Integrated medical school ultrasound: development of an ultrasound vertical curriculum
Tóm tắt
Physician-performed focused ultrasonography is a rapidly growing field with numerous clinical applications. Focused ultrasound is a clinically useful tool with relevant applications across most specialties. Ultrasound technology has outpaced the education, necessitating an early introduction to the technology within the medical education system. There are many challenges to integrating ultrasound into medical education including identifying appropriately trained faculty, access to adequate resources, and appropriate integration into existing medical education curricula. As focused ultrasonography increasingly penetrates academic and community practices, access to ultrasound equipment and trained faculty is improving. However, there has remained the major challenge of determining at which level is integrating ultrasound training within the medical training paradigm most appropriate. The Ohio State University College of Medicine has developed a novel vertical curriculum for focused ultrasonography which is concordant with the 4-year medical school curriculum. Given current evidenced-based practices, a curriculum was developed which provides medical students an exposure in focused ultrasonography. The curriculum utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science within the medical school curriculum. The objectives of the course are to develop student understanding in indications for use, acquisition of images, interpretation of an ultrasound examination, and appropriate decision-making of ultrasound findings. Preliminary data indicate that a vertical ultrasound curriculum is a feasible and effective means of teaching focused ultrasonography. The foreseeable limitations include faculty skill level and training, initial cost of equipment, and incorporating additional information into an already saturated medical school curriculum. Focused ultrasonography is an evolving concept in medicine. It has been shown to improve education and patient care. The indications for and implementation of focused ultrasound is rapidly expanding in all levels of medicine. The ideal method for teaching ultrasound has yet to be established. The vertical curriculum in ultrasound at The Ohio State University College of Medicine is a novel evidenced-based training regimen at the medical school level which integrates ultrasound training into medical education and serves as a model for future integrated ultrasound curricula.
Tài liệu tham khảo
Moore CL, Copel JA: Point-of-care ultrasonography. N Engl J Med 2011,364(8):749–757.
Maitino AJ, Levin DC, Rao VM, Parker L, Sunshine JH: Do emergency medicine physicians perform ultrasound and conventional radiography in the emergency department? Recent trends from 1993 to 2001. J Am Coll Radiol 2005,2(3):274–278.
American Medical Association House of Delegates: Privileging for ultrasound imaging. H-230.960 (Res. 802) (I-99). American Medical Association, Chicago; 1999.
American Medical Association House of Delegates: Reimbursement for office-based or outpatient ultrasound imaging. H-385.934 (Sub. Res. 108) (A-00). American Medical Association, Chicago; 2000.
American College of Emergency Physicians: Use of ultrasound imaging by emergency physicians. Ann Emerg Med 2001,38(4):469–470.
American College of Emergency Physicians: Emergency ultrasound guidelines. Ann Emerg Med 2009,53(4):550–570.
American Medical Association: Physicians’ Current Procedural Terminology (CPT) 2011. American Medical Association, Chicago; 2011.
Thomas B, Falcone RE, Vasquez D, Santanello S, Townsend M, Hockenberry S, Innes J, Wanamaker S: Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve. J Trauma 1997,42(3):384–388. discussion 388–90
Accreditation Council for Graduate Medical Education (ACGME): Emergency Medicine Guidelines. 2012. . Accessed February 2013 http://www.acgme.org/acgmeweb/tabid/292/ProgramandInstitutionalGuidelines/Hospital-BasedAccreditation/EmergencyMedicine/EmergencyMedicineGuidelines.aspx
Accreditation Council for Graduate Medical Education (ACGME): ACGME Program Requirements for Graduate Medical Education in Obstetrics and Gynecology. 2008. . Accessed February 2013 http://www.acgme.org/acWebsite/downloads/RRC_progReq/220obstetricsandgynecology01012008.pdf
Accreditation Council for Graduate Medical Education (ACGME): Program Requirements for Graduate Medical Education in Diagnostic Radiology. 2008. . Accessed February 2013 https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/420_diagnostic_radiology_07012008.pdf
Filly RA: Radiology residency training in diagnostic sonography. J Ultrasound Med 1989,8(9):475.
Kern SJ, Smith RS, Fry WR, Helmer SD, Reed JA, Chang FC: Sonographic examination of abdominal trauma by senior surgical residents. Am Surg 1997,63(8):669–674.
Akhtar S, Theodoro D, Gaspari R, Tayal V, Sierzenski P, Lamantia J, Stahmer S, Raio C: Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference. Acad Emerg Med 2009,16(Suppl 2):S32-S36.
