The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience

Richard A Hoppmann, Victor V Rao, Floyd Bell, Mary Beth Poston, Duncan B Howe, Shaun Riffle, Stephen Harris, Ruth Riley, Carol McMahon, L Britt Wilson, Erika Blanck, Nancy A Richeson, Lynn K Thomas, Celia Hartman, Francis H Neuffer, Brian D Keisler, Kerry M Sims, Matthew D Garber, C Osborne Shuler, Michael Blaivas, Shawn A Chillag, Michael Wagner, Keith Barron, Danielle Davis, James R Wells, Donald J Kenney, Jeffrey W Hall, Paul H Bornemann, David Schrift, Patrick S Hunt, William B Owens, R Stephen Smith, Allison G Jackson, Kelsey Hagon, Steven P Wilson, Stanley D Fowler, James F Catroppo, Ali A Rizvi, Caroline K Powell, Thomas Cook, Eric Brown, Fernando A Navarro, Joshua Thornhill, Judith Burgis, William R Jennings, James B McCallum, James M Nottingham, James Kreiner, Robert Haddad, James R Augustine, Norman W Pedigo, Paul V Catalana, Richard A Hoppmann, Victor V Rao, Floyd Bell, Mary Beth Poston, Duncan B Howe, Shaun Riffle, Stephen Harris, Ruth Riley, Carol McMahon, L Britt Wilson, Erika Blanck, Nancy A Richeson, Lynn K Thomas, Celia Hartman, Francis H Neuffer, Brian D Keisler, Kerry M Sims, Matthew D Garber, C Osborne Shuler, Michael Blaivas, Shawn A Chillag, Michael Wagner, Keith Barron, Danielle Davis, James R Wells, Donald J Kenney, Jeffrey W Hall, Paul H Bornemann, David Schrift, Patrick S Hunt, William B Owens, R Stephen Smith, Allison G Jackson, Kelsey Hagon, Steven P Wilson, Stanley D Fowler, James F Catroppo, Ali A Rizvi, Caroline K Powell, Thomas Cook, Eric Brown, Fernando A Navarro, Joshua Thornhill, Judith Burgis, William R Jennings, James B McCallum, James M Nottingham, James Kreiner, Robert Haddad, James R Augustine, Norman W Pedigo, Paul V Catalana

Abstract

Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years. A review of the curriculum is presented, including curricular content, methods of delivery of the content, student assessment, and program assessment. Lessons learned in implementing and expanding an integrated ultrasound curriculum are also presented as are thoughts on future directions of undergraduate ultrasound education. Ultrasound has proven to be a valuable active learning tool that can serve as a platform for integrating the medical student curriculum across many disciplines and clinical settings. It is also well-suited for a competency-based model of medical education. Students learn ultrasound well and have embraced it as an important component of their education and future practice of medicine. An international consensus conference on ultrasound education is recommended to help define the essential elements of ultrasound education globally to ensure ultrasound is taught and ultimately practiced to its full potential. Ultrasound has the potential to fundamentally change how we teach and practice medicine to the benefit of learners and patients across the globe.

Keywords: Education; Integrated curriculum; Medical students; Ultrasound.

Figures

Fig. 1
Fig. 1
Ultrasound OSCE scoring checklist
Fig. 2
Fig. 2
Student ultrasound image evaluation via cloud-based review portal

