Student ultrasound education – current views and controversies

Abstract

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.

Zusammenfassung

Als Erweiterung der klinischen Untersuchung, als Diagnose- und Problemlösungsinstrument ist die Sonografie zu einer etablierten Technik für den Arzt geworden. Voraussetzung für eine qualitativ hochwertige klinische Ultraschallpraxis ist die angemessene Ultraschallausbildung der Studierenden. Angesichts der beträchtlichen Heterogenität der Ultraschall-Curricula im Medizinstudium weltweit werden in dieser Übersicht die Grundprinzipien der modernen Ultraschall-Ausbildung von Medizinstudenten vorgestellt und die Einführung eines Ultraschall-Kerncurriculums befürwortet, das sowohl horizontal als auch vertikal in das Medizinstudium eingebettet ist.

Keywords

METHODS & TECHNIQUES - ultrasound - Education, Training, Quality Assurance - student

Introduction

Ultrasound has been widely used for decades by medical specialties such as emergency medicine, critical care, radiology, gastroenterology, cardiology, urology, obstetrics and gynecology and is rapidly expanding across other specialties [1]. The miniaturization of ultrasound machines has paved the way for hand-held ultrasound devices with decreasing costs. This miniaturization and the lower cost of ownership have also made ultrasound more accessible to practitioners, learners, and educators in clinical and basic science [2].

Incorporation of ultrasound education into medical schools has become a widespread trend worldwide [3] [4]. This is reflected in a fast-growing body of literature [5] which is summarized by five meta-analyses and further scoping reviews [6] [7] [8] [9] [10] [11] [12]. Both the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) [4] and the World Federation of Ultrasound in Medicine and Biology (WFUMB) issued position papers suggesting “that ultrasound should be used systematically as an easily accessible and instructive educational tool in the curriculum of modern medical schools” [3] [13]. Furthermore, the Society of Ultrasound Medical Education (SUSME) recently published a consensus statement regarding this topic [5].

Despite international recommendations and national learning objectives, universities offer very heterogeneous practical ultrasound education. No uniform curriculum for students’ ultrasound education is currently used across universities [14] [15] [16] [17]. However, the expansion of ultrasound reflects a persuasive argument that all medical students, regardless of their career choice for daily practice, should learn basic ultrasound skills alongside other skills of physical examination such as auscultation. Knowledge of sonographic indications, techniques, applications, and limitations will deepen clinical understanding of most medical disciplines [18]. The ultrasound educational spectrum should include high-resolution dynamic real-time imaging, which facilitates diagnostic scans and ultrasound-guided interventions across many medical specialties at the point of care. As a no-risk and low-cost teaching tool for basic science and clinical medicine, ultrasound improves patient care and safety and may decrease healthcare costs if qualified interpretation is performed [19]. Basic ultrasound training could begin in the first year of medical school as a complementary modality to the visual and haptic experience in anatomy and physiology courses [20]. Nevertheless, before students use ultrasound to visualize anatomy, they must learn the underlying physics and ultrasound imaging optimization termed “knobology” [21] [22], which is the term used to describe an understanding of the various buttons and knobs or touch screens that affect image quality during acquisition. Such knowledge makes it easier to understand why the images appear the way they do and how they can be adjusted and improved [23].

Regarding didactic approaches, the evolution from traditional time and process-based training concepts to competency-based ones has been considered a paradigm shift and a considerable challenge in recent years [14] [24]. Competency-based ultrasound education, meant to foster a student’s ability to perform ultrasound intuitively, yet with a structured technique, should begin early in medical school, with a longitudinal curriculum, which should continue throughout a physician’s university and professional careers [15] [16]. Early skill-based ultrasound education implies that significantly more practical skills and knowledge can be imparted, resulting in improved overall performance and ultrasound becoming a reliable, broadly applicable diagnostic tool [17] [25]. However, the main obstacles for introducing ultrasound courses in medical school are the limited curricular time due to many learning objectives and important study contents within the curriculum, the lack of adequately trained instructors, and the differences in the knowledge as well as practical experience of ultrasound instructors [8] [15] [25] [26].

