Wilma Chan
University of Pennsylvania, Perelman School of Medicine
Dr. Chan completed her residency in Emergency Medicine at the University of Chicago and ultrasound fellowship at Brigham and Women’s Hospital in Boston. She has a Master’s in Education from the Harvard Graduate School of Education in the program of Technology, Innovation and Education. She obtained her medical and undergraduate degrees at Tufts University.She joined the Department of Emergency Medicine at University of Pennsylvania in July 2015 and is the inaugural Director of Ultrasound Education at the Perelman School of Medicine. Her academic interests include design thinking in educational spaces, social media and technology utilization.
Objectives
Clinician-performed ultrasound (CPU) is an increasingly widely used tool in many specialties. While some medical schools have started to implement ultrasound training programs in the pre-clinical curriculum, capacity for CPU education during the clinical clerkships is unknown. Due to limited numbers of faculty that are formally trained in CPU, clerkship students may lack opportunities to apply and reinforce CPU skills in a clinical practice environment. This study seeks to assess current practice patterns, comfort with image interpretation, and knowledge of CPU indications among clinical clerkship faculty (CCF) involved in undergraduate medical education.
Methods
This was a web-based, cross-sectional survey assessing the use and awareness of indications for CPU among CCF from five specialties (Internal Medicine, Surgery, Family Medicine, Emergency Medicine (EM), and Pediatric EM) in a single medical school. The target population were CCF with medical education leadership positions, as identified by the School of Medicine’s Curriculum Office. The survey examined CCFs’ demographics, comfort using and interpreting CPU, frequency of CPU use, and knowledge of 12 widely accepted CPU indications and 3 “false indications” (diseases not known to benefit from CPU: stroke, urinary tract infection, and acute otitis media). Knowledge of CPU indications was based on a 4-point Likert scale from 0 (“Never use CPU”) to 3 (“Always use CPU”) to evaluate the given indications. The 22-item survey was developed by content experts with extensive experience in CPU and ultrasound education and was pilot tested prior to being sent to respondents. Results were analysed using standard statistical methods, including a chi-squared analysis for statistical significance.
Results
Forty-six percent (88/192) of invited CCF responded to the survey. Overall, only 32% of faculty considered themselves to be moderately or very comfortable performing CPU; nearly 50% reported feeling uncomfortable with CPU use. Similarly, nearly three-quarters of the respondents were uncomfortable (46%) or only somewhat comfortable (26%) interpreting CPU images.
Comfort performing CPU varied by medical specialty, with the highest comfort level among EM and the lowest comfort level among Internal Medicine physicians. Comfort performing CPU was significantly higher in EM and Pediatric EM physicians (p=.0002). Knowledge of CPU indications was also higher among EM and Pediatric EM physicians, with a statistically significant difference for 8 of 12 CPU indications.
Awareness of when to use CPU for true indications ranged from an average high of 2.14 (often to always) for diagnosing cardiac tamponade and a low of 0.25 (never to sometimes) for diagnosing elevated intracranial pressure, based on a 4-point Likert scale. The respondents appropriately avoided CPU for the “false indications”, including stroke (0.21), urinary tract infection (0.24), and acute otitis media (0.07).
Both comfort level and knowledge of CPU indications decreased with increasing years since residency. More recent graduates (0-15 years since residency) were significantly more comfortable using CPU than the more senior respondents (15+ years since residency) (p=.0029).
Conclusion
Half of CCF in educational leadership positions are uncomfortable performing and interpreting clinician-performed ultrasound. CPU comfort and awareness decreases with increasing years since residency and is higher in EM and Pediatric EM physicians. Many time-sensitive conditions with widely recognized utility of CPU (e.g. pulmonary edema, pneumothorax, AAA) were identified as needing CPU only sometimes or rarely by many faculty. These results suggest that educational resources for CPU education may be lacking during the clinical portion of the medical school curriculum.
