- Email: [email protected]
Teaching clinical ultrasonography to undergraduates. A need for systematic training programs
Rev Clin Esp. 2015;215(4):219---220
Revista Clínica Española www.elsevier.es/rce
EDITORIAL
Teaching clinical ultrasonography to undergraduates. A need for systematic training programs La formación de estudiantes de pregrado en ecografía clínica. La necesidad de programas sistemáticos de formación
Bedside focused ultrasound use has increased dramatically as the demand for quick, efficient diagnostic bedside imaging has increased.1 Currently, focused bedside ultrasound is used to assist clinicians with diagnostic evaluations, invasive procedures and therapeutic interventions in multiple specialties.2 As a result of rapid technological advancement and miniaturization of devices, the development of uses and applicability in the various fields of medicine has outpaced the professional education of those practitioners who could use them. The skills of focused ultrasonography will need to be integrated into the medical educational process so future practitioners can keep pace with this steady innovation. Teaching ultrasound within medical school has experienced tremendous growth over the last few years as training programs have developed novel methods to integrate ultrasound teaching.3---5 Multiple schools have established integrated ultrasound programs where ultrasound is incorporated into all 4 years of training.3,4 Further, articles have described how ultrasound can be used to enhance the teaching of anatomy, physiology, physical examination and an introduction to clinical practice.6---9 Additionally, there have been reports on ultrasound as both one month and longitudinal electives.3,4,10,11 Though many medical schools acknowledge the importance of teaching focused ultrasound, the integration of ultrasound education is highly variable which may be due to a number of key barriers including lack of space in current curricula, lack of financial support, equipment and of trained faculty.12 In this issue of Rev Clin Esp, García de Casasola Sánchez et al. address the lack of trained faculty to instruct young practitioners in the use of focused bedside ultrasound.13 Authors have described their experience with teaching ultrasound by using peer mentors.13 Each of the peer mentors was a senior student with previous training in ultrasound that included a 5 h theoretical/practical course along with http://dx.doi.org/10.1016/j.rce.2015.01.009 0014-2565/© 2015 Published by Elsevier España, S.L.U.
20 supervised scans. The 20 scans were conducted over a 10-day period on clinical patients with active disease processes. These peers then had an objective evaluation of 5 scans to demonstrate proficiency. Peer mentors then trained 24 other medical students. These secondarily trained students underwent 10---15 h of online course material followed by 20 ultrasound examinations supervised by the ‘‘peer mentors’’ (total time 15 h). The authors discovered that the use of peer mentors to secondarily train their colleagues in basic cardiac and abdominal ultrasound was feasible. The majority of scans were rated as 2.78 ± 0.19 on a scale of 1---3 (1 = poor; 2 = regular; 3 = excellent). Interestingly, there was significant variability in the identification of key anatomical images by these students which was higher in the cardiac ultrasound views. This suggests that the training through peer mentors is feasible and imparts elementary knowledge, but may need to be augmented for long term practitioner success. We applaud the authors for investigating this important topic area. Previous work in this area has evaluated the use of peer mentors for ultrasound education and has demonstrated positive results.14---16 However, in comparison to this evaluation, peer mentors in these studies were extensively trained with either a full time elective for 2---4 weeks with didactics, video review and many proctored scans14---16 or had been involved in a one-year longitudinal ultrasound program with monthly didactics, online didactics and quizzes, journal club, monthly hands-on faculty sessions and clinical research.11 This study presents a streamlined system which would train senior students and thus allow for more available mentors to instruct junior students. Future studies will need to focus on (a) the optimal training paradigm to prepare peer to peer and near peer mentors for focused ultrasound teaching; (b) key curriculum components necessary for medical student teaching to maximize scan time versus didactic time, and (c) understanding the long term
220 knowledge retention of medical students following peer mentoring education compared to traditional teaching roles. As ultrasound continues to expand in the practice of medicine with multiple providers from multiple specialties, there will be a need for more systematic training programs. The faculty and personnel required to meet the demand will continue to grow and many times outstrip the current resources of a school or department. Near peer and peer to peer mentoring may be an alternative for this shortage of competent faculty. Focused ultrasound can be taught to medical students but takes a considerable investment in time and energy from the requisite faculty. It takes experts in focused ultrasound to be engaged in training these ‘‘peer mentors’’ to be able to convey this information to other novice learners. The authors have contributed to this growing body of knowledge of students serving as peer to peer and near peer mentoring in the effort to learn focused bedside ultrasound.13 This strategy can work, is feasible, and needs further study on how best to implement this student driven personnel strategy for ultrasound training.
References 1. Moore CL, Gregg S, Lambert M. Performance, training, quality assurance, and reimbursement of emergency physicianperformed ultrasonography at academic medical centers. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2004;23: 459---66. 2. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749---57. 3. Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J. 2011;3: 1---12. 4. Bahner DP, Adkins EJ, Hughes D, Barrie M, Boulger CT, Royall NA. Integrated medical school ultrasound: development of an ultrasound vertical curriculum. Crit Ultrasound J. 2013;5:6. 5. Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2008;27:745---9. 6. Shapiro RS, Ko PK, Jacobson S. A pilot project to study the use of ultrasonography for teaching physical examination to medical students. Comput Biol Med. 2002;32:403---9.
