Richard Hoppmann

Teaching Medical Students Ultrasound to Measure Liver Size: Comparison With Experienced Clinicians Using Physical Examination Alone

Background: Ultrasound is increasingly recognized as a valuable addition to medical school curriculum. Purpose: In this study, we tested the ability of rising second year students to learn and conduct an ultrasound examination of vertical liver span at the point of care. Methods: Six patients from a GI clinic volunteered to have their liver size measured. Ten students were trained to measure vertical liver span with ultrasound. Four physicians were recruited to measure liver span with standard methods. Student and physician measurements were compared to each other and to a reference ultrasound measurement for accuracy and variability. Results: Compared to the reference, students overestimated liver size an average of 1.5 cm. Physicians underestimated liver size an average of 6.7 cm. Variance in student measurements for each patient was 10% to 17% and among physicians 20% to 50%. Conclusion: With limited instruction and clinical experience medical students can obtain liver size measurements with ultrasound that are more accurate and have less variability than those by physicians using physical examination. Given the ease with which students can learn to use ultrasound and the teaching and clinical value of ultrasound, ultrasound should be considered as a standard of medical education in the future.

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.

Ultrasound performs better than radiographs

We applaud the British Thoracic Society (BTS) for its efforts to improve patient care through scientific evidence. We thus recognise the recent guidelines on pleural procedures and thoracic ultrasound (TUS) as an important attempt to develop a rational approach to chest sonography.1 However, we are concerned that the BTS has reached conclusions based on a less complete review of TUS. The guidelines state that ‘the utility of thoracic ultrasound for diagnosing a pneumothorax is limited in hospital practice due to the ready availability of chest x-rays (CXR) and conflicting data from published reports’.1 This conclusion appears to be based on a small (but landmark) study of 11 patients from 1986 to 1989, two small studies with only four pneumothoraces in …

Musculoskeletal problems of performing artists

Within the new field of performing arts medicine is an active group of researchers and clinicians who are dedicated to advancing our understanding of musculoskeletal problems of performers. Among these problems are those of the upper extremity in instrumental musicians such as overuse syndrome, entrapment neuropathies, focal dystonia, osteoarthritis, and problems related to joint hypermobility. The epidemiology of these problems is presented as well as results of recent studies investigating their etiology as they relate to musicians. A brief discussion of the treatment of injured musicians also is included.

Using ultrasound to teach medical students cardiac physiology.

Ultrasound is being incorporated more into undergraduate medical education. Studies have shown that medical students have positive perceptions about the value of ultrasound in teaching courses like anatomy and physiology. The purpose of the present study was to provide objective evidence of whether ultrasound helps students learn cardiac physiology. In this study, 20 medical students took a pretest to assess their background knowledge of cardiac physiology. Next, they acquired ultrasound video loops of the heart. Faculty members taught them nonelectrical aspects of cardiac physiology using those loops. Finally, students took a posttest to evaluate for improvements in their knowledge. Students also completed an anonymous questionnaire about their experience. The mean pretest score was 4.8 of 9 (53.3%). The mean posttest score was 7.35 of 9 (81.7%). The mean difference was significant at P < 0.0001. Student feedback was very positive about the ultrasound laboratory. Ninety-five percent of the students agreed or strongly agreed that the ultrasound laboratory was a valuable teaching tool and that it improved their understanding of cardiac physiology. All students agreed or strongly agreed the laboratory was helpful from a visual learning standpoint. A hands-on ultrasound laboratory can indeed help medical students learn the nonelectrical components of cardiac physiology.

Medical Student Identification of Knee Effusion by Ultrasound

Twenty-one fourth-year medical students were given a brief lecture on ultrasound of the knee and fifteen minutes of supervised ultrasound scanning of three cadavers which had been injected with saline to give varying degrees of knee effusions. Each student was then individually observed and required to scan both knees of a cadaver different from the practice cadavers and identify the patella, the femur, the quadriceps tendon and if a suprapatellar effusion was present, and which knee had the larger effusion. All twenty-one students correctly identified all anatomical structures, suprapatellar effusions, and which knee had the larger effusion. Identifying a knee effusion can be an important clinical finding in diagnosing and managing a patient with knee complaints. Fourth-year medical students can learn to identify knee effusions with ultrasound following a brief introductory lecture and hands-on scanning practice session.

Ulnar nerve entrapment in a French horn player.

Nerve entrapment syndromes are frequent among musicians. Because of the demands on the musculoskeletal system and the great agility needed to per-form, musicians often present with vague complaints early in the course of entrapment, which makes the diagnosis a challenge for the clinician. Presented here is such a case of ulnar nerve entrapment at the left elbow of a French horn player. This case points out some of the difficulties in establishing a diagnosis of nerve entrapment in musicians. It also supports the theory that prolonged elbow flexion and repetitive finger movement contribute to the development of ulnar entrapment at the elbow. Although surgery is not required for most of the musculoskeletal problems of musicians, release of an entrapped nerve refractory to conservative therapy may be career-saving for the musician.

Point of Care Ultrasound by Primary Care Physicians and Geriatricians: Old Adults, New Technology, Potential Benefits and Burdens

Background/Objectives: Availability of economical, portable ultrasound systems that provide rapidly available, useful, information has transformed the clinical assessment of patients. As hand-held ultrasound systems become widely accessible, this technology will become standard of care in primary care practices. Little has been written about the use of ultrasound by Geriatricians, and the usefulness of POC-US specifically in caring for Older Adults. Study design: In order to assess the current state of knowledge regarding use of ultrasound by geriatricians, and assess (POC-US) for the population of older adults, we conducted a review of published studies using Pub Med and Ovid search engines. Selected publications were included in a systematic review. Results: Thirty-five articles were identified for systematic review. Eighteen articles addressed the use of ultrasound in the evaluation of Older Adult patients. Four articles that identified performance of ultrasound by Geriatricians, and an additional three articles were not clear the specialty performing the exam, but geriatricians used the information gained. A total of fifteen articles highlighted use by primary care physicians. Thirty-one articles identified the usefulness in specific diseases and conditions that are more common in older adults. Limitations and potential harm were identified in twelve articles. Conclusion: There is very little literature on POC-US in Geriatrics, but existing literature highlights significant potential clinical use. POC-US holds great promise in primary care practices and in geriatrics. Our literature review found numerous potential uses for POC-US in caring for older adults. Few studies addressing the application of ultrasound in the geriatric population have been reported. The usefulness of POC-US by Geriatricians remains to be clarified. Judicious use of this technology in the geriatric population will be necessary to maximize the potential benefit while avoiding the potential harm of unnecessary tests, anxiety, and iatrogenic illness.