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      Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience

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          Abstract

          Introduction

          Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students.

          Methods

          This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students. Didactic and hands-on sessions were introduced to first-year students during gross anatomy and to second-year students in the physical exam course. Student-perceived attitudes, understanding, and knowledge of US, and its applications to learning the physical exam, were measured by a post-assessment survey.

          Results

          All first-year anatomy students (n=176) participated in small group hands-on US sessions. In the second-year physical diagnosis course, 38 students participated in four sessions. All students (91%) agreed or strongly agreed that additional US teaching should be incorporated throughout the four-year medical school curriculum.

          Conclusion

          POCUS can effectively be integrated into the existing medical school curriculum by using didactic and small group hands-on sessions. Medical students perceived US training as valuable in understanding human anatomy and in learning physical exam skills. This innovative program demonstrates US as an additional learning modality. Future goals include expanding on this work to incorporate US education into all four years of medical school.

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          Most cited references 21

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          An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience

          A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.
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            Point-of-care ultrasound in medical education--stop listening and look.

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              Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination.

              This study compared the accuracy of cardiovascular diagnoses by medical students operating a small hand-carried ultrasound (HCU) device with that of board-certified cardiologists using standard physical examinations. Sixty-one patients (38% women; mean age 70 +/- 19 years) with clinically significant cardiac disease had HCU studies performed by 1 of 2 medical students with 18 hours of training in cardiac ultrasound and physical examinations by 1 of 5 cardiologists. Diagnostic accuracy was determined by standard echocardiography. Two-hundred thirty-nine abnormal findings were detected by standard echocardiography. The students correctly identified 75% (180 of 239) of the pathologies, whereas cardiologists found 49% (116 of 239) (p <0.001). The students' diagnostic specificity of 87% was also greater than cardiologists' specificity of 76% (p <0.001). For nonvalvular pathologies (115 findings), students' sensitivity was 61%, compared with 47% for cardiologists (p = 0.040). There were 124 clinically significant valvular lesions (111 regurgitations, 13 stenoses). Students' and cardiologists' sensitivities for recognizing lesions that cause a systolic murmur were 93% and 62% (p <0.001), respectively. Students' sensitivity for diagnosing lesions that produce a diastolic murmur was 75%; cardiologists recognized 16% of these lesions (p <0.001). The diagnostic accuracy of medical students using an HCU device after brief echocardiographic training to detect valvular disease, left ventricular dysfunction, enlargement, and hypertrophy was superior to that of experienced cardiologists performing cardiac physical examinations.
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                Author and article information

                Journal
                West J Emerg Med
                West J Emerg Med
                WestJEM
                Western Journal of Emergency Medicine
                Department of Emergency Medicine, University of California, Irvine School of Medicine
                1936-900X
                1936-9018
                November 2016
                12 September 2016
                : 17
                : 6
                : 734-740
                Affiliations
                [* ]Harvard Medical School, Boston, Massachusetts
                []Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
                []Brigham and Women’s Hospital, Department of Cardiovascular Medicine, Boston, Massachusetts
                [§ ]Brigham and Women’s Hospital, Department of Internal Medicine, Boston, Massachusetts
                []Brigham and Women’s Hospital, Department of Radiology, Boston, Massachusetts
                [|| ]Harvard Medical School, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
                [# ]Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
                [** ]Harvard Medical School, Department of Medicine, Division of Rheumatology, Allergy, Immunology, Boston, Massachusetts
                Author notes
                Address for Correspondence: Joshua S. Rempell, MD, MPH, Harvard Medical School, Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis Street, Boston, MA 02115. Email: jrempell@ 123456partners.org .
                Article
                wjem-17-734
                10.5811/westjem.2016.8.31387
                5102600
                09834cb2-c078-4a12-873f-ea64716a725f
                © 2016 Rempell et al.

                This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/

                Categories
                Education
                Educational Advances

                Emergency medicine & Trauma

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