David P. Bahner

Integrated medical school ultrasound: development of an ultrasound vertical curriculum

BackgroundPhysician-performed focused ultrasonography is a rapidly growing field with numerous clinical applications. Focused ultrasound is a clinically useful tool with relevant applications across most specialties. Ultrasound technology has outpaced the education, necessitating an early introduction to the technology within the medical education system. There are many challenges to integrating ultrasound into medical education including identifying appropriately trained faculty, access to adequate resources, and appropriate integration into existing medical education curricula. As focused ultrasonography increasingly penetrates academic and community practices, access to ultrasound equipment and trained faculty is improving. However, there has remained the major challenge of determining at which level is integrating ultrasound training within the medical training paradigm most appropriate.MethodsThe Ohio State University College of Medicine has developed a novel vertical curriculum for focused ultrasonography which is concordant with the 4-year medical school curriculum. Given current evidenced-based practices, a curriculum was developed which provides medical students an exposure in focused ultrasonography. The curriculum utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science within the medical school curriculum. The objectives of the course are to develop student understanding in indications for use, acquisition of images, interpretation of an ultrasound examination, and appropriate decision-making of ultrasound findings.ResultsPreliminary data indicate that a vertical ultrasound curriculum is a feasible and effective means of teaching focused ultrasonography. The foreseeable limitations include faculty skill level and training, initial cost of equipment, and incorporating additional information into an already saturated medical school curriculum.ConclusionsFocused ultrasonography is an evolving concept in medicine. It has been shown to improve education and patient care. The indications for and implementation of focused ultrasound is rapidly expanding in all levels of medicine. The ideal method for teaching ultrasound has yet to be established. The vertical curriculum in ultrasound at The Ohio State University College of Medicine is a novel evidenced-based training regimen at the medical school level which integrates ultrasound training into medical education and serves as a model for future integrated ultrasound curricula.

How we use social media to supplement a novel curriculum in medical education

Background: The millennial learner is reliant on technology to gain knowledge. Social media in the form of Twitter and Facebook provide a unique way to reach these learners. Aims: To demonstrate a supplement to a curriculum using “push technology” via Twitter and Facebook to deliver educational content to mobile devices. Methods: A curriculum consisting of high-yield ultrasound concepts was developed and posted to Twitter @EDUltrasound daily. Followers received tweets “pushed” directly to their mobile devices. Following the year-long program, followers were surveyed regarding the programs effectiveness. To determine the ways in which tweets were reaching users, followers were categorized demographically. Results: Daily “tweets” were posted each morning beginning on July 1, 2010. By the end of the year, there were 87 followers on Twitter and 78 on Facebook. The majority of followers (55.6%) had not previously used Twitter. The majority of followers (88.9%) found Twitter user-friendly, while most (81.5%) found the information useful. Conclusions: Due to ease of use and widespread applicability, Twitter and Facebook are excellent applications of “push technology” as a means to deliver educational content. This pilot project demonstrates the potential of social media to both supplement and enhance traditional educational methods.

The state of ultrasound education in U.S. medical schools: results of a national survey.

Purpose To determine the state of ultrasound education in U.S. medical schools and assess curricular administrators’ opinions on its integration in undergraduate medical education (UME). Method In 2012, curricular administrators at 134 U.S. MD-granting medical schools were surveyed concerning the nature of ultrasound education in medical school. The questionnaire sought ultrasound education program characteristics, structures, and objectives. It also sought respondents’ opinions on the role of ultrasound education in UME and barriers to its integration. Frequency and distribution analyses were conducted for survey responses; Rasch analysis was performed for barrier responses. Results Responses were received from 82 (61.2%) medical schools; these institutions were representative of the U.S. medical school population. Fifty-one respondents (62.2%) reported ultrasound training was integrated into their UME curriculum. Ultrasound was most commonly taught in the third year (38/82; 46.3%), and the purpose of training varied by curricular year. There was agreement that ultrasound should be part of the UME curriculum (56/71; 78.9%), but few respondents reported it was a priority at their institution (13/70; 18.6%). Respondents perceived lack of space in the curriculum (logit = +0.49; standard error [SE] = 0.11) and lack of financial support (logit = +0.42; SE = 0.11) as the most significant barriers to integration. Conclusions Despite a general consensus that ultrasound is an important skill to teach in medical school, the integration of ultrasound education in U.S. schools is highly variable. This study indicates a need for national standards to guide the integration of ultrasound education into U.S. medical school curricula.

Advanced Ultrasound Training for Fourth-Year Medical Students: A Novel Training Program at The Ohio State University College of Medicine

Ultrasound training and education in medical schools is rare, and the foci of current ultrasound curricula are limited. There is a significant need for advanced ultrasound training models in medical school curricula to reduce educational burdens for physician residency programs and improve overall physician competency. The authors describe and evaluate the advanced ultrasound training program developed at The Ohio State University College of Medicine (OSU COM). The OSU COM program is a longitudinal advanced ultrasound curriculum for fourth-year medical students pursuing specialties that require frequent use of focused ultrasound. One hundred fifty student participants have completed the yearlong program to date. Participants engage in didactic lectures, journal club sessions, hands-on training, teaching and patient-modeling activities, and complete a final project. Experienced Ohio State University Medical Center faculty are recruited from specialties that frequently use ultrasound (e.g., emergency medicine, internal medicine, obstetrics–gynecology). A multimodal instructional assessment approach ensures that ultrasound training yields experience with cognitive, behavioral, and constructive learning components. The authors discuss the benefits of the program as well as its challenges and future directions. The advanced ultrasound training program at OSU COM demonstrates a novel approach to providing ultrasound training for medical students, offering a feasible model for meeting training guidelines without increasing the educational requirements for residency programs.