The aim of this article series is to develop an ultrasound core curriculum. Such a core curriculum should be a step-by-step open access living document that is steadily improving and expanding.

The content of the ultrasound course should reflect the clinical topics and pathologies that are being taught in each semester.

Arriving at a consensus on a core curriculum will be difficult because of the many different disciplines, experiences, and opinions. This paper provides a discussion platform to allow input from universities, teachers, students, and regulatory bodies to debate these issues. The paper series is structured according to categories of controversies in SUSE.

1. This first part introduces the subject and provides a short history of student ultrasound education.

2. The second part discusses the role of teachers, students (including peer student teaching), and sonographers.

3. The third part deals with didactic structures, knowledge, simulation and skill evaluation (theoretical and practical examination of learning success), and certification.

4. The fourth part discusses learning materials and skills lab.

5. The fifth part examines the role of measurements and knowledge of reference values, teaching pathological findings during SUSE, ethical issues and misinterpretations.

Short history and review of the literature

Student ultrasound education (SUSE) was introduced over forty years ago at Hannover Medical School (MHH) and later at other medical schools including the universities of Liverpool, Vienna, and Bonn as a valuable teaching tool in courses including anatomy and physiology, as well as for teaching clinical knowledge and skills such as physical examination [1] [2] [3] [4] [5] [6]. There are good reasons for ultrasound to be regarded as a necessary component of diagnostic investigation for almost all patient presentations and therefore, it could be classified as essential clinical competency in medical education [4] [7].

In German-speaking countries, ultrasound is mainly performed by clinicians (clinical ultrasound “CLINUS”) following the anamnesis (history taking) and clinical exam an approach that is gaining more attention. Clinical ultrasound has been called “point-of-care ultrasound” in many Anglo-American countries, as the ultrasound results combined with other clinical information during initial patient consultation can assist with the diagnosis and improve accuracy beyond the individual components [8] [9]. In contrast, an alternative approach used in several countries is to perform ultrasound as a separate investigation by a radiologist or sonographer with only limited information about the clinical setting.

In a study published in 2020, a questionnaire survey regarding ultrasound education was sent to medical universities from 17 European countries. Forty-six universities responded [27]. This study revealed that ultrasound was taught in 87% (40/46) of the responding universities, was being integrated into anatomy courses in only 17% (8/46), and was part of basic science courses in 35% (16/46). Practical ultrasound skills were taught in 56% (26/46) of the responding universities, followed by a practical exam in only 15% (7/46) of them. This demonstrates that although ultrasound is included in training at many European universities, it has already been integrated into preclinical subjects and made a compulsory part of the curriculum only in a few cases.

There is a global movement to adopt ultrasound curricula in medical schools [4]. One of the earliest published advanced ultrasound training programs for students was implemented by the School of Medicine at the University of South Carolina. The program started in 2006 and consists of an integrated ultrasound curriculum across all four years of medical school, essentially a longitudinal point-of-care “focused” ultrasound program [15] [25]. This program was particularly successful due to support from the medical school Dean, who was one of the initiatives main proponents. The short-term gain of competence and long-term learning success are the essential aspects of such curricula and are the subject of current research [28] [29].

EFSUMB and WFUMB position papers regarding students’ ultrasound training

Both international federations of ultrasound societies agree that ultrasound training should start during the undergraduate years in medical school. However, there are difficulties regarding the overcrowded curriculum and the lack of funding (the costs of ultrasound machines, teaching staff, etc.). Furthermore, defining a unified curriculum can prove to be complicated. Several recommendations of EFSUMB and WFUMB are in response to practical questions, which are summarized in the following paragraphs.

