Using triple stimulation provides a powerful learning tool integrating surface anatomy landmarks with ultrasound imaging to augment medical students' physical examination skills

CRAWFORD, Kendall1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon, OR.... [ view full abstract ]

CRAWFORD, Kendall1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon, OR. USA. Departments of Orthopaedics5, General Surgery6 and Sports Medicine7, Samaritan Health Services, Corvallis, OR. USA. Departments of Surgery8, Orthopaedics & Rehabilitation9, Oregon Health & Science University, Portland, OR. USA.

INTRODUCTION. Anatomy is the cornerstone and foundation of medicine and other human sciences. Learning anatomy is generally focused deep beneath the skin. Invasive procedures that require needle placement can be more accurately positioned by using ultrasound and understanding visual and palpable surface anatomy landmarks. The objective of this study was to identify clinically important surface and palpatory anatomy representing common pathology. METHODS. Literature search was conducted regarding surface anatomy teaching in high-school baccalaureate, and medical school levels. Fukuda Denshi UF-760 AG ultrasound system with a novel Sonic Eye finger probe was used to identify neurovascular and muscle-tendon structures, osteology landmarks, and organs while recording the surface landmark to target vector angle for optimum visualization. Ten healthy volunteers were imaged for surface anatomy landmarks of the trunk, limbs, and head & neck. Once target structures were identified, Molotow skin writing markers were used to draw and outline target structures. RESULTS. All ten subjects consistently revealed common landmarks for both surface and palpable anatomy. Ultrasound confirmed neurovascular and muscle-tendon structures, osteology landmarks, and organs that were mapped out onto a volunteer for the body art. Subjects successfully drew the organ outlines from ultrasound. DISCUSSION. Literature search revealed no known studies regarding surface anatomy with ultrasound guidance for anatomy teaching k-12, baccalaureate, and medical school teaching. This study developed a surface anatomy module that was used by k-12, baccalaureate, and medical students. Surface anatomy should have at least two major components, one being visual and the second being palpable. Generally when people are learning surface anatomy they do not use ultrasound to confirm what is deep to the surface or the palpable landmarks. This study demonstrated the utility of using ultrasound to identify the architecture beneath surface contours of common landmarks. This pilot study was successful when conducted with a group of 20 medical students and is now ready for trial with larger groups. CONCLUSION. This study revealed triple stimulation can be applied to learn surface anatomy while integrating a dynamic ultrasound image modality which could have a profound effect on physical examination skills.