Introduction Point of care ultrasound (POCUS) is increasingly prevalent and standardized in undergraduate medical education (UME); however, roughly 25% of United States medical schools lack an ultrasound curriculum. One of the commonly cited barriers to ultrasound training in UME is faculty time resources. Here, we describe an ultrasound scholarly concentration program (SCP) designed to provide medical students with ultrasound opportunities in clinical and scholarly domains, while reducing the need for extensive faculty resources. Methods SCPs at the University of North Carolina School of Medicine have 3 requirements: an elective course, a longitudinal portfolio, and a final scholarly project. Thus, the ultrasound SCP was designed to comprise an introductory clinical elective to ultrasound, development of a longitudinal scan portfolio, and a final scholarly project in ultrasound related research or educational innovation. A review of the literature and search of the top 50 US medical schools by US News & World Report was performed to assess the novelty of the ultrasound SCP. Results To the best of our knowledge, the ultrasound SCP is the first scholarly concentration, track or pathway offered to medical students in the United States. It is the first description of a student designed and student led curriculum focused on providing meaningful ultrasound opportunities to students without necessitating unavailable faculty resources and educational infrastructure. Conclusion A novel ultrasound SCP is described which has clinical aims to expose students to clinical ultrasound as well as scholarly aims to facilitate ultrasound related research and educational innovation. It is designed to enable students to make ultrasound a defining characteristic of their medical school experience. The SCP relies on motivated student involvement and near-peer teaching in a way that is self-sustaining and self-improving.

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Background: Ultrasound integration in undergraduate medical education (UME) has been a focused endeavor in recent years. According to the American Institute of Ultrasound in Medicine, more than a third of all US medical schools have adopted a focused ultrasound training program for medical students. Medical student perspectives on best practices in ultrasound education are lacking in the literature. Curricula Experiences: Two students' reflections are presented regarding two different didactic approaches, flipped classroom and self-study learning models, to teaching ultrasound in the pre-clinical medical education curriculum. Students present reflections on these didactic approaches to facilitate further improvement in ultrasound education curricula. Discussion: The self-directed learning model enabled students to learn foundational ultrasound exam techniques efficiently in a lowstress environment and subsequently optimized the efficiency of later faculty-led learning events. However, we noted that in both the flipped classroom and self-study learning models of education, the training on basic physical properties of ultrasound, tissue characteristics, and probe manipulation was limited. Conclusion:A self-study learning model ultrasound curricula improves perceived learning efficiency and student confidence, especially when followed by faculty-guided didactics and scanning opportunities. We suggest a framework for ultrasound education curricula that includes components of both formats of ultrasound education alongside faculty-led sessions as an ideal model of ultrasound education. Further, we propose the added benefit of inanimate object scanning to optimize students' knowledge of waveform physics (image acquisition and physical properties of materials) early in the ultrasound education process.

Statement of Significance: This study aimed to assess geographic trends in COVID-19 cases and deaths across North Carolina (NC). Our study found that population-adjusted COVID-19 cases and deaths were lower in the coastal region of NC during the study period, independent of demographic composition and population-density within the region. This represents an interesting finding regarding COVID-19 transmission that deserves further investigation. One possible explanation for this finding is differing environmental conditions between the inland and coastal region. Background: Existing literature has explored the geographic and spatial variations in COVID-19 prevalence. Some studies suggest that the transmission and total prevalence of COVID-19 is diminished in areas with low levels of air pollution, high humidity, and more sunlight. The coastal regions of NC are more likely to have these environmental characteristics than the inland regions. Given these trends, we analyzed and compared population-adjusted COVID-19 case and death counts in the coastal and inland regions of NC. Methods: Time series data displaying the prevalence of population adjusted COVID-19 case and death counts from 15 March 2020 to 15 August 2020 were plotted for a variety of North Carolina regional and population density classifications. A local regression analysis was computed to further assess the observed relationships. Basic demographic characteristics were also compared for the coastal versus inland region. Results: There were fewer population-adjusted COVID-19 cases and deaths in the coastal region (889 cases/100,000; 12.5 deaths/100,000) than in the inland region (1426 cases/100,000; 23.5 deaths/100,000) at the endpoint of this study. This trend is observed even when controlling for population density, and in the absence of significant demographic differences between the two regions. Conclusions: The prevalence of population-adjusted COVID-19 cases and deaths was lower in coastal versus inland NC during this study period. Given that the NC coastal region is associated with lower pollution, higher humidity, and more exposure to sunlight, our findings suggest that more research should be done to explore the correlation between environmental variables and the spread of COVID-19.

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