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Introduction of Ultrasound into Gross Anatomy Curriculum: Perceptions of Medical Students
The Journal of Emergency Medicine, Vol. 43, No. 6, pp. 1098–1102, 2012 Copyright Ó 2012 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
doi:10.1016/j.jemermed.2012.01.041
Education INTRODUCTION OF ULTRASOUND INTO GROSS ANATOMY CURRICULUM: PERCEPTIONS OF MEDICAL STUDENTS Bart Brown, MD,* Srikar Adhikari, MD, MS, RDMS,† Jared Marx, MD,‡ Lina Lander, SCD,§ and Gordon L. Todd, PHDjj *Department of Emergency Medicine, St. Mary’s Medical Center, Evansville, Indiana, †Department of Emergency Medicine, University of Arizona Health Sciences Center, Tucson, Arizona, ‡Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas, §Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, and jjDepartment of Genetics, Cell Biology & Anatomy, University of Nebraska Medical Center, Omaha, Nebraska Reprint Address: Srikar Adhikari, MD, MS, RDMS, Department of Emergency Medicine, University of Arizona Health Sciences Center, PO Box 245057, Tucson, AZ 85724-5057
, Abstract—Background: The exposure to ultrasound technology during medical school education is highly variable across institutions. Objectives: The objectives of this study were to assess medical students’ perceptions of ultrasound use to teach Gross Anatomy along with traditional teaching methods, and determine their ability to identify sonographic anatomy after focused didactic sessions. Methods: Prospective observational study. Phase I of the study included three focused ultrasound didactic sessions integrated into Gross Anatomy curriculum. During Phase II, first-year medical students completed a questionnaire. Results: One hundred nine subjects participated in this study; 96% (95% confidence interval [CI] 92–99%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods. Ninety-two percent (95% CI 87–97%) indicated that ultrasound-based teaching increases confidence to perform invasive procedures in the future. Ninety-one percent (95% CI 85–96%) believed that it is feasible to integrate ultrasound into the current Anatomy curriculum. Ninety-eight percent (95% CI 95–100%) of medical students accurately identified vascular structures on ultrasound images of normal anatomy of the neck. On a scale of 1 to 10, the average confidence level reported in interpreting the images was 7.4 (95% CI 7.1–7.7). Overall, 94% (95% CI 91–99%)
accurately answered questions about ultrasound fundamentals and sonographic anatomy. Conclusions: The majority of medical students believed that it is feasible and beneficial to use ultrasound in conjunction with traditional teaching methods to teach Gross Anatomy. Medical students were very accurate in identifying sonographic vascular anatomy of the neck after brief didactic sessions. Ó 2012 Elsevier Inc. , Keywords—Gross Anatomy; ultrasound; medical students; sonographic anatomy
INTRODUCTION The use of bedside ultrasound by clinicians has greatly expanded across medical specialties over the past few decades. This rapid, non-invasive imaging tool is increasingly being used for both diagnostic purposes and procedural guidance. Recent advances in technology have resulted in a dramatic decrease in size of the ultrasound machines. The portability of compact ultrasound systems has made the technology readily accessible for bedside use in both inpatient and outpatient settings. The utilization of bedside ultrasound by an increasing number of medical specialties creates the need for more ultrasound exposure and teaching at the medical student level. However, medical students typically have minimal to no formal teaching in the use of ultrasound.
This work was presented as an Abstract at the Society of Academic Emergency Medicine annual meeting, Phoenix, AZ, June 2010.
RECEIVED: 18 April 2011; FINAL SUBMISSION RECEIVED: 26 July 2011; ACCEPTED: 22 January 2012 1098
Ultrasound to Teach Gross Anatomy
Figure 1. B-mode image of internal jugular vein (IJV) and carotid artery (CA) in sternocleidomastoid (SCM) muscle triangle (transverse view).