1. How can ultrasound be used in student training? There are two primary areas that are not mutually exclusive: ultrasound can be used in a preclinical setting as a tool to enhance student understanding of anatomy, physiology and pathology, and/or in a clinical setting in which students are taught how to use ultrasound effectively as a problem-solving tool in the diagnosis of different diseases, as well as the limits of ultrasound as a diagnostic test [4]. There is significant variability in the curricula regarding the number of hours (2–28 hours) and evaluation methods [4] [27]. In some universities, ultrasound education is included in the radiology curriculum. In others, there is a dedicated ultrasound education module, or it is included in or combined with clinical lectures (e.g., cardiology and angiology). Some include hands-on sessions, which are labor-intensive for the faculty, but this burden can be eased by peer-to-peer teaching.

2. How should ultrasound be taught and by whom? The classic methods include didactic presentations for large audiences, workshops, and hands-on training. However, an adequate number of hands-on hours is difficult to achieve due to the aforementioned lack of personnel, space, devices, and time, leaving the student dissatisfied and with poor image acquisition skills [3] [4]. Peer-to-peer teaching and a teach-the-teacher approach for hands-on training can be a solution to the limited availability of experienced faculty. It also has the advantage of a better connection between the student and the tutor and improvement of the tutor’s ultrasound skills through teaching [30] [31] [32]. Several studies demonstrated similar performance of students taught via the peer-to-peer approach versus classic faculty teaching [9] [33] [34] [35]. The classic approach of didactic presentations has the advantage that it can target large audiences, is an established methodology, does not need further funding from the university, and is appropriate, for instance, for teaching the fundamentals of ultrasound. Modern teaching methods include E-learning and the use of simulators. The former implies the development of electronic material that is easily accessible to students, ideally standardized, systematic, reproducible, and appropriate for structured teaching and learning purposes [3]. E-learning tools include video lectures, teleconferences, webinars, webcasts, e-books, and material posted on social media. Simulators can be used for training and evaluation during the objective structured clinical examination (OSCE) [36] [37]. However, they are quite expensive, with “standardized” virtual patients sometimes lacking accuracy and replication of the image acquisition skills required in the case of live humans [36].

3. Is hands-on ultrasound education needed? Hands-on ultrasound education is considered to be mandatory for students’ ultrasound training [3] [4] [13]. It is a critical component of learning and understanding the modality. It increases student motivation and is vital for developing spatial coordination. Ideally, it should be done one-on-one, but this is not always feasible. There is no conclusive data on the optimal tutor/trainee ratio although 1:4 is a commonly accepted rule. The tutor should be an experienced sonographer, which can be an obstacle. The teach-the-teacher approach followed by peer-to-peer approach has been successful in several settings and can be an option. There is no consensus regarding the duration of training.

4. What kind of ultrasound devices should be used? According to the WFUMB position paper, three types of ultrasound devices can be used for students’ ultrasound training [3]: Level 1 – hand-held devices (the size of a mobile phone or tablet) – used to answer focused clinical questions [38] [39]; Level 2 – mobile, cart-based systems with expanded capability compared with level 1 devices and with 2 probes and color Doppler integrated, which are also used for point-of-care ultrasound; and Level 3 – more expensive, high-resolution ultrasound systems with advanced capabilities and a selection of transducers, usually located in a separate room where the patient is brought for examination. These systems allow comprehensive examination of the patient. However, it is important to note that in the future any difference in capability between handheld and larger cart-based systems will decrease with technological advances and will likely disappear completely, thereby upsetting the loose guidelines proposed above. Digital ultrasound simulation is a new, probably more cost-efficient concept combining both approaches [40]. There are advantages to each type of device, and learners may benefit from using a combination of devices [41] [42] [43].

5. What should be included in an ultrasound curriculum? An ultrasound curriculum should include the following topics: [3] [4] [13]:

   • Anatomy and physiology: Ultrasound allows a better understanding of the topography, function, and relationships of adjacent organs. Dynamic visualization of moving structures or blood flow can demonstrate physiology. Knowledge regarding the normal anatomic ultrasound aspect is mandatory to recognize pathologic changes.

