S

A NOVEL ULTRASOUND CURRICULUM FOR

TEACHING THE FOCUSED ASSESSMENT WITH

SONOGRAPHY IN TRAUMA EXAM TO UNDERGRADUATE

MEDICAL STUDENTSTrevor Gessel, BS, Daniel Cieslak, BS, BA, Richmond Doxey, BS, Mary Beth Phelan, MD, RDMS,

Caroline Pace, MD

OVERVIEW

INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION

INTRODUCTION

Ultrasound curriculum needed in Medical School Ubiquity among specialties Operator-dependent skill Students have shown interest

Undergraduate medical education ultrasound training Quantity? Components?

FAST exam

http://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Bugatti_Veyron_16.4_–_Frontansicht

Right upper quadrant

Subxiphoid

Left upper quadrant

Suprapubic

http://upload.wikimedia.org/wikipedia/commons/2/2c Inside_a_classroom_of_a_school_in_Kabul.jpg

2nd Year Medical Students

MATERIALS AND METHODS

Online Modules Society for Ultrasound in Medical Education (SUSME)

Didactic Sessions 2 one-hour sessions

Training Session Live model Normal exam

MATERIALS AND METHODS

Simulation Session UltraSim® from MedSim Abnormal exam (positive findings)

Final Competency Exam Simulator (abnormal) exam Live (normal) exam

MATERIALS AND METHODS

Data Collection Participant surveys

Previous experience and Interest Satisfaction and Confidence

Analysis Surveys Performance on Final Competency Exam

 

Did not Respond, n=182Declined to Participate, n=3

Completed Modules, n=12Lost to Follow-up, n=1

No-Showed, n=10Declined to Participate, n=0

Recruitmentn=208

Introductory Sessionn=23

Online Modulesn=13

FAST Didactic Sessionsn=12

Training Session for the Normal FAST Exam

n=12

Final Competency Examn=12

Simulation Session for the Abnormal FAST Exams

n=12

Completed Session, n=12Did Not Complete Session, n=0

RESULTS

RESULTS

0

1

2

3

4

5

Satisfaction

Satis

fact

ion

Didactic Session 1

Didactic Session 2

Hands-On Session

Simulation Session

Final Exam

RESULTS - CONFIDENCE

0

1

2

3

4

5

RUQ View

Confi

denc

e

Didactic Session 1

Didactic Session 2

Hands-On Session

Simulation Session

FinalExam Didactic

Session 1Didactic

Session 2Hands-On

SessionSimulation

Session

FinalExam

Didactic Session 1

Didactic Session 2

Hands-On Session

Simulation Session

FinalExam

Didactic Session 1

Didactic Session 2

Hands-On Session

Simulation Session

FinalExam

0

1

2

3

4

5

Subxiphoid View

Confi

denc

e

0

1

2

3

4

5

LUQ View

Confi

denc

e

0

1

2

3

4

5

Suprapubic View

Confi

denc

e

RESULTS - COMPETENCE

0

1

2

3

4

5

6

Final Exam Performance

Tim

e (M

inut

es)

Live Model Exam

Simulator Exam0

1

2

3

4

5

6

Resident Performance Times

Tim

e (M

inut

es)

PGY1 PGY2 PGY3

CONCLUSIONS

Successfully taught basic sonography skills Students generally satisfied with the curriculum Multiple strategies successful in ultrasound

curricula Hands-on experience is vital

Questions?

Thank you!

REFERENCES

Predanic M, Cho A, Ingrid F, Pelletieri J. Ultrasonographic estimation of fetal weight: acquiring accuracy in residency. J Ultrasound Med 2002; 21:495-500.

International Society of Ultrasound in Obstetrics & Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’. Ultrasound Obstet Gynecol 2007; 29: 109-116.

Steno A, Karlik M, Mendel P, Steno J. Navigated three-dimensional intraoperative ultrasound-guided awake resection of low-grade glioma partially infiltrating optic radiation. Acta Neurohir 2012;154:1255-1262.

Hamann MF, Hamann C, Schenk E, et al. Computer-aided (histoscanning) biopsies versus conventional transrectal ultrasound-guided prostate biopsies: do targeted biopsy schemes improve the cancer detection rate? Urology 2013; 81:370-375.

