carire V, McGaghie WC. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?. Med Educ 2007; 41: 843-848
• 17 Tixa S. Atlas of Surface Palpation. Anatomy of the neck, trunk, upper and lower limbs. Second Edition Churchill Livingstone Elsevier; 2008
• 18 Tshibwabwa ET, Groves HM, Levine MA. Teaching musculoskeletal ultrasound in the undergraduate medical curriculum. Med Educ 2007; 41: 517-518
• 19 Edwards WD, Tajik AJ, Seward JB. Standardized nomenclature and anatomic basis for regional tomographic analysis of the heart. Mayo Clin Proc 1981; 56: 479-497
• 20 Waller BF, Taliercio CP, Slack JD, Orr CM, Howard J, Smith ML. Tomographic views of normal and abnormal hearts: The anatomic basis for various cardiac imaging techniques. Part I. Clin Cardiol 1990; 13: 804-812
• 21 Lafortune M, Madore F, Patriquin H, Breton G. Segmental anatomy of the liver: A sonographic approach to the Couinaud nomenclature. Radiology 1991; 181: 443-448
• 22 Skandalakis JE, Skandalakis LJ, Skandalakis PN, Mirilas P. Hepatic surgical anatomy. Surg Clin North Am 2004; 84: 413-435
• 23 Lafortune M, Denys A, Sauvanet A, Schmidt S. Anatomy of the liver: What you need to know. J Radiol 2007; 88: 1020-1035
• 24 Heinzow HS, Friederichs H, Lenz P, Schmedt A, Becker JC, Hengst K, Marschall B, Domagk D. Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: A prospective study. BMC Med Educ 2013; 11: 13-84
• 25 Colbert-Getz JM, Tackett S, Wright SM, Shochet RS. Does academic performance or personal growth share a stronger association with learning environment perception?. Int J Med Educ. 2016; 7: 274-278
• 26 Konietschke F, Placzek M, Schaarschmidt F, Hothorn LA. An R Software package for nonparametric multiple comparisons and simultaneous confidence intervals. J Stat Soft 2015; 64: 1-17
• 27 Sykes Tottenham L, Saucier DM, Elias LJ, Gutwin C. Men are more accurate than women in aiming at targets in both near space and extrapersonal space. Percept Mot Skills 2005; 101: 3-12
• 28 Moreno-Briseño P, Díaz R, Campos-Romo A, Fernandez-Ruiz J. Sex-related differences in motor learning and performance. Behav Brain Funct 2010; 6: 74
• 29 Kolozsvari NO, Andalib A, Kaneva P, Cao J, Vassiliou MC, Fried GM, Feldman LS. Sex is not everything: the role of gender in early performance of a fundamental laparoscopic skill. Surg Endosc. 2011; 25: 1037-1042
• 30 Thorson CM, Kelly JP, Forse RA, Turaga KK. Can we continue to ignore gender differences in performance on simulation trainers?. J Laparoendosc Adv Surg Tech A. 2011; 21: 329-333
• 31 Krych AJ, March CN, Bryan RE, Peake BJ, Pawlina W, Carmichael SW. Reciprocal peer teaching: Students teaching students in the gross anatomy laboratory. Clin Anat 2005; 18: 296-301
• 32 Blohm M, Krautter M, Lauter J, Huber J, Weyrich P, Herzog W, Jünger J, Nikendei C. Voluntary undergraduate technical skills training course to prepare students for clerkship assignment: tutees' and tutors' perspectives. BMC Med Educ 2014; 14: 71
• 33 Wong I, Jayatilleke T, Kendall R, Atkinson P. Feasibility of a focused ultrasound training programme for medical undergraduate students. Clin Teach 2011; 8: 3-7
• 34 Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, Nuernberg D, Serra AL, Sidhu PS, Radzina M, Piscaglia F, Bachmann Nielsen M, Ewertsen C, Săftoiu A, Calliada F, Gilja OH. Ultrasound Int Open. 2016; 2: E2-E7
• 35 Fodor D, Badea R, Poanta L, Dumitrascu DL, Buzoianu AD, Mircea PA. The use of ultrasonography in learning clinical examination – a pilot study involving third year medical students. Med Ultrason 2012; 14: 177-181
• 36 Buckley S, Zamora J. Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors’ skills and attitudes toward teacher and teaching. BMC Med Educ 2007; 7: 20-29