   • Examination technique: Each ultrasound examination requires certain movements and techniques dependent on the organ being scanned, including patient positioning, transducer placement, manipulation, and machine operation [44].

   • Knobology: Knobology refers to machine controls and operation, which differ slightly from machine to machine, even if they are conceptually similar. The controls operate image modification, activation of adjunct ultrasound techniques (i.e., Doppler, elastography), image acquisition, measurements, and more. Knowing how to use an ultrasound machine is an essential prerequisite to be able to perform ultrasound.

   • Terminology: Standardized terminology allows a comprehensible description with explicit wording of ultrasound images to clearly interpret and document the ultrasound examination. This includes description of the image (e.g., hyperechoic, anechoic), the display (e.g., indicator, leading edge), the plane (e.g., short, long, sagittal), or probe movements (e.g., sweep, rotate, compress).

   • Safety: Even if ultrasound is considered a safe method (no ionizing radiation), thermal and mechanical bioeffects can occur. Knowledge of the energy output display, how to modify these settings, and using it as low as reasonably achievable (ALARA) are components of safely performing ultrasound. Furthermore, infection prevention and disinfection precautions should be known and applied.

   • Relevant pathology: An overview of common pathologies prioritized based on clinical settings should also be included in the curriculum.

   • Knowledge regarding data storage and reporting: Correct documentation of the ultrasound examination and potential findings is essential to interpret changes in follow-up examinations. For this purpose, it is very important to know how to take and store ultrasound images as well as use correct terminology in the examination report.

6. What is the ideal course structure? [13] WFUMB and EFSUMB agree that ultrasound education should be available to all medical students. The proposed course structure includes a combination of online and hands-on learning for 1–3 months, which should begin as early in the curriculum as possible, including at least 40 hours during the early years. Study materials should be available to prepare students for hands-on training. In this regard, a large quantity of free downloadable E-learning materials are available on both the WFUMB and the EFSUMB websites, including the EFSUMB Course Book (ECB), the EFSUMB Course Book Student Edition (ECBSE) focusing on anatomy, topography, and examination technique, an Atlas on echoscopy, teaching videos on anatomy and examination technique (www.efsumb.org), the WFUMB Ultrasound book (www.wfumb.info), and WFUMB/EFSUMB webinars for students (www.wfumb.info/webinars). Before the course, a pre-course test is optional, and a post-course test is recommended. Hands-on ultrasound should also be started as early as possible, with different equipment, varying patient positions, and diverse ultrasound models (different body habitus, shape, comorbidities, prepared, and unprepared). The basic teaching content should be examination technique, anatomy (normal findings), safety issues, and standardized medical sonography terminology. Structured scanning is recommended, with optional access to common and frequent pathologies pertinent to the student’s skill level (real cases and simulators). Documentation techniques using the ultrasound machine as well as the procedure for reporting normal anatomy should be learned. In advanced training levels, students should practice fast vs. slow examinations and be able to perform supervised patient scanning in clinical settings. There should be a continuous assessment of theoretical and practical teaching.

7. What is the ideal method of assessment? WFUMB position paper [13]. Theoretical and practical competence in ultrasound should be assessed using standardized tools like the “Direct observation of procedural skills” test or “Objective structured clinical examinations” (OSCEs) as well as theory, knowledge, and image recognition evaluations [45] [46]. The use of simulators has been reported to be a successful tool for standardized assessment of certain sonographic competencies [43] [47].

Consensus statement of the Society for Ultrasound Medical Education (SUSME) [5]

The aim of SUSME, an academic society focusing exclusively on ultrasound in medical education, is to promote the use of ultrasound in medical education. Its goal is to benefit medical education by integrating ultrasound into medical schools. The recently published consensus included more than 150 experts who analyzed published data regarding student’s ultrasound education then recommended how it is to be best achieved.

