A Limited First Year Medical Student Ultrasound Exposure Program Designed to Emphasize Standardized Patient Interactions: Student Assessment of Program Success

INTRODUCTION Inclusion of ultrasound training in preclinical years of medical education is gaining widespread acceptance. Budgetary constraints coupled with limitations in available faculty and facility resources and... [ view full abstract ]

INTRODUCTION
Inclusion of ultrasound training in preclinical years of medical education is gaining widespread acceptance. Budgetary constraints coupled with limitations in available faculty and facility resources and curricular free time necessitates different institutional approaches. We recently completed an inaugural year of a limited ultrasound curriculum designed for first year students that required only a minimal investment in the purchasing of point-of-care devices, relied on volunteer clinical faculty and emphasized interactive scanning with standardized patients (SPs).

METHODS
Our College of Medicine (COM) budget placed constraints on how we could institute an ultrasound curriculum. The COM provided funds to purchase 12 GE Dual Probe Vscan devices with an additional four backup Vscan devices funded by grants from the Parents Club and the Arkansas Medical Society. The COM curriculum committee only released 6 hours for our inaugural M1 ultrasound curriculum. This included a one-hour introductory lecture by a radiologist and 5 separate one-hour hands on sessions (i.e., introductory, abdomen, heart and lungs, peripheral vessels, and kidneys/pelvic organs). The first session involved student use of the devices on classmates in our active learning center. The remaining four sessions involved scanning of standardized patients in a simulated clinical exam room environment. The standardized patients were paid but received no formal training for the ultrasound sessions. The 174 student class was subdivided into groups based on their existing 5 member gross anatomy dissection teams. Student groups were randomly assigned to one of three rotating one-hour sessions conducted on a single afternoon (~60 students/hr; 12 SPs). Six basic science faculty from the gross anatomy course were supplemented by volunteer clinicians (faculty, residents and fellows) recruited primarily from radiology, emergency medicine and cardiology. All faculty were instructed to verbally guide students through the session objectives or physically manipulate student hands on the probes rather than demonstrate themselves in order to maximize student hands on experience during the limited length of the sessions. Each student obtained specific scans before the group proceeded to the next scanning target. In two of the sessions, groups rotated to adjacent examination rooms to gain exposure to patient variability. An end of year anonymous survey (LIKERT and open response) was used to assess student overall assessment of the program, the program faculty, student interactions with the SPs and student self reported learning (69 responses to date).

RESULTS
Students agreed/strongly agreed that the limited M1 ultrasound curriculum was outstanding (85%), that the sessions provided clinically relevant knowledge (95%), and that they were satisfied with the overall experience (92%). The vast majority thought that the number (81%) and length (79%) of the ultrasound sessions throughout the year was about right, though 18% indicated that the number of sessions was too few and 15% indicated that the sessions were too short. Students agreed/strongly agreed that they had received sufficient training on how to use the Vscan devices during the year (84%) but a significant percentage indicated that they didn’t understand specific aspects of the underlying physics (range of 13-33%). They overwhelmingly liked using the state-of-the-art Vscan devices (79%), visualizing dynamic anatomy (89%), and using ultrasound to review anatomical concepts (87%). They liked conducting scans on SPs (90%), enjoyed their interactions with the SPs (95%) and thought these interactions were a valuable experience (97%). Students considered the group of clinicians to be excellent facilitators (90%) more so than the group of PhDs (62%), however only 20% thought that only clinicians should be used to run the sessions. Most of the students indicated that they were looking forward to the M2 ultrasound curriculum (79%) but expected to see more examples of patients with diseases next year (70%).

CONCLUSIONS
The success of our inaugural curriculum demonstrates that positive outcomes are achievable from a limited first year ultrasound exposure program. The small number of dedicated curricular hours and available ultrasound devices coupled with the use of existing resources (i.e., faculty and SPs) indicates that budgetary and resource constraints do not need to be a deterrent to inclusion of ultrasound training in undergraduate medical education. The student evaluations provided valuable feedback for ongoing curricular revisions and planning for the upcoming year.