References

    1. 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.
    1. 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. doi: 10.1007/s13089-011-0052-9.
    1. PubMed (2015) Bethesda, MD. . Accessed 29 August 2015
    1. Solomon SD, Saldana F. Point-of-care ultrasound in medical education—stop listening and look. N Engl J Med. 2014;370:1083–1085. doi: 10.1056/NEJMp1311944.
    1. Hoppmann R, Blaivas M, Elbarbary M. Better medical education and healthcare through point-of-care ultrasound. Acad Med. 2012;87:134. doi: 10.1097/ACM.0b013e31823f0e8f.
    1. Alpert JS, Mladenovic J, Hellman DB. Should a hand-carried ultrasound machine become standard equipment for every internist? Am J Med. 2009;122:1–3. doi: 10.1016/j.amjmed.2008.05.013.
    1. Pawlina W, Drake R. New (or not-so-new) tricks for old dogs: ultrasound imaging in anatomy laboratories. Anat Sci Educ. 2015;8(3):195–196. doi: 10.1002/ase.1533.
    1. Badea R. Medical education of students and residents—a new paradigm? Med Ultrason. 2012;14(3):175–176.
    1. Baltarowich OH, Di Salvo DN, Scoutt LM, Brown DL, Cox CW, DiPietro MA, Glazer DI, Hamper UM, Manning MA, Nazarian LN, Neutze JA, Romero M, Stephenson JW, Dubinsky TJ. National ultrasound curriculum for medical students. Ultrasound Q. 2014;30(1):13–19. doi: 10.1097/RUQ.0000000000000066.
    1. Cawthorn TR, Nickel C, O’Reilly M, Kafka H, Tam JW, Jackson LC, Sanfilippo AJ, Johri AM. Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. J Am Soc Echocardiogr. 2014;27:302–309. doi: 10.1016/j.echo.2013.12.006.
    1. Mulvagh SL, Bhagra A, Nelson BP, Narula J. Handheld ultrasound devices and the training conundrum: how to get to “seeing is believing”. J Am Soc Echocardiogr. 2014;27:310–313. doi: 10.1016/j.echo.2014.01.011.
    1. Cortez EJ, Boulger CT, Eastin T, Adkins EJ, Granitto E, Pollard K, Bahner DP. The ultrasound challenge 2.0: introducing interinstitutional competition in medical student ultrasound education. J Ultrasound Med. 2014;33(12):2193–2196. doi: 10.7863/ultra.33.12.2193.
    1. Dubosh NM. Ultrasound interest group: a novel method of expanding ultrasound education in medical school. Crit Ultrasound J. 2011;3:131–134. doi: 10.1007/s13089-011-0088-x.
    1. Connolly K, Beier L, Langdorf MI, Anderson CL, Fox JC. Ultrafest: a novel approach to ultrasound in medical education leads to improvement in written and clinical examinations. West J Emerg Med. 2015;16(1):143–148. doi: 10.5811/westjem.2014.11.23746.
    1. Hoppmann R, Harper S, Harris S, Howe D, Poston MB, Rao V, Riffle S, Riley R. Ultrasound: a core clinical competency for medical students. J S C Med Assoc. 2014;110(2):54–57.
    1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757. doi: 10.1056/NEJMra0909487.
    1. Shekelle PG, Pronovost PJ, Wachter RM, McDonald KM, Schoelles K, Dy SM, Shojania K, Reston JT, Adams AS, Angood PB, Bates DW, Bickman L, Carayon P, Donaldson L, Duan N, Farley DO, Greenhalgh T, Haughom JL, Lake E, Lilford R, Lohr KN, Meyer GS, Miller MR, Neuhauser DV, Ryan G, Saint S, Shortell SM, Stevens DP, Walshe K. The top patient safety strategies that can be encouraged for adoption now. Ann Intern Med. 2013;158(5 Pt 2):365–368. doi: 10.7326/0003-4819-158-5-201303051-00001.
    1. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117–125. doi: 10.1378/chest.07-2800.
    1. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: rapid ultrasound in shock in the critically ill. Emerg Med Clin N Am. 2010;28:29–56. doi: 10.1016/j.emc.2009.09.010.