The consensus statement refers to four domains: Domain 1: scope of consensus conference curriculum; Domain 2: rationale for curriculum; Domain 3: curriculum characteristics; and Domain 4: curricular content items.

Domains 1–3 include 28 statements that can serve as a guide for medical school curriculum directors. The most important statements refer to the need for an integrated ultrasound curriculum aimed at unifying separate areas of knowledge (statement D.1.1) since ultrasound is considered to be a core clinical competency for all graduates, regardless of specialty choice (statement D.1.2). The curriculum enhances the overall educational experience (statement D.2.8), and students enjoy learning ultrasound since they feel it enhances their education. Furthermore, students can readily learn basic ultrasound (statement D.2.9), a fact already proven by numerous studies [6]. Image integration into clinical settings requires clinical experience that will be further acquired after graduation. Statement D.3.1 refers to the fact that an “ultrasound curriculum should be the foundation for ultrasound training along a continuum of medical education from undergraduate through graduate to continuing medical education” [5]. Another vital statement (D.3.8) is that “the ultrasound curriculum enhances the learning of clinical sciences through the integration of ultrasound into clinical problem solving”. The ultrasound curriculum is based on evidence and expert opinion (statement D.3.12), consistent with recommendations and guidelines of well-established specialty organizations (statement D.3.13) and with recommendations and guidelines of regulatory bodies with significant ultrasound experience (statement D.3.14).

Domain 4 focuses on the content of the ultrasound curriculum for students. Of the 304 Domain 4 content items, 117 (38.5%) were strongly recommended. Among these were notions related to the basic physics of ultrasound; the fundamental principles of ultrasound and indications for B-mode ultrasound, M-mode ultrasound, Doppler mode ultrasound; the components, parts, types of ultrasound probes; probe storage, cleaning, and manipulation; image description; ultrasound terminology; machine adjustments; basic ultrasound artifacts; proper care for the patient during ultrasound examination; ultrasound description of different types of tissues; as well as a plethora of normal and pathological aspects.

Conclusion

EFSUMB, WFUMB, and SUSME agree that students’ undergraduate ultrasound education is valuable and should be started as soon as possible in an integrated curriculum where hands-on sessions should play a central role. Implementation should include modern teaching methods such as blended learning, peer-to-peer teaching, and simulation.

Horizontal and vertical curricular integration would allow students to achieve basic understanding of the main imaging techniques including US, CT, and MRI and of their relative value for various diagnoses and to attain a basic understanding of typical imaging findings in common diseases. Undergraduate ultrasound education is the basis for postgraduate ultrasound education, which should ideally continue throughout the medical career.