Currently, a majority of medical schools rely on clerkship experiences to teach ultrasound skills to medical students (1). The integration of ultrasound education into the medical school curriculum is slowly evolving. At present, the exposure to ultrasound technology during medical school training is highly variable across the institutions. Some institutions have begun to integrate a vertical ultrasound curriculum into their medical school curriculum that includes both didactics and hands-on training sessions (2–4). In many institutions the curriculum is usually limited to review of a few ultrasound images during their anatomy course. We believe that ultrasonography is a useful adjunct to the traditional teaching methods, such as cadaver laboratories, in teaching Gross Anatomy. The objectives of this study were to assess medical students’ perceptions of ultrasound use to teach Gross Anatomy along with traditional teaching methods, and determine medical students’ ability to identify sonographic neck anatomy after focused didactic sessions. METHODS Study Design and Population This prospective observational study was conducted at an academic medical center between September and December 2009. The study was approved by the Institutional Review Board (IRB). IRB-approved verbal consent process was followed to enroll subjects. All first-year medical students enrolled in Gross Anatomy class were eligible to participate in this study. Study Protocol The study was conducted in two phases. Phase I included three focused ultrasound didactic sessions integrated into
1099
Gross Anatomy curriculum. The three 20-min didactic sessions were delivered over a 2-month period for the first-year medical students by three of the investigators with expertise in ultrasound. The PowerPoint (Microsoft Corporation, Redmond, WA) presentations were made available to medical students via the Blackboard Academic Suite (Blackboard Inc., Washington, DC). The educational elements included ultrasound fundamentals, sonographic anatomy of the neck, anatomical variations, and ultrasound-guided procedural skills. The ultrasound didactic sessions were coordinated with cadaver laboratories during the course section devoted to neck anatomy. Ultrasound images (Figure 1) and video clips were reviewed in the didactic sessions to familiarize medical students with the ultrasound system, expose them to sonographic anatomy, and provide a foundation for performing ultrasound-guided procedures in future clinical practice. During Phase II of the study, medical students were asked to complete a questionnaire. The questionnaire was developed based on current literature using standard survey methods. Three emergency physicians with expertise in ultrasound reviewed the questionnaire for face validity, relevance, and clarity. A five-point Likert scale was used to assess agreement with statements regarding the learning experience. Fourteen specific questions addressing medical student’s perceptions of the integration of ultrasound teaching into their Gross Anatomy curriculum were included in the questionnaire. The questionnaire also contained questions to assess the student’s comprehension of the ultrasound fundamentals and ability to accurately interpret ultrasound images of vascular structures in the neck. Participation in this study was voluntary and had no bearing on a student’s standing in the course. A verbal consent was obtained from the medical students before administering the questionnaires. The questionnaires were administered and collected anonymously to protect students’ confidentiality. The percentage of questionnaires returned was tracked. One research assistant blinded to the study hypothesis entered all questionnaire data into an Excel database (Microsoft). To assess the accuracy of data entry, a randomly sampled 20% of questionnaires were reentered by one of the investigators. Measures The primary outcomes were medical students’ perceptions of ultrasound use for Gross Anatomy teaching. The secondary outcomes were accuracy of medical students in interpreting ultrasound images of vascular structures in the neck and answering questions related to ultrasound principles and sonographic anatomy. The accuracy was determined based on the responses
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provided to questions in the questionnaire. Ultrasound image acquisition skills were not evaluated in this study. Data Analysis Descriptive analyses were performed using SAS software (SAS Institute Inc., Cary, NC). Questionnaire responses were reported as percentage of total respondents, along with 95% confidence intervals (CI). Continuous data were presented as means with SDs. RESULTS One hundred nine first-year medical students participated in this study. The questionnaire response rate was 91%. Data reentry by a second investigator showed 100% agreement. The majority of medical students (96%, 95% CI 92–99%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods. Ninety-six percent (95% CI 92–99%) felt that ultrasound is a useful adjunct in effectively demonstrating anatomical variations. An overwhelming number of medical students (99%, 95% CI 97–100%) agreed that it was beneficial to learn ultrasound-based anatomy in addition to the traditional methods of teaching. Ninety-two percent (95% CI 87– 97%) indicated that ultrasound-based teaching increases confidence to perform invasive procedures in the future. Ninety-one percent (95% CI 85–96%) felt it is feasible to integrate ultrasound into the current Anatomy curriculum. Ninety-eight percent (95% CI 95–100%) expressed interest in learning focused scanning if the ultrasound equipment and expertise were available. The most common barriers reported for the use of ultrasound to teach Gross Anatomy were inadequate allocation of time for ultrasound-based teaching in the Anatomy curriculum (68%, 95% CI 59–76%) and lack of ultrasound equipment in the Anatomy department (87%, 95% CI 80–93%). Ninety-eight percent (95% CI 95–100%) of medical students accurately identified vascular structures on sonographic images of normal anatomy of the neck. On a scale of 1 to 10, the average confidence level reported in interpreting the images was 7.4 (95% CI 7.1–7.7). Approximately three-fourths (76%, 95% CI 70–84%) of the medical students reported no difficulty recognizing vascular structures. Overall, 94% (95% CI 91–99%) accurately answered questions about ultrasound fundamentals and sonographic anatomy.
