Advanced Competency in Bedside Ultrasound for Medical Students

Objectives The outcome goals for clinician-performed ultrasound education in medical school remain largely undefined. We sought to create an adaptable framework of goals to guide bedside ultrasound education in medical school.... [ view full abstract ]

Objectives
The outcome goals for clinician-performed ultrasound education in medical school remain largely undefined. We sought to create an adaptable framework of goals to guide bedside ultrasound education in medical school. Our aim was to provide a framework for producing "advanced competency" in ultrasound for students. We define advanced competency as a compliment of skills and knowledge which will have relevance to practice immediately upon entering residency. The framework presented here is meant to be adaptable to a wide variety of educational needs at different institutions.

Methods
We began with a review of institutional practices at the Ohio State University College of Medicine (OSUCOM). OSUCOM has a well-established longitudinal US education program for undergraduate medical students. Literature review was also conducted focusing on education and assessment practices in other ultrasound education programs. After reviewing the experiences at out own institution and others, we defined four key competency areas for advanced competency: conceptual knowledge, scanning skills, practice improvement, and leadership.

Results
To achieve advanced competency students must meet requirements in each of the four competency areas. The benchmark requirement for conceptual knowledge is 150 hours of participation in faculty-approved focused ultrasound curriculum. This curriculum ideally covers basic ultrasound physics and machine operation as well as anatomy, physiology, indications, interpretation, and medical decision-making associated with ultrasound scans in multiple organ systems. We see asynchronous computer learning as a major tool for aiding in the delivery this conceptual knowledge. There are a number of high quality ultrasound teaching tools available and asynchronous learning is widely used in current ultrasound education programs.

Requirements for scanning skills are meant to ensure students have the technical expertise to acquire quality images in a simulated and clinical setting. The scanning requirements include performing at least 50 complete scans. At least 10 of these must be completed in a clinical setting. Furthermore, at least five of these clinical scans should undergo faculty review for scanning quality. The type and number of scans completed should ideally cover a wide range of organ systems, but can be determined by the goals of the individual program.

The practice improvement competency insures students have the ability to develop and adapt their ultrasound practice based on new knowledge. Practice improvement competency requires students to participate in at least 10 hours of a physician-led journal club. The student must evaluate and lead discussion on a scholarly work related to ultrasound on at least one occasion.

The leadership competency is meant to insure students have skills to advocate and implement improved use of appropriate focused ultrasound in the clinical and educational setting. This competency requires students to participate in extracurricular activities related to promoting ultrasound education and practice. Some institutions have a formal Ultrasound Interest Group (USIG) which might serve as a means to achieve this goal. However, each institution should be free to structure such advocacy and improvement work based on their unique situation.

Some students at our institution have gone above and beyond these basic requirements, and other interested students may choose to do so in the future. As such, we have created higher levels of distinction as a means to emphasize the performance of such students who surpass the minimum competency requirements in each of the key areas (see table).

Conclusion
This framework seeks to aid in the education of ultrasound-capable physicians with broad skills in ultrasound usage and systems improvement. Past OSUCOM students have achieved these competency goals and have gone on to make positive contributions to clinical care using bedside ultrasound. This is why we believe achieving advanced competency as a student is both feasible and clinically relevant. This framework is also adaptable: the educational content itself is to be determined by the needs of individual programs. Furthermore, the increasing use of asynchronous learning and simulation technology provides a wide range of possibilities on how to deliver content. Further work remains to be done on the optimal approach to ultrasound education of medical students. However we believe other institutions might adopt and adapt this framework as a means to structure new or existing ultrasound training programs for medical students.