Ongoing societal changes leading to ever-rising health care costs, expanding elderly and vulnerable patient populations, coupled with increasing performance and time pressure on health care providers will drive change and adaptation in medical education. Therefore, cost-effective, low-risk and high-yield diagnostic methods like ultrasound should be implemented into the core curriculum whenever possible.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Dietrich CF, Bolondi L, Duck F. et al. History of Ultrasound in Medicine from its birth to date (2022), on occasion of the 50 Years Anniversary of EFSUMB. A publication of the European Federation of Societies for Ultrasound In Medicine and Biology (EFSUMB), designed to record the historical development of medical ultrasound. Med Ultrason 2022; 24: 434-450
• 2 Dietrich CF, Bulla P, Dudwiesus H. et al. [Perspectives and Challenges of hand-held Ultrasound]. Z Gastroenterol 2022;
• 3 Dietrich CF, Hoffmann B, Abramowicz J. et al. Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. Ultrasound Med Biol 2019; 45: 271-281
• 4 Cantisani V, Dietrich CF, Badea R. et al. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2: E2-7
• 5 Hoppmann RA, Mladenovic J, Melniker L. et al. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14: 31
• 6 Davis JJ, Wessner CE, Potts J. et al. Ultrasonography in Undergraduate Medical Education: A Systematic Review. J Ultrasound Med 2018; 37: 2667-2679
• 7 Feilchenfeld Z, Dornan T, Whitehead C. et al. Ultrasound in undergraduate medical education: a systematic and critical review. Med Educ 2017; 51: 366-378
• 8 Kenny EJG, Makwana HN, Thankachan M. et al. The Use of Ultrasound in Undergraduate Medical Anatomy Education: a Systematic Review with Narrative Synthesis. Med Sci Educ 2022; 32: 1195-1208
• 9 Duarte ML, Santos LRD, Iared W. et al. Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review. Sao Paulo Med J 2022; 140: 806-817
• 10 DeBiasio C, Pageau P, Shefrin A. et al. Point-of-Care-ultrasound in undergraduate medical education: a scoping review of assessment methods. Ultrasound J 2023; 15: 30
• 11 Tarique U, Tang B, Singh M. et al. Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review. J Ultrasound Med 2018; 37: 69-82
• 12 Birrane J, Misran H, Creaney M. et al. A scoping review of ultrasound teaching in undergraduate medical education. Medical Science Educator 2018; 28: 45-56
• 13 Hoffmann B, Blaivas M, Abramowicz J. et al. Medical Student Ultrasound Education, a WFUMB Position Paper, Part II. A consensus statement of ultrasound societies. Med Ultrason 2020; 22: 220-229
• 14 Cook T, Hunt P, Hoppman R. Emergency medicine leads the way for training medical students in clinician-based ultrasound: a radical paradigm shift in patient imaging. Acad Emerg Med 2007; 14: 558-561
• 15 Hoppmann RA, Rao VV, Poston MB. et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011; 3: 1-12
• 16 Hoppmann R, Cook T, Hunt P. et al. Ultrasound in medical education: a vertical curriculum at the University of South Carolina School of Medicine. J S C Med Assoc 2006; 102: 330-334
• 17 Dinh VA, Lakoff D, Hess J. et al. Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States. J Ultrasound Med 2016; 35: 421-434
• 18 Dietrich CF, Fraser AG, Dong Y. et al. Managing Incidental Findings Reported by Medical, Sonography and Other Students Performing Educational Ultrasound Examinations. Ultrasound Med Biol 2022; 48: 180-187
• 19 Lentz B, Fong T, Rhyne R. et al. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound J 2021; 13: 16
• 20 Jurjus RA, Dimorier K, Brown K. et al. Can anatomists teach living anatomy using ultrasound as a teaching tool?. Anat Sci Educ 2014; 7: 340-349
• 21 Zander D, Huske S, Hoffmann B. et al. Ultrasound Image Optimization (“Knobology”): B-Mode. Ultrasound Int Open 2020; 6: E14-E24
• 22 Lowe A, Jenssen C, Huske S. et al. “Knobology” in Doppler Ultrasound. Med Ultrason 2021; 23: 480-486
• 23 Zervides C, Kefala-Karli P, Sassis L. Importance of Ultrasound Education in Undergraduate Medical Curriculum: A Survey Study Based on First-Year Medical Students’ Perception of the 6-Year Doctor of Medicine Program of the University of Nicosia Medical School in Cyprus. Ultrasound Q 2020; 36: 328-332