anatomy with ultrasound can augment the student’s knowledge of anatomy acquired through traditional teaching methods while improving understanding of the clinical relevance of anatomical principles. Ultrasoundbased anatomy instruction can also potentially increase the student’s confidence in their ability to perform invasive procedures during residency training. Prior studies have shown that basic ultrasound concepts can be effectively taught to medical students using short training courses (5). The use of ultrasound as an adjunct to traditional teaching methods has been shown to improve medical students’ physical examination skills (6,7). Decara and colleagues demonstrated that it was feasible for medical students to use hand-carried ultrasound devices, and their use led to significantly more accurate bedside diagnoses (8). In a study done by Teichgraber et al., hands-on ultrasound workshops performed by medical students were successfully integrated into an Anatomy course (9). In our study, the majority of first-year medical students found ultrasound didactic sessions to be very effective in teaching Gross Anatomy. There was a strong agreement among medical students with the statement that it is beneficial to supplement traditional teaching methods with ultrasound. The medical students have indicated that they would like to gain experience in focused hands-on scanning and suggested that they were very interested in learning more about ultrasound skills. Additionally, medical students performed exceedingly well in ultrasound image interpretation and answering questions covering basic ultrasound principles. This suggests that they can satisfactorily comprehend and apply ultrasound principles after short focused training sessions. Our questionnaire responses indicated that students were enthusiastic about ultrasound technology and believed that they were benefiting from participating in the ultrasound didactic sessions. The real-time and dynamic anatomic evaluation with ultrasonography appeals to the current generation of medical students because it is technologically advanced compared to traditional static teaching methods (10). Our study findings indicated that students were receptive to establishing an ultrasound-based adjunct curriculum, and believed it will aid in their confidence to perform invasive procedures in the future. Our study also provided insights into medical students’ perception of barriers to ultrasound-based anatomy teaching, which can be used to integrate ultrasound into medical school curriculum. Our results strongly support the integration of ultrasonography into the medical school curriculum.
DISCUSSION Limitations The cost-effectiveness and portability of ultrasound make it an ideal tool to supplement traditional methods of Gross Anatomy instruction in medical school. Demonstration of
There were several methodological limitations, including a small sample size. As with any survey study, results are
Ultrasound to Teach Gross Anatomy
dependent on the validity of the self-reported data. The media resources of the Anatomy department at our institution may not approximate that of their cohorts in other locations. Our study was limited to teaching sonographic neck anatomy, and it will be useful to know if student perceptions of the use of ultrasound technology to learn anatomy of other regions would be as equally positive. Another limitation was the amount of time available for the ultrasound didactic sessions secondary to many didactic requirements of the first-year medical students during their Gross Anatomy course. We did not evaluate longterm retention of ultrasound concepts taught during focused didactic sessions. We also did not look at the overall impact of early ultrasound exposure within medical school education. Future studies could focus on the long-term benefits related to patient care from early exposure to ultrasound technology during medical school training. CONCLUSIONS The majority of medical students felt that it is feasible and beneficial to use ultrasound in conjunction with traditional teaching methods to teach Gross Anatomy. Medical students were very accurate in identifying sonographic vascular anatomy of the neck after brief didactic sessions.