AIUM practice guideline for the performance of the focused assessment with sonography for trauma (FAST) examination.

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. To promote this mission, the AIUM is pleased to publish, in conjunction with the American College of Emergency Physicians (ACEP), this AIUM Practice Guideline for the Performance of the Focused Assessment With Sonography for Trauma (FAST) Examination. We are indebted to the many volunteers who contributed their time, knowledge, and energy to bringing this document to completion. The AIUM represents the entire range of clinical and basic science interests in medical diagnostic ultrasound, and with hundreds of volunteers, the AIUM has promoted the safe and effective use of ultrasound in clinical medicine for more than 50 years. This document and others like it will continue to advance this mission. Practice guidelines of the AIUM are intended to provide the medical ultra-sound community with guidelines for the performance and recording of high-quality ultrasound examinations. The guidelines reflect what the AIUM considers the minimum criteria for a complete examination in each area but are not intended to establish a legal standard of care. AIUM-accredited practices are expected to generally follow the guidelines with the recognition that deviations from the guidelines will be needed in some cases depending on patient needs and available equipment. Practices are encouraged to go beyond the guidelines to provide additional service and information as needed by their referring physicians and patients.

Teaching Bedside Sonography Using Peer Mentoring A Prospective Randomized Trial

Bedside sonography is a growing field of medicine, but there is little evidence about how to teach it to medical students. A peer‐mentoring system may help preclinical medical students learn bedside sonography.

Portable ultrasonography in mass casualty incidents: The CAVEAT examination

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments, including pre-hospital triage, emergency department, and critical care settings. The increasing availability of light-weight, robust, user-friendly, and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident (MCI). Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid, focused protocols using hand-carried emergency ultrasonography could be developed. Following a detailed review of the current use of portable ultrasonography in military and civilian MCI settings, we propose a protocol for sonographic evaluation of the chest, abdomen, vena cava, and extremities for acute triage. The protocol is two-tiered, based on the urgency and technical difficulty of the sonographic examination. In addition to utilization of well-established bedside abdominal and thoracic sonography applications, this protocol incorporates extremity assessment for long-bone fractures. Studies of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.

Medical Student Core Clinical Ultrasound Milestones A Consensus Among Directors in the United States

Many medical schools are implementing point‐of‐care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point‐of‐care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point‐of‐care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed.

I-AIM A Novel Model for Teaching and Performing Focused Sonography

This project was designed to use existing evidence in education and clinical quality improvement to design an educational and clinical model specific for physician‐performed focused sonography. The I‐AIM model (indication, acquisition, interpretation, and medical decision making) was created to serve as both a mnemonic and checklist. The model follows a stepwise logic for performing focused sonographic examinations and contains detailed subcomponent listings that cover specific areas to improve use and performance. Although validation and reliability studies will be required before implementation, the I‐AIM model represents the first effort to standardize and improve clinical and educational focused‐sonography.

Using Second Life Virtual Simulation Environment for Mock Oral Emergency Medicine Examination

OBJECTIVES Oral examination is a method used to evaluate emergency medicine (EM) residents and is a requirement for board certification of emergency physicians. Second Life (SL) is a virtual three-dimensional (3-D) immersive learning environment that has been used for medical education. In this study we explore the use of SL virtual simulation technology to administer mock oral examinations to EM residents. METHODS This was a prospective observational study of EM residents who had previously completed mock oral examinations, participating in a similar mock oral examination case scenario conducted via SL. EM residents in this training program completed mock oral examinations in a traditional format, conducted face to face with a faculty examiner. All current residents were invited to participate in a similar case scenario conducted via SL for this study. The examinee managed the case while acting as the physician avatar and communicated via headset and microphone from a remote computer with a faculty examiner who acted as the patient avatar. Participants were surveyed regarding their experience with the traditional and virtual formats using a Likert scale. RESULTS Twenty-seven EM residents participated in the virtual oral examination. None of the examinees had used SL previously. SL proved easy for examinees to log into (92.6%) and navigate (96.3%). All felt comfortable communicating with the examiner via remote computer. Most examinees thought the SL encounter was realistic (92.6%), and many found it more realistic than the traditional format (70.3%). All examinees felt that the virtual examination was fair, objective, and conducted efficiently. A majority preferred to take oral examinations via SL over the traditional format and expressed interest in using SL for other educational experiences (66.6 and 92.6%, respectively). CONCLUSIONS Application of SL virtual simulation technology is a potential alternative to traditional mock oral examinations for EM residents.