Wittich CM, Montgomery SC, Neben MA, Palmer BA, Callahan MJ, Seward JB, Pawlina W, Bruce CJ: Teaching cardiovascular anatomy to medical students by using a handheld ultrasound device. JAMA 2002,288(9):1062–1063.
Shapiro RS, Ko PK, Jacobson S: A pilot project to study the use of ultrasonography for teaching physical examination to medical students. Comput Biol Med 2002,32(6):403–409.
Yoo MC, Villegas L, Jones DB: Basic ultrasound curriculum for medical students: validation of content and phantom. J Laparoendosc Adv Surg Tech A 2004,14(6):374–379.
Tshibwabwa ET, Groves HM: Integration of ultrasound in the education programme in anatomy. Med Educ 2005,39(11):1148.
Decara JM, Kirkpatrick JN, Spencer KT, Ward RP, Kasza K, Furlong K, Lang RM: Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses. J Am Soc Echocardiogr 2005,18(3):257–263.
Arger PH, Schultz SM, Sehgal CM, Cary TW, Aronchick J: Teaching medical students diagnostic sonography. J Ultrasound Med 2005,24(10):1365–1369.
Hoppmann R, Cook T, Hunt P, Fowler S, Paulman L, Wells J, Richeson N, Thomas L, Wilson B, Neuffer F, McCallum J, Smith S: Ultrasound in medical education: a vertical curriculum at the University of South Carolina School of Medicine. J S C Med Assoc 2006,102(10):330–334.
Tshibwabwa ET, Groves HM, Levine MA: Teaching musculoskeletal ultrasound in the undergraduate medical curriculum. Med Educ 2007,41(5):517–518.
Butter J, Grant TH, Egan M, Kaye M, Wayne DB, Carrión-Carire V, McGaghie WC: Does ultrasound training boost year 1 medical student competence and confidence when learning abdominal examination? Med Educ 2007,41(9):843–848.
Angtuaco TL, Hopkins RH, DuBose TJ, Bursac Z, Angtuaco MJ, Ferris EJ: Sonographic physical diagnosis 101: teaching senior medical students basic ultrasound scanning skills using a compact ultrasound system. Ultrasound Q 2007,23(2):157–160.
Wright SA, Bell AL: Enhancement of undergraduate rheumatology teaching through the use of musculoskeletal ultrasound. Rheumatology (Oxford) 2008,47(10):1564–1566.
Syperda VA, Trivedi PN, Melo LC, Freeman ML, Ledermann EJ, Smith TM, Alben JO: Ultrasonography in preclinical education: a pilot study. J Am Osteopath Assoc 2008,108(10):601–605.
Afonso N, Amponsah D, Yang J, Mendez J, Bridge P, Hays G, Baliga S, Crist K, Brennan S, Jackson M, Dulchavsky S: Adding new tools to the black bag—introduction of ultrasound into the physical diagnosis course. J Gen Intern Med 2010,25(11):1248–1252.
Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, Paulman LE, Wells JR, Richeson NA, Catalana PV, Thomas LK, Britt Wilson L, Cook T, Riffle S, Neuffer FH, McCallum JB, Keisler BD, Brown RS, Gregg AR, Sims KM, Powell CK, Garber MD, Morrison JE, Owens WB, Carnevale KA, Jennings WR, Fletcher S: An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011,3(1):1–12.
Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, Jackson M, Dulchavsky SA: A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med 2008,27(5):745–749.
Cook T, Hunt P, Hoppman R: Emergency medicine leads the way for training medical students in clinician-based ultrasound: a radical paradigm shift in patient imaging. Acad Emerg Med 2007,14(6):558–561.
Kessler C, Bhandarkar S: Ultrasound training for medical students and internal medicine residents—a needs assessment. J Clin Ultrasound 2010,38(8):401–408.
Bahner DP: Trinity: a hypotensive ultrasound protocol. JDMS 2002,18(4):193–198.
Bahner DP, Hughes D, Royall NA: I-AIM: a novel model for teaching and performing focused ultrasound. J Ultrasound Med 2012,31(2):295–300.
Blankenship R, Jones R: EMSONO. 2011. . Accessed February 2011 http://www.emsono.com
Frezza EE, Solis RL, Silich RJ, Spence RK, Martin M: Competency-based instruction to improve the surgical resident technique and accuracy of the trauma ultrasound. Am Surg 1999,65(9):884–888.
Bahner DP, Adkins EJ, Nagel N, Way D, Werman HA, Royall NA: Brightness mode quality ultrasound imaging examination technique (BQUIET): quantifying quality in ultrasound imaging. J Ultrasound Med 2011,30(12):1649–1655.