Preceptor and medical students' perception of medical students' comfort with ultrasonography

Preceptor and medical students’ perception of medical students’ comfort with ultrasonography Tracey Criss, MD; Jeffrey Papazian, MD; Corey Heitz, MD; A Paul Dallas, MD; Tarin Schmidt-Dalton, MD; Janet Young, MD; Michael... [ view full abstract ]

Preceptor and medical students’ perception of medical students’ comfort with ultrasonography

Tracey Criss, MD; Jeffrey Papazian, MD; Corey Heitz, MD; A Paul Dallas, MD; Tarin Schmidt-Dalton, MD; Janet Young, MD; Michael Jones, MD; Elizabeth Pline, LMSW

Introduction:
As ultrasound-guided procedures have become an essential component of patient care across medical sub-specialties, we are challenged with ensuring that our medical school curriculum is reflective of its growing use. While incorporation into curriculum is becoming more common, important questions about the efficacy of formally implemented US-guided procedure training on medical student proficiency and comfort with ultrasound in the clinical setting have not yet been answered. At VTCSOM, our students have a 2 year longitudinal curriculum prior to clinical rotations. Beginning in 2014, during orientation to the 3rd year clerkships, they participate in a workshop in which they learn how to perform common procedures using US guidance. This study aims to evaluate whether medical student and preceptor perceptions of medical student comfort with ultrasound-guided procedures change with implementation of an orientation workshop.

Methods:
Surveys were given to both medical students and faculty to gauge medical student comfort with US procedures both with and without the workshop. Likert scales of 1-6 were used on 6 questions ranging from understanding of US physics and procedural efficiency to the use of US in clinical decision-making. Consecutive medical student classes (and their preceptors) were surveyed, with only the second class having undergone US workshop training. These two populations (and their preceptor perceptions) were statistically compared on each question using two-tailed P values to evaluate for statistical significance of changes in either medical student or preceptor perceptions.

Results:
Unpaired T-tests were done to evaluate for both preceptor and student perceptions of comfort with ultrasound-guided procedures. Responses of both preceptors and students varied, with student responses (31/40 for class of 2015 and 34/43 for class of 2016) exceeding those of faculty (18 responses regarding untrained class, 8 responses regarding trained class). Unpaired T-testing did not reveal significant changes in the Likert responses, before and after training, of both faculty and student perceptions. There were, however, trends toward improved scores from students regarding fundamental understanding, suggestion of US use for certain procedures, proficiency, and ability to augment decision making with ultrasound, with mean scores increasing in these areas. There were non-significant but decreased means in questions regarding knowledge of implementation and proficiency obtaining images. Regarding faculty, trending toward improvement was seen in 2 of the 6 questions (basic working knowledge of implementation and augmenting clinical decision-making with bedside ultrasonography).

Discussion:
As ultrasound use expands in the clinical setting, its integration into medical school clinical curriculum must be considered to ensure both competency in the mechanics of its use as well as early incorporation into clinical decision making. Our study aimed to evaluate the effect of an annual single-day procedural workshop on both faculty and medical student perceptions of comfort with ultrasonography. While our results did not reach statistical significance, they do suggest that such workshops may be correlated with increased student comfort with the use of procedural ultrasound. The extent and timing of training may be better elucidated with further studies, but the importance of training in this procedure will unquestionably become more vital as ultrasonography grows in its clinical footprint.