Integration of Lung Point-of-care Ultrasound into Clinical Decision Making for Medical Students in Simulated Cases

Lum, Michelle; Sheehy, Lauren; Lai, Jason; Tillman, David; Damewood, Sara; Schmidt, Jessica

doi:10.5811/westjem.2020.12.48717

Cited by 5 publications

(10 citation statements)

References 7 publications

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“…We found significant improvement in comfort and knowledge when comparing pre-instruction to postinstruction, which is similar to many prior studies assessing POCUS in UME [7,8,14].…”

Section: Discussionsupporting

confidence: 88%

“…Lum et al assessed the ability of 64 medical students, during their clinical years, to integrate lung ultrasound into a simulated case of patients with undifferentiated dyspnea [14]. Nine student groups were evaluated, of which correctly four identified pulmonary edema on lung ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…Because of these limitations, we were unable to assess the ability of individual students to acquire and interpret POCUS images and independently assess their ability to use cardiac POCUS within a simulated clinical scenario. Thus, they worked as a group to acquire images and make a diagnosis, similar to a prior study [14]. It is possible that some students in the groups that had correct imaging techniques and responses may not have been able to perform or interpret a POCUS cardiac examination independently.…”

Section: Limitationsmentioning

confidence: 99%

“…The literature surrounding undergraduate medical education (UME) curriculum implementation has primarily focused on student attitudes towards POCUS, knowledge of POCUS, and skill with acquiring images [5][6][7][8][9]. Few studies have evaluated outcomes outside of this [10][11][12][13][14], including assessing the effectiveness of teaching on the student's ability to utilize POCUS within a clinical context.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Medical Students' Ability to Integrate Point-of-Care Cardiac Ultrasound Into a Case-Based Simulation After a Short Intervention

Russell¹,

Herbert²,

Peterson³

et al. 2022

Cureus

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Introduction: While a large amount of point-of-care ultrasound (POCUS) undergraduate medical education research exists, very little assesses the effectiveness of teaching on the student's ability to utilize POCUS within a clinical context. We set out to assess the ability of pre-clinical (second year) medical students to perform and interpret a parasternal long axis (PSLA) cardiac ultrasound view, and to diagnose a pericardial effusion on POCUS in a simulated patient with hypotension.Methods: This was a prospective study assessing second-year medical students before and after focused cardiac POCUS instruction. Pre-instruction, students completed a pre-assessment and test. They then watched a short video on cardiac ultrasound technique, anatomy, and pathology. Students then participated in 10 minutes of one-on-one hands-on instruction using a simulated patient. Immediately after didactics and hands-on instruction, students in groups of two to four completed a case simulation where they performed a PSLA view, identified pathology, and made a diagnosis. Differences between pre-and postworkshop responses were analyzed using the Chi-square test.Results: We analyzed data on 132 pre-clinical second-year medical students; 126 (95%) had limited to no POCUS experience prior to the workshop. Comparing pre-to post-workshop responses, we found significant improvement in students' ability to identify a pericardial effusion (46% to 69%) (p=0.002) on a PSLA cardiac view. Of the 57 student groups (132 students), 41 (72%) groups were able to adequately obtain a PSLA view on a mannequin using an ultrasound simulator without needing guidance with probe placement or maneuvering. Thirty-five (61%) student groups were able to identify a pericardial effusion and diagnose cardiac tamponade in a simulated patient with hypotension. Conclusion: After short, structured training, pre-clinical medical students, novice to cardiac POCUS, showed improved knowledge with identifying a pericardial effusion on an ultrasound image. The majority of students were able to obtain a PSLA view and diagnose cardiac tamponade in a hypotensive patient during a during a case-based simulation.

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“…We found significant improvement in comfort and knowledge when comparing pre-instruction to postinstruction, which is similar to many prior studies assessing POCUS in UME [7,8,14].…”

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Medical Students' Ability to Integrate Point-of-Care Cardiac Ultrasound Into a Case-Based Simulation After a Short Intervention

Russell¹,

Herbert²,

Peterson³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…An initial study on lung ultrasound showed that, among medical students without ultrasound experience, limited education to improve their knowledge and image acquisition and interpretation skills was successful [ 61 ]. However, another study showed that medical students struggled to translate knowledge of lung ultrasound into performance in a simulated clinical scenario [ 62 ]. In detecting pleural effusion in hospitalized patients, Steinmetz et al demonstrated that the odds of medical students correctly identifying the presence versus absence of pleural effusion was five times greater when using ultrasound as an adjunct to a physical examination than with a physical examination alone [ 63 ].…”

Section: Gaining An Understanding Of Ultrasound and Fostering Technical Skillsmentioning

confidence: 99%

Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University

et al. 2022

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The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.

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Integrating a self-directed ultrasound curriculum for the internal medicine clerkship

Signor,

Gerstenberger,

Cotton

et al. 2024

Ultrasound J

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Background Incorporating ultrasound into the clinical curriculum of undergraduate medical education has been limited by a need for faculty support. Without integration into the clinical learning environment, ultrasound skills become a stand-alone skill and may decline by the time of matriculation into residency. A less time intensive ultrasound curriculum is needed to preserve skills acquired in preclinical years. We aimed to create a self-directed ultrasound curriculum to support and assess students’ ability to acquire ultrasound images and to utilize ultrasound to inform clinical decision-making. Methods Third year students completed the self-directed ultrasound curriculum during their required internal medicine clerkship. Students used Butterfly iQ+ portable ultrasound probes. The curriculum included online modules that focused on clinical application of ultrasound as well as image acquisition technique. Students were graded on image acquisition quality and setting, a patient write-up focused on clinical decision-making, and a multiple-choice quiz. Student feedback was gathered with an end-of-course survey. Faculty time was tracked. Results One hundred and ten students participated. Students averaged 1.79 (scale 0–2; SD = 0.21) on image acquisition, 78% (SD = 15%) on the quiz, and all students passed the patient write-up. Most reported the curriculum improved their clinical reasoning (72%), learning of pathophysiology (69%), and patient care (55%). Faculty time to create the curriculum was approximately 45 h. Faculty time to grade student assignments was 38.5 h per year. Conclusions Students were able to demonstrate adequate image acquisition, use of ultrasound to aid in clinical decision-making, and interpretation of ultrasound pathology with no in-person faculty instruction. Additionally, students reported improved learning of pathophysiology, clinical reasoning, and rapport with patients. The self-directed curriculum required less faculty time than prior descriptions of ultrasound curricula in the clinical years and could be considered at institutions that have limited faculty support.

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Integration of Lung Point-of-care Ultrasound into Clinical Decision Making for Medical Students in Simulated Cases

Cited by 5 publications

References 7 publications

Assessment of Medical Students' Ability to Integrate Point-of-Care Cardiac Ultrasound Into a Case-Based Simulation After a Short Intervention

Assessment of Medical Students' Ability to Integrate Point-of-Care Cardiac Ultrasound Into a Case-Based Simulation After a Short Intervention

Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University

Integrating a self-directed ultrasound curriculum for the internal medicine clerkship

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