Gravvanis A, Tsoutsos D, Delikonstantinou I, Dimitriou V, Katsikeris N. Impact of portable duplex ultrasonography in head and neck reconstruction. J Craniofac Surg 2012; 23:140-144.

Balki M. Locating the epidural space in obstetric patients-ultrasound a useful tool: continuing professional development. Can J Anaesth 2010; 57:1111-1126.

Antonakakis JG, Ting PH, Sites B. Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review. Anesthesiology Clin 2011; 29:179-191.

REFERENCES

Lamperti M, Bodenham AR, Pittiruti M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 2012; 38:1105-1117.

Tirado A, Wu T, Noble VE, et al. Ultrasound-guided procedures in the emergency department–diagnostic and therapeutic asset. Emerg Med Clin N Amer 2013; 31:117-149.

Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound 2012; 40:135-141.

Yim ES, Gillis EF, Ojala K. Focused transthoracic echocardiography by sports medicine physicians: measurements relevant to hypertrophic cardiomyopathy. J Ultrasound Med 2013; 32:333-338.

Chiang YP, Wang TG Hsief SF. Application of ultrasound in sports injury. J Med Ultrasound 2013; 21:1-8.

Wolfman DJ, Allison SJ. Applications of ultrasound in gynecologic oncology. Ultrasound Clin 2010; 5:289-298.

Rove KO, Sullivan KF, Crawford ED. High-intensity focused ultrasound: ready for primetime. Urol Clin N Am 2010; 37: 27-35.

Holland GA, Mironov O, Aubry JF, Hananel A, Duba JB. High-intensity focused ultrasound. Ultrasound Clin 2013; 8:213-226.

REFERENCES

Perito ER, Tsai PM, Hawley S, Lustig RH, Feldstein VA. Targeted hepatic sonography during clinic visits for detection of fatty liver in overweight children. J Ultrasound Med 2013; 32:637-643.

Xu ZS, Lee RJ, Chu SS, et al. Evidence of changes in brain tissue stiffness after ischemic stroke derived from ultrasound-based elastography. J Ultrasound Med 2013; 32:485-494.

Hwang J. Time to integrate ultrasound into medical school curricula. Emerg Med News 2010; 32: 3, 18.

Davis DP, Campbell CJ, Poste JC, Ma G. The association between operator and accuracy of ultrasonography performed by novice emergency physicians. J Emerg Med 2005; 29: 259-264.

Kessler C, Bhandarkar S. Ultrasound training for medical students and internal medicine residents – a needs assessment. J Clin Ultrasound 2010; 38:401-408.

Gogalniceanu P, Sheena Y, Kashef E, et al. Is basic emergency ultrasound training feasible as part of standard undergraduate medical education? J Surg Ed 2010; 67:151-156.

Hoppmann RA, Rao VV, Poston MB, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011; 3:1-12.

REFERENCES

Arger PH, Schultz SM, Sehgal CM, Cary TW, Aronchick J. Teaching medical students diagnostic sonography. J Ultrasound Med 2005; 24:1365-1369.

Benninger B, Corbett R, Delamarter T. Teaching a sonographically guided invasive procedure to first-year medical students using a novel finger transducer. J Ultrasound Med 2013; 32:659-664.

Fox JC, Chiem AT, Rooney KP, Maldonado G. Web-based lectures, peer instruction and ultrasound-integrated medical education. Med Educ 2012; 46:1109-1110

Lanoix R, Baker WE, Mele JM, Dharmarajan L. Evaluation of an instructional model for emergency ultrasonography. Acad Emerg Med 1998; 5:58-63.

Knudson MM, Sisley AC. Training residents using simulation technology: experience with ultrasound for trauma.  J Trauma 2000; 48:659-665.

Damewood S, Jeanmonod D, Cadigan B. Comparison of a multimedia simulator to a human model for teaching FAST exam image interpretation and image acquisition. Acad Emerg Med 2011; 18:413-419

Bahner DP, Jasne A, Boore S, Mueller A, Cortez E. The ultrasound challenge: a novel approach to medical student ultrasound education. J Ultrasound Med 2012; 31:2013-2016.

NEXT STEPS

Currently repeating the curriculum Added quizzes

Board-style questions Proper position/use Images – negative and positive findings

Increased hands-on teaching Increased # of sessions more experience