EDITORIAL 7. Tshibwabwa ET, Groves HM. Integration of ultrasound in the education programme in anatomy. Med Educ. 2005;39:1148. 8. Arger PH, Schultz SM, Sehgal CM, Cary TW, Aronchick J. Teaching medical students diagnostic sonography. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2005;24:1365---9. 9. Afonso N, Amponsah D, Yang J, Mendez J, Bridge P, Hays G, et al. Adding new tools to the black bag --- introduction of ultrasound into the physical diagnosis course. J Gen Intern Med. 2010;25:1248---52. 10. Fox JC, Anderson CL, Ahmed SS, McDonough J, Wiechmann W, Waters M, et al. Effect of a medical student emergency ultrasound clerkship on number of emergency department ultrasounds. West J Emerg Med. 2010;11:31---4. 11. Bahner DP, Royall NA. Advanced ultrasound training for fourthyear medical students: a novel training program at The Ohio State University College of Medicine. Acad Med: J Assoc Am Med Coll. 2013;88:206---13. 12. Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in U.S medical schools: results of a national survey. Acad Med: J Assoc Am Med Coll. 2014;89:1681---6. 13. García de Casasola G, González Peinado D, Sánchez Gollarte A, Mu˜ noz Aceituno E, Pe˜ na Vázquez I, Torres Macho J. Teaching clinical ultrasonography to undergraduates: students as mentors. Rev Clin Esp. 2015;215:205---10. 14. Ahn JS, French AJ, Thiessen ME, Kendall JL. Training peer instructors for a combined ultrasound/physical exam curriculum. Teach Learn Med. 2014;26:292---5. 15. Jeppesen KM, Bahner DP. Teaching bedside sonography using peer mentoring: a prospective randomized trial. J Ultrasound Medicine: Off J Am Inst Ultrasound Med. 2012;31:455---9. 16. Celebi N, Zwirner K, Lischner U, Bauder M, Ditthard K, Schürger S, et al. Student tutors are able to teach basic sonographic anatomy effectively --- a prospective randomized controlled trial. Ultraschall Med. 2012;33:141---5.
A.R. Panchal (MD, Ph.D., RDMS) a,b , D. Bahner (MD, RDMS) a,∗ a Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States b Center of EMS, The Ohio State University Wexner Medical Center, Columbus, OH, United States ∗
Corresponding author. E-mail address: [email protected] (D. Bahner).
Revista Clínica Española www.elsevier.es/rce
EDITORIAL
Teaching clinical ultrasonography to undergraduates. A need for systematic training programs La formación de estudiantes de pregrado en ecografía clínica. La necesidad de programas sistemáticos de formación
Bedside focused ultrasound use has increased dramatically as the demand for quick, efficient diagnostic bedside imaging has increased.1 Currently, focused bedside ultrasound is used to assist clinicians with diagnostic evaluations, invasive procedures and therapeutic interventions in multiple specialties.2 As a result of rapid technological advancement and miniaturization of devices, the development of uses and applicability in the various fields of medicine has outpaced the professional education of those practitioners who could use them. The skills of focused ultrasonography will need to be integrated into the medical educational process so future practitioners can keep pace with this steady innovation. Teaching ultrasound within medical school has experienced tremendous growth over the last few years as training programs have developed novel methods to integrate ultrasound teaching.3---5 Multiple schools have established integrated ultrasound programs where ultrasound is incorporated into all 4 years of training.3,4 Further, articles have described how ultrasound can be used to enhance the teaching of anatomy, physiology, physical examination and an introduction to clinical practice.6---9 Additionally, there have been reports on ultrasound as both one month and longitudinal electives.3,4,10,11 Though many medical schools acknowledge the importance of teaching focused ultrasound, the integration of ultrasound education is highly variable which may be due to a number of key barriers including lack of space in current curricula, lack of financial support, equipment and of trained faculty.12 In this issue of Rev Clin Esp, García de Casasola Sánchez et al. address the lack of trained faculty to instruct young practitioners in the use of focused bedside ultrasound.13 Authors have described their experience with teaching ultrasound by using peer mentors.13 Each of the peer mentors was a senior student with previous training in ultrasound that included a 5 h theoretical/practical course along with http://dx.doi.org/10.1016/j.rce.2015.01.009 0014-2565/© 2015 Published by Elsevier España, S.L.U.
