Efficacy of Ultrasound Education for Foreign Physicians Taught by First Year Medical Students

Background and Objective In developing countries, the use of ultrasonography has been implicated as a cost effective and efficient tool to supplement and/or use in conjunction with more expensive and non-portable radiological... [ view full abstract ]

Background and Objective
In developing countries, the use of ultrasonography has been implicated as a cost effective and efficient tool to supplement and/or use in conjunction with more expensive and non-portable radiological services. As a rapid and safe measurement, the utility of ultrasonography has been indicatefd to extend beyond the specialists’ office to the general practitioner's clinic to facilitate diagnosis and treatment. Ultrasound education programs established by foreign physicians in developing countries have been proven to be successful and sustainable; evidencing that ultrasound is a teachable skill that may be mastered at a sufficient level within the course of a short-term intensive training. The aim of this study was to assess the short-term efficacy of a 4-week ultrasound curriculum taught by University of California, Irvine first-year medical students to attending and resident general practitioners working in public health care clinics—called puskesmas—in Bandung, Indonesia.

Methods
The short-term ultrasonography course was conducted at Dinas Kesehatan, the government-run health office that oversees all of the public clinics in Bandung, Indonesia. It was three weeks long and was divided into a session per subject along with 3 office hour periods.
During the first session, the subjects were administered a pre-course survey and pre-test. The course was taught in English, but subjects were given an Indonesian version to enhance comprehension. The ultrasound course curriculum was structured to begin each session with a lecture presentation on the given topic (30 mins), followed by hands-on ultrasound training (2 hours), followed by a short multiple choice quiz (10 minutes).

During the final session of the course, the students were given the post-test, which was identical to the pre-test. They also took a practical exam, a post-course survey, as well as an Intent to Use survey. The practical exam required the subjects to perform certain scans from each teaching session and was graded by the UCISOM medical student course directors for accuracy. For each question, the students could earn up to 3 points - 1 point for correct probe orientation and indicator positioning, 1 point for placing the probe in the correct anatomical position, and 1 point for producing the correct image and correctly identifying the structures on the image.

Results
The ultrasound curriculum had 52 physicians enrolled, with 41 completing the course, resulting in a 78.9% retention rate. Out of the 41 physicians who completed the course, 38 had attended all 6 class sessions . A majority of those physicians who completed the course reported minimal prior ultrasound exposure.

The average practical score was 83.2% (SD=0.145) with 82.9% of the class passing (score above 70.0%). The average pre-course final exam score was 35.2% with a 2.4% pass rate, whereas the average post-course final exam score was 82.0% with a 92.7% pass rate. Assuming equal variance, a two-tailed t-test was utilized, finding a highly significant difference in the scores between the pre-course final exam scores (M=0.352, SD=0.141) and post-course final exam scores (M=0.820, SD=0.117); t(80)= -16.4, p=2.83E-27.

Post-survey feedback indicated that the physicians found that watching the scans being performed was most helpful (M=4.60, SD=0.63), followed by practicing the scans (M=4.28, SD=1.21), attending class lecture (M=4.23, SD=0.80), studying online materials (M=3.54, SD=0.98), using other study tools (M=3.50, SD=0.92), and using the study guides (M=3.42, SD=1.36). On average, the physicians independently studied 2.57+/- 3.37 hours per week, and spent 0.66+/-1.49 hours per week in office hours.

Conclusion
Given our data, there is strong evidence that 1st year medical students with high quality, integrative, year long ultrasound education, can teach ultrasound to attending physicians in foreign countries, effectively, in a three week time frame. Further studies are necessary in order to characterize the long term retention of ultrasound knowledge as well as to determine the accuracy with which the physicians are able to diagnose pathology in clinical practice after taking the course.