• 24 Hoppmann RA, Riley R, Fletcher S. et al. First World Congress on ultrasound in medical education hosted by the University of South Carolina School of Medicine. J S C Med Assoc 2011; 107: 189-190
• 25 Hoppmann RA, Rao VV, Bell F. et al. The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Crit Ultrasound J 2015; 7: 18
• 26 Hoppmann R, Michell W, Carter J. et al. Ultrasound in second year pathology medical education. J SC Acad Sci 2008; 7: 11-12
• 27 Prosch H, Radzina M, Dietrich CF. et al. Ultrasound Curricula of Student Education in Europe: Summary of the Experience. Ultrasound Int Open 2020; 6: E25-E33
• 28 Nourkami-Tutdibi N, Tutdibi E, Schmidt S. et al. Long-Term Knowledge Retention after Peer-Assisted Abdominal Ultrasound Teaching: Is PAL a Successful Model for Achieving Knowledge Retention?. Ultraschall Med 2020; 41: 36-43
• 29 Weimer JM, Widmer N, Strelow KU. et al. Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School – A Prospective Study. Tomography 2023; 9: 1315-1328
• 30 Rong K, Lee G, Herbst MK. Effectiveness of Near-Peer Versus Faculty Point-of-Care Ultrasound Instruction to Third-Year Medical Students. POCUS J 2022; 7: 239-244
• 31 Hari R, Caprez R, Dolmans D. et al. Describing Ultrasound Skills Teaching by Near-Peer and Faculty Tutors Using Cognitive Apprenticeship. Teach Learn Med 2022; 1-10
• 32 Tanveer MA, Mildestvedt T, Skjaerseth IG. et al. Peer Teaching in Undergraduate Medical Education: What are the Learning Outputs for the Student-Teachers? A Systematic Review. Adv Med Educ Pract 2023; 14: 723-739
• 33 Knobe M, Munker R, Sellei RM. et al. Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound. Med Educ 2010; 44: 148-155
• 34 Celebi N, Zwirner K, Lischner U. et al. Student tutors are able to teach basic sonographic anatomy effectively – a prospective randomized controlled trial. Ultraschall Med 2012; 33: 141-145
• 35 Vallee A, Blacher J, Cariou A. et al. Blended Learning Compared to Traditional Learning in Medical Education: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22: e16504
• 36 Konge L, Albrecht-Beste E, Nielsen MB. Virtual-reality simulation-based training in ultrasound. Ultraschall Med 2014; 35: 95-97
• 37 Lewiss RE, Hoffmann B, Beaulieu Y. et al. Point-of-care ultrasound education: the increasing role of simulation and multimedia resources. J Ultrasound Med 2014; 33: 27-32
• 38 Mirabel M, Celermajer D, Beraud AS. et al. Pocket-sized focused cardiac ultrasound: strengths and limitations. Arch Cardiovasc Dis 2015; 108: 197-205
• 39 Piscaglia FDC, Nolsoe C, Gilja OH. et al. Birth of echoscopy: The EFSUMB point of view. Ultraschall Med 2013; 34 (01) 92
• 40 Blank V, Strobel D, Karlas T. Digital Training Formats in Ultrasound Diagnostics for physicians: What options are available and how can they be successfully integrated into current DEGUM certified course concepts?. Ultraschall Med 2022; 43: 428-434
• 41 Dietrich CF, Lucius C, Nielsen MB. et al. The ultrasound use of simulators, current view, and perspectives: Requirements and technical aspects (WFUMB state of the art paper). Endosc Ultrasound 2023; 12: 38-49
• 42 Lucius C, Koch J, Jenssen C. et al. State of the art: Simulation in der Ultraschallausbildung. Z Gastroenterol 2023;
• 43 Lucius C, Nielsen MB, Blaivas M. et al. The use of simulation in medical ultrasound: Current perspectives on applications and practical implementation (WFUMB state-of-the-art paper). Endosc Ultrasound 2023; 12: 311-318
• 44 Bahner DP, Hughes D, Royall NA. I-AIM: a novel model for teaching and performing focused sonography. J Ultrasound Med 2012; 31: 295-300
• 45 Hohne E, Recker F, Dietrich CF. et al. Assessment Methods in Medical Ultrasound Education. Front Med (Lausanne) 2022; 9: 871957
• 46 Neubauer R, Bauer CN, Dietrich CF. et al. Evidence-based ultrasound education? - An analysis of undergraduate ultrasound training studies. UIO 2024 (in press).
• 47 Lucius C, Koch JBH, Jenssen C. et al. State of the art: Simulation in der Ultraschallausbildung [State of the art: Simulation in US]. Z Gastroenterol 2024, in press.

Publication History

Received: 07 January 2024

Accepted: 05 February 2024

Article published online:
14 March 2024