20 supervised scans. The 20 scans were conducted over a 10-day period on clinical patients with active disease processes. These peers then had an objective evaluation of 5 scans to demonstrate proficiency. Peer mentors then trained 24 other medical students. These secondarily trained students underwent 10---15 h of online course material followed by 20 ultrasound examinations supervised by the ‘‘peer mentors’’ (total time 15 h). The authors discovered that the use of peer mentors to secondarily train their colleagues in basic cardiac and abdominal ultrasound was feasible. The majority of scans were rated as 2.78 ± 0.19 on a scale of 1---3 (1 = poor; 2 = regular; 3 = excellent). Interestingly, there was significant variability in the identification of key anatomical images by these students which was higher in the cardiac ultrasound views. This suggests that the training through peer mentors is feasible and imparts elementary knowledge, but may need to be augmented for long term practitioner success. We applaud the authors for investigating this important topic area. Previous work in this area has evaluated the use of peer mentors for ultrasound education and has demonstrated positive results.14---16 However, in comparison to this evaluation, peer mentors in these studies were extensively trained with either a full time elective for 2---4 weeks with didactics, video review and many proctored scans14---16 or had been involved in a one-year longitudinal ultrasound program with monthly didactics, online didactics and quizzes, journal club, monthly hands-on faculty sessions and clinical research.11 This study presents a streamlined system which would train senior students and thus allow for more available mentors to instruct junior students. Future studies will need to focus on (a) the optimal training paradigm to prepare peer to peer and near peer mentors for focused ultrasound teaching; (b) key curriculum components necessary for medical student teaching to maximize scan time versus didactic time, and (c) understanding the long term
220 knowledge retention of medical students following peer mentoring education compared to traditional teaching roles. As ultrasound continues to expand in the practice of medicine with multiple providers from multiple specialties, there will be a need for more systematic training programs. The faculty and personnel required to meet the demand will continue to grow and many times outstrip the current resources of a school or department. Near peer and peer to peer mentoring may be an alternative for this shortage of competent faculty. Focused ultrasound can be taught to medical students but takes a considerable investment in time and energy from the requisite faculty. It takes experts in focused ultrasound to be engaged in training these ‘‘peer mentors’’ to be able to convey this information to other novice learners. The authors have contributed to this growing body of knowledge of students serving as peer to peer and near peer mentoring in the effort to learn focused bedside ultrasound.13 This strategy can work, is feasible, and needs further study on how best to implement this student driven personnel strategy for ultrasound training.
References 1. Moore CL, Gregg S, Lambert M. Performance, training, quality assurance, and reimbursement of emergency physicianperformed ultrasonography at academic medical centers. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2004;23: 459---66. 2. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749---57. 3. Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J. 2011;3: 1---12. 4. Bahner DP, Adkins EJ, Hughes D, Barrie M, Boulger CT, Royall NA. Integrated medical school ultrasound: development of an ultrasound vertical curriculum. Crit Ultrasound J. 2013;5:6. 5. Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2008;27:745---9. 6. Shapiro RS, Ko PK, Jacobson S. A pilot project to study the use of ultrasonography for teaching physical examination to medical students. Comput Biol Med. 2002;32:403---9.
EDITORIAL 7. Tshibwabwa ET, Groves HM. Integration of ultrasound in the education programme in anatomy. Med Educ. 2005;39:1148. 8. Arger PH, Schultz SM, Sehgal CM, Cary TW, Aronchick J. Teaching medical students diagnostic sonography. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2005;24:1365---9. 9. Afonso N, Amponsah D, Yang J, Mendez J, Bridge P, Hays G, et al. Adding new tools to the black bag --- introduction of ultrasound into the physical diagnosis course. J Gen Intern Med. 2010;25:1248---52. 10. Fox JC, Anderson CL, Ahmed SS, McDonough J, Wiechmann W, Waters M, et al. Effect of a medical student emergency ultrasound clerkship on number of emergency department ultrasounds. West J Emerg Med. 2010;11:31---4. 11. Bahner DP, Royall NA. Advanced ultrasound training for fourthyear medical students: a novel training program at The Ohio State University College of Medicine. Acad Med: J Assoc Am Med Coll. 2013;88:206---13. 12. Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in U.S medical schools: results of a national survey. Acad Med: J Assoc Am Med Coll. 2014;89:1681---6. 13. García de Casasola G, González Peinado D, Sánchez Gollarte A, Mu˜ noz Aceituno E, Pe˜ na Vázquez I, Torres Macho J. Teaching clinical ultrasonography to undergraduates: students as mentors. Rev Clin Esp. 2015;215:205---10. 14. Ahn JS, French AJ, Thiessen ME, Kendall JL. Training peer instructors for a combined ultrasound/physical exam curriculum. Teach Learn Med. 2014;26:292---5. 15. Jeppesen KM, Bahner DP. Teaching bedside sonography using peer mentoring: a prospective randomized trial. J Ultrasound Medicine: Off J Am Inst Ultrasound Med. 2012;31:455---9. 16. Celebi N, Zwirner K, Lischner U, Bauder M, Ditthard K, Schürger S, et al. Student tutors are able to teach basic sonographic anatomy effectively --- a prospective randomized controlled trial. Ultraschall Med. 2012;33:141---5.
A.R. Panchal (MD, Ph.D., RDMS) a,b , D. Bahner (MD, RDMS) a,∗ a Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States b Center of EMS, The Ohio State University Wexner Medical Center, Columbus, OH, United States ∗
Corresponding author. E-mail address: [email protected] (D. Bahner).