1101
REFERENCES 1. Fox JC, Cusick S, Scruggs W, et al. Educational assessment of medical student rotation in emergency ultrasound. West J Emerg Med 2007;8:84–7. 2. 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;102:330–4. 3. 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: 558–61. 4. 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. J Ultrasound Med 2008;27:745–9. 5. Yoo MC, Villegas L, Jones DB. Basic ultrasound curriculum for medical students: validation of content and phantom. J Laparoendosc Adv Surg Tech A 2004;14:374–9. 6. Butter J, Grant TH, Egan M, et al. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination? Med Educ 2007;41:843–8. 7. Barloon TJ, Brown BP, Abu-Yousef MM, et al. Teaching physical examination of the adult liver with use of real-time sonography. Acad Radiol 1998;5:101–3. 8. Decara JM, Kirkpatrick JN, Spencer KT, et al. Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses. J Am Soc Echocardiogr 2005;18:257–63. 9. Teichgra¨ber UK, Meyer JM. Poulsen Nautrup C, von Rautenfeld DB. Ultrasound anatomy: a practical teaching system in human gross anatomy. Med Educ 1996;30:296–8. 10. Ivanusic J, Cowie B, Barrington M. Undergraduate student perceptions of the use of ultrasonography in the study of ‘‘living anatomy’’ Anat Sci Educ 2010;3:318–22.
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B. Brown et al.
ARTICLE SUMMARY 1. Why is this topic important? The increasing use of bedside ultrasound by different medical specialties creates the need for more ultrasound education at the medical student level. Currently, medical students receive minimal to no formal training in the use of bedside ultrasound. 2. What does this study attempt to show? This study attempts to assess perceptions of the medical students of ultrasound use to teach Gross Anatomy in conjunction with traditional teaching methods, and determine their ability to recognize sonographic anatomy after focused didactic sessions. 3. What are the key findings? A majority of medical students (96%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods and is a useful adjunct in effectively demonstrating anatomical variations. Most of the medical students (>90%) indicated that it is feasible to integrate ultrasound into the current Anatomy curriculum and increases confidence to perform invasive procedures in the future. Overall, a majority (98%) of medical students accurately identified sonographic vascular anatomy of the neck. 4. How is patient care impacted? Medical student ultrasound education will ultimately improve patient care by increasing their confidence and ability to use bedside ultrasound in their daily clinical practice.
doi:10.1016/j.jemermed.2012.01.041
Education INTRODUCTION OF ULTRASOUND INTO GROSS ANATOMY CURRICULUM: PERCEPTIONS OF MEDICAL STUDENTS Bart Brown, MD,* Srikar Adhikari, MD, MS, RDMS,† Jared Marx, MD,‡ Lina Lander, SCD,§ and Gordon L. Todd, PHDjj *Department of Emergency Medicine, St. Mary’s Medical Center, Evansville, Indiana, †Department of Emergency Medicine, University of Arizona Health Sciences Center, Tucson, Arizona, ‡Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas, §Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, and jjDepartment of Genetics, Cell Biology & Anatomy, University of Nebraska Medical Center, Omaha, Nebraska Reprint Address: Srikar Adhikari, MD, MS, RDMS, Department of Emergency Medicine, University of Arizona Health Sciences Center, PO Box 245057, Tucson, AZ 85724-5057
, Abstract—Background: The exposure to ultrasound technology during medical school education is highly variable across institutions. Objectives: The objectives of this study were to assess medical students’ perceptions of ultrasound use to teach Gross Anatomy along with traditional teaching methods, and determine their ability to identify sonographic anatomy after focused didactic sessions. Methods: Prospective observational study. Phase I of the study included three focused ultrasound didactic sessions integrated into Gross Anatomy curriculum. During Phase II, first-year medical students completed a questionnaire. Results: One hundred nine subjects participated in this study; 96% (95% confidence interval [CI] 92–99%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods. Ninety-two percent (95% CI 87–97%) indicated that ultrasound-based teaching increases confidence to perform invasive procedures in the future. Ninety-one percent (95% CI 85–96%) believed that it is feasible to integrate ultrasound into the current Anatomy curriculum. Ninety-eight percent (95% CI 95–100%) of medical students accurately identified vascular structures on ultrasound images of normal anatomy of the neck. On a scale of 1 to 10, the average confidence level reported in interpreting the images was 7.4 (95% CI 7.1–7.7). Overall, 94% (95% CI 91–99%)
accurately answered questions about ultrasound fundamentals and sonographic anatomy. Conclusions: The majority of medical students believed that it is feasible and beneficial to use ultrasound in conjunction with traditional teaching methods to teach Gross Anatomy. Medical students were very accurate in identifying sonographic vascular anatomy of the neck after brief didactic sessions. Ó 2012 Elsevier Inc. , Keywords—Gross Anatomy; ultrasound; medical students; sonographic anatomy
INTRODUCTION The use of bedside ultrasound by clinicians has greatly expanded across medical specialties over the past few decades. This rapid, non-invasive imaging tool is increasingly being used for both diagnostic purposes and procedural guidance. Recent advances in technology have resulted in a dramatic decrease in size of the ultrasound machines. The portability of compact ultrasound systems has made the technology readily accessible for bedside use in both inpatient and outpatient settings. The utilization of bedside ultrasound by an increasing number of medical specialties creates the need for more ultrasound exposure and teaching at the medical student level. However, medical students typically have minimal to no formal teaching in the use of ultrasound.
