Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability

Abstract

Introduction: The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. Methods: Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. Results: For the sonographic anatomy, there was a statistically significant increase ( P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. Conclusion: The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.

Videos of demonstration versus text and image-based material for pre-skill conceptualisation in flipped newborn resuscitation training for medical students: a pilot study

“…Fortunately, carefully designed content can optimize preparation by reducing cognitive load and positively influencing student engagement and motivation [22]. While manuals [23,24], PowerPoint presentations (PPs) [25,26] and video lectures [27,28] have been used to present various types of knowledge in flipped PS training, instructional theory suggests that PK is better learnt by the observation of a demonstration of the skill being performed [29]. Although demonstration videos (DVs) have been used as pre-skill conceptualisation in simulation-based flipped PS training in a handful of studies [7,8,[30][31][32][33], singly or in combination with other material, only 3 of these reported on objective measures of skills acquisition and presented conflicting results [7,8,31].…”

First year internal medicine residents’ self-report point-of-care ultrasound knowledge and skills: what (Little) difference three years make

“…The University of Saskatchewan, since 2018, has published on a number of their innovative medical student POCUS education initiatives [ 26 , 27 ]. More recently the University of Ottawa published the results of on their pre-clerkship POCUS training [ 28 ]. With this increase incorporation of POCUS training in Canadian medical schools, we hypothesized that more recent cohorts of learners would enter residency with higher POCUS knowledge and skills.…”

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

“…They further demonstrated that electronic educational modules were as effective as traditional lectures for delivering such knowledge, although self-directed scan training on a high-fidelity simulator was not as effective as scan training by a sonographer [34]. Recently, several educational programs related to point-of-care cardiac ultrasound for undergraduate medical education were found to have positive outcomes, including eliciting improvements in confidence in obtaining proper images [35] and observed OSCE scores [36][37][38][39][40].…”