    1. Benacerraf BR, Abuhamad AZ, Bromley B, Goldstein SR, Groszmann Y, Shipp TD, Timor-Tritsch IE. Consider ultrasound first for imaging of the female pelvis. Am J Obstet Gynecol. 2015;212(4):450–455. doi: 10.1016/j.ajog.2015.02.015.
    1. Minton KK, Abuhamad A. 2012 ultrasound first forum proceedings. J Ultrasound Med. 2013;32(4):555–566. doi: 10.7863/ultra.32.4.555.
    1. Adhikari S, Blaivas M. Sonography first for subcutaneous abscess and cellulitis evaluation. J Ultrasound Med. 2012;31(10):1509–1512.
    1. Goldstein SR. The sound judgment series. J Ultrasound Med. 2012;31:189–190.
    1. Linam LE, Munder M. Sonography as the first line of evaluation in children with suspected acute appendicitis. J Ultrasound Med. 2012;31:1153–1157.
    1. Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Jr, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL, Kriesel DR, Ma OJ, Mallin M, Manson W, Melnikow J, Miglioretti DL, Miller SK, Mills LD, Miner JR, Moghadassi M, Noble VE, Press GM, Stoller ML, Valencia VE, Wang J, Wang RC, Cummings SR. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014;371(12):1100–1110. doi: 10.1056/NEJMoa1404446.
    1. Ng C, Tsung JW. Avoiding computed tomography scans by using point-of-care ultrasound when evaluating suspected pediatric renal colic. J Emerg Med. 2015
    1. Ma OJ, Norvell JG, Subramanian S. Ultrasound applications in mass casualties and extreme environments. Crit Care Med. 2007;35:S275–S279. doi: 10.1097/01.CCM.0000260677.29207.B4.
    1. Peoples GE, Gerlinger T, Craig R, Burlingame B. Combat casualties in Afghanistan cared for by a single forward surgical team during the initial phases of operation enduring freedom. Mil Med. 2005;170:462–468. doi: 10.7205/MILMED.170.6.462.
    1. Kimberly HH, Stone MB. Clinician-performed ultrasonography during the Boston marathon bombing mass casualty incident. Ann Emerg Med. 2013;62(2):199–200. doi: 10.1016/j.annemergmed.2013.05.014.
    1. Shah S, Noble VE, Umulisa I, Dushimiyimana JMV, Bukhman G, Mukherjee J, Rich M, Epino H. Development of an ultrasound training curriculum in a limited resource international setting: successes and challenges of ultrasound training in rural Rwanda. Int J Emerg Med. 2008;1:193–196. doi: 10.1007/s12245-008-0053-z.
    1. Wagner MS, Garcia K, Martin DS. Point-of-care ultrasound in aerospace medicine: known and potential applications. Aviat Space Environ Med. 2014;85(7):730–739. doi: 10.3357/ASEM.3754.2014.
    1. Kufta JM, Dulchavsky SA. Medical care in outer space: a useful paradigm for underserved regions on the planet. Sur. 2013;154(5):943–945. doi: 10.1016/j.surg.2013.06.003.
    1. Zadel S, Strnad M, Prosen G, Mekis D. Point of care ultrasound for orotracheal tube placement assessment in out-of-hospital setting. Resusc. 2015;87:1–6.
    1. Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in U.S. medical schools: results of a national survey. Acad Med. 2014;89(12):1681–1686. doi: 10.1097/ACM.0000000000000414.
    1. 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.
    1. Bahner DP. Advanced ultrasound training for fourth-year medical students: a novel training program at the Ohio State University College of Medicine. Acad Med. 2013;88:206–213. doi: 10.1097/ACM.0b013e31827c562d.
    1. Brown B, Adhikari Srikar, Marx Jared, Lander Lina, Todd Gordon L. Introduction of ultrasound into gross anatomy curriculum: perceptions of medical students. J Emerg Med. 2012;43(6):1098–1102. doi: 10.1016/j.jemermed.2012.01.041.