This work was presented as an Abstract at the Society of Academic Emergency Medicine annual meeting, Phoenix, AZ, June 2010.
RECEIVED: 18 April 2011; FINAL SUBMISSION RECEIVED: 26 July 2011; ACCEPTED: 22 January 2012 1098
Ultrasound to Teach Gross Anatomy
Figure 1. B-mode image of internal jugular vein (IJV) and carotid artery (CA) in sternocleidomastoid (SCM) muscle triangle (transverse view).
Currently, a majority of medical schools rely on clerkship experiences to teach ultrasound skills to medical students (1). The integration of ultrasound education into the medical school curriculum is slowly evolving. At present, the exposure to ultrasound technology during medical school training is highly variable across the institutions. Some institutions have begun to integrate a vertical ultrasound curriculum into their medical school curriculum that includes both didactics and hands-on training sessions (2–4). In many institutions the curriculum is usually limited to review of a few ultrasound images during their anatomy course. We believe that ultrasonography is a useful adjunct to the traditional teaching methods, such as cadaver laboratories, in teaching Gross Anatomy. The objectives of this study were to assess medical students’ perceptions of ultrasound use to teach Gross Anatomy along with traditional teaching methods, and determine medical students’ ability to identify sonographic neck anatomy after focused didactic sessions. METHODS Study Design and Population This prospective observational study was conducted at an academic medical center between September and December 2009. The study was approved by the Institutional Review Board (IRB). IRB-approved verbal consent process was followed to enroll subjects. All first-year medical students enrolled in Gross Anatomy class were eligible to participate in this study. Study Protocol The study was conducted in two phases. Phase I included three focused ultrasound didactic sessions integrated into
1099
Gross Anatomy curriculum. The three 20-min didactic sessions were delivered over a 2-month period for the first-year medical students by three of the investigators with expertise in ultrasound. The PowerPoint (Microsoft Corporation, Redmond, WA) presentations were made available to medical students via the Blackboard Academic Suite (Blackboard Inc., Washington, DC). The educational elements included ultrasound fundamentals, sonographic anatomy of the neck, anatomical variations, and ultrasound-guided procedural skills. The ultrasound didactic sessions were coordinated with cadaver laboratories during the course section devoted to neck anatomy. Ultrasound images (Figure 1) and video clips were reviewed in the didactic sessions to familiarize medical students with the ultrasound system, expose them to sonographic anatomy, and provide a foundation for performing ultrasound-guided procedures in future clinical practice. During Phase II of the study, medical students were asked to complete a questionnaire. The questionnaire was developed based on current literature using standard survey methods. Three emergency physicians with expertise in ultrasound reviewed the questionnaire for face validity, relevance, and clarity. A five-point Likert scale was used to assess agreement with statements regarding the learning experience. Fourteen specific questions addressing medical student’s perceptions of the integration of ultrasound teaching into their Gross Anatomy curriculum were included in the questionnaire. The questionnaire also contained questions to assess the student’s comprehension of the ultrasound fundamentals and ability to accurately interpret ultrasound images of vascular structures in the neck. Participation in this study was voluntary and had no bearing on a student’s standing in the course. A verbal consent was obtained from the medical students before administering the questionnaires. The questionnaires were administered and collected anonymously to protect students’ confidentiality. The percentage of questionnaires returned was tracked. One research assistant blinded to the study hypothesis entered all questionnaire data into an Excel database (Microsoft). To assess the accuracy of data entry, a randomly sampled 20% of questionnaires were reentered by one of the investigators. Measures The primary outcomes were medical students’ perceptions of ultrasound use for Gross Anatomy teaching. The secondary outcomes were accuracy of medical students in interpreting ultrasound images of vascular structures in the neck and answering questions related to ultrasound principles and sonographic anatomy. The accuracy was determined based on the responses
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B. Brown et al.
provided to questions in the questionnaire. Ultrasound image acquisition skills were not evaluated in this study. Data Analysis Descriptive analyses were performed using SAS software (SAS Institute Inc., Cary, NC). Questionnaire responses were reported as percentage of total respondents, along with 95% confidence intervals (CI). Continuous data were presented as means with SDs. RESULTS One hundred nine first-year medical students participated in this study. The questionnaire response rate was 91%. Data reentry by a second investigator showed 100% agreement. The majority of medical students (96%, 95% CI 92–99%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods. Ninety-six percent (95% CI 92–99%) felt that ultrasound is a useful adjunct in effectively demonstrating anatomical variations. An overwhelming number of medical students (99%, 95% CI 97–100%) agreed that it was beneficial to learn ultrasound-based anatomy in addition to the traditional methods of teaching. Ninety-two percent (95% CI 87– 97%) indicated that ultrasound-based teaching increases confidence to perform invasive procedures in the future. Ninety-one percent (95% CI 85–96%) felt it is feasible to integrate ultrasound into the current Anatomy curriculum. Ninety-eight percent (95% CI 95–100%) expressed interest in learning focused scanning if the ultrasound equipment and expertise were available. The most common barriers reported for the use of ultrasound to teach Gross Anatomy were inadequate allocation of time for ultrasound-based teaching in the Anatomy curriculum (68%, 95% CI 59–76%) and lack of ultrasound equipment in the Anatomy department (87%, 95% CI 80–93%). Ninety-eight percent (95% CI 95–100%) of medical students accurately identified vascular structures on sonographic images of normal anatomy of the neck. On a scale of 1 to 10, the average confidence level reported in interpreting the images was 7.4 (95% CI 7.1–7.7). Approximately three-fourths (76%, 95% CI 70–84%) of the medical students reported no difficulty recognizing vascular structures. Overall, 94% (95% CI 91–99%) accurately answered questions about ultrasound fundamentals and sonographic anatomy.
anatomy with ultrasound can augment the student’s knowledge of anatomy acquired through traditional teaching methods while improving understanding of the clinical relevance of anatomical principles. Ultrasoundbased anatomy instruction can also potentially increase the student’s confidence in their ability to perform invasive procedures during residency training. Prior studies have shown that basic ultrasound concepts can be effectively taught to medical students using short training courses (5). The use of ultrasound as an adjunct to traditional teaching methods has been shown to improve medical students’ physical examination skills (6,7). Decara and colleagues demonstrated that it was feasible for medical students to use hand-carried ultrasound devices, and their use led to significantly more accurate bedside diagnoses (8). In a study done by Teichgraber et al., hands-on ultrasound workshops performed by medical students were successfully integrated into an Anatomy course (9). In our study, the majority of first-year medical students found ultrasound didactic sessions to be very effective in teaching Gross Anatomy. There was a strong agreement among medical students with the statement that it is beneficial to supplement traditional teaching methods with ultrasound. The medical students have indicated that they would like to gain experience in focused hands-on scanning and suggested that they were very interested in learning more about ultrasound skills. Additionally, medical students performed exceedingly well in ultrasound image interpretation and answering questions covering basic ultrasound principles. This suggests that they can satisfactorily comprehend and apply ultrasound principles after short focused training sessions. Our questionnaire responses indicated that students were enthusiastic about ultrasound technology and believed that they were benefiting from participating in the ultrasound didactic sessions. The real-time and dynamic anatomic evaluation with ultrasonography appeals to the current generation of medical students because it is technologically advanced compared to traditional static teaching methods (10). Our study findings indicated that students were receptive to establishing an ultrasound-based adjunct curriculum, and believed it will aid in their confidence to perform invasive procedures in the future. Our study also provided insights into medical students’ perception of barriers to ultrasound-based anatomy teaching, which can be used to integrate ultrasound into medical school curriculum. Our results strongly support the integration of ultrasonography into the medical school curriculum.
DISCUSSION Limitations The cost-effectiveness and portability of ultrasound make it an ideal tool to supplement traditional methods of Gross Anatomy instruction in medical school. Demonstration of
There were several methodological limitations, including a small sample size. As with any survey study, results are
Ultrasound to Teach Gross Anatomy
dependent on the validity of the self-reported data. The media resources of the Anatomy department at our institution may not approximate that of their cohorts in other locations. Our study was limited to teaching sonographic neck anatomy, and it will be useful to know if student perceptions of the use of ultrasound technology to learn anatomy of other regions would be as equally positive. Another limitation was the amount of time available for the ultrasound didactic sessions secondary to many didactic requirements of the first-year medical students during their Gross Anatomy course. We did not evaluate longterm retention of ultrasound concepts taught during focused didactic sessions. We also did not look at the overall impact of early ultrasound exposure within medical school education. Future studies could focus on the long-term benefits related to patient care from early exposure to ultrasound technology during medical school training. CONCLUSIONS The majority of medical students felt that it is feasible and beneficial to use ultrasound in conjunction with traditional teaching methods to teach Gross Anatomy. Medical students were very accurate in identifying sonographic vascular anatomy of the neck after brief didactic sessions.
1101
REFERENCES 1. Fox JC, Cusick S, Scruggs W, et al. Educational assessment of medical student rotation in emergency ultrasound. West J Emerg Med 2007;8:84–7. 2. 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;102:330–4. 3. 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: 558–61. 4. 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. J Ultrasound Med 2008;27:745–9. 5. Yoo MC, Villegas L, Jones DB. Basic ultrasound curriculum for medical students: validation of content and phantom. J Laparoendosc Adv Surg Tech A 2004;14:374–9. 6. Butter J, Grant TH, Egan M, et al. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination? Med Educ 2007;41:843–8. 7. Barloon TJ, Brown BP, Abu-Yousef MM, et al. Teaching physical examination of the adult liver with use of real-time sonography. Acad Radiol 1998;5:101–3. 8. Decara JM, Kirkpatrick JN, Spencer KT, et al. Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses. J Am Soc Echocardiogr 2005;18:257–63. 9. Teichgra¨ber UK, Meyer JM. Poulsen Nautrup C, von Rautenfeld DB. Ultrasound anatomy: a practical teaching system in human gross anatomy. Med Educ 1996;30:296–8. 10. Ivanusic J, Cowie B, Barrington M. Undergraduate student perceptions of the use of ultrasonography in the study of ‘‘living anatomy’’ Anat Sci Educ 2010;3:318–22.
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B. Brown et al.
ARTICLE SUMMARY 1. Why is this topic important? The increasing use of bedside ultrasound by different medical specialties creates the need for more ultrasound education at the medical student level. Currently, medical students receive minimal to no formal training in the use of bedside ultrasound. 2. What does this study attempt to show? This study attempts to assess perceptions of the medical students of ultrasound use to teach Gross Anatomy in conjunction with traditional teaching methods, and determine their ability to recognize sonographic anatomy after focused didactic sessions. 3. What are the key findings? A majority of medical students (96%) agreed that ultrasound-based teaching increased students’ knowledge of anatomy acquired through traditional teaching methods and is a useful adjunct in effectively demonstrating anatomical variations. Most of the medical students (>90%) indicated that it is feasible to integrate ultrasound into the current Anatomy curriculum and increases confidence to perform invasive procedures in the future. Overall, a majority (98%) of medical students accurately identified sonographic vascular anatomy of the neck. 4. How is patient care impacted? Medical student ultrasound education will ultimately improve patient care by increasing their confidence and ability to use bedside ultrasound in their daily clinical practice.