    1. Dinh VA, Frederick J, Bartos R, Shankel TM, Werner Effects of ultrasound implementation on physical examination learning and teaching during the first year of medical education. J Ultrasound Med. 2015;34(1):43–50. doi: 10.7863/ultra.34.1.43.
    1. Di Salvo DN. Redesign and implementation of the radiology clerkship: from traditional to longitudinal and integrative. J Am Coll Radiol. 2014;11(4):413–420. doi: 10.1016/j.jacr.2013.05.018.
    1. Fernandez-Frackelton M, Peterson M, Lewis RJ, Perez JE, Coates WC. A bedside ultrasound curriculum for medical students: prospective evaluation of skill acquisition. Teach Learn Med. 2007;19(1):14–19. doi: 10.1080/10401330709336618.
    1. Fox JC, Schlang JR, Maldonado G, Lotfipour S, Clayman RV. Proactive medicine: the “UCI 30,” an ultrasound-based clinical initiative from the University of California, Irvine. Acad Med. 2014;89(7):984–989. doi: 10.1097/ACM.0000000000000292.
    1. Fodor D, Badea R, Poanta L, Dumitrascu DL, Buzoianu AD, Mircea PA. The use of ultrasonography in learning clinical examination—a pilot study involving third year medical students. Med Ultrason. 2012;14(3):177–181. doi: 10.11152/mu.2013.2066.143.df177.
    1. Ahn JS, French AJ, Thiessen ME, Kendall JL. Training peer instructors for a combined ultrasound/physical exam curriculum. Teach Learn Med. 2014;26(3):292–295. doi: 10.1080/10401334.2014.910464.
    1. Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of ultrasound into gross anatomy curriculum: perceptions of medical students. J Emerg Med. 2012;43:1098–1102. doi: 10.1016/j.jemermed.2012.01.041.
    1. Jamniczky HA, McLaughlin K, Kaminska ME, Raman M, Somayaji R, Wright B, Ma IWY. Cognitive load imposed by knobology may adversely affect learners’ perception of utility in using ultrasonography to learn physical examination skills, but not anatomy. Anat Sci Educ. 2015;8:197–204. doi: 10.1002/ase.1467.
    1. Jurjus RA, Dimorier K, Brown K, Slaby F, Shokoohi H, Boniface K, Liu YT. Can anatomists teach living anatomy using ultrasound as a teaching tool? Anat Sci Educ. 2014;7:340–349. doi: 10.1002/ase.1417.
    1. Ultrasound Institute (2015) Learning modules. . Accessed 1 September 2015
    1. Ultrasound Institute (2015) YouTube channel. . Accessed 1 September 2015
    1. Hoppmann R, Michell W, Carter J, McMahon C, Lill P, Brownlee N, Carnevale K. Ultrasound in second year pathology medical education. J South Carolina Acad Sci. 2008;7:11–12.
    1. Williams SR, Perera P, Gharahbaghian L. The FAST and E-FAST in 2013: trauma ultrasonography: overview, practical techniques, controversies, and new frontiers. Crit Care Clin. 2014;30(1):119–150. doi: 10.1016/j.ccc.2013.08.005.
    1. Kimura BJ, Yogo N, O’Connell WO, Phan JN, Showalter BK, Wolfson T. Cardiopulmonary limited ultrasound examination for “Quick-Look” bedside application. Am J Cardiol. 2011;108:586–590. doi: 10.1016/j.amjcard.2011.03.091.
    1. Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Med Teach. 2010;32:631–637. doi: 10.3109/0142159X.2010.500898.
    1. Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32:638–645. doi: 10.3109/0142159X.2010.501190.
    1. Hoppmann R, Hunt P, Louis H, Keisler B, Richeson N, Rao V, Stacy J, Howe D. Medical student identification of knee effusion by ultrasound. ISRN Rheumatol. 2011
    1. Mouratev G, Howe D, Hoppmann R, Poston MB, Reid R, Varnadoe J, Smith S, McCallum B, Rao V, Demarco P. Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone. Teach Learn Med. 2013;25(1):84–88. doi: 10.1080/10401334.2012.741535.
    1. The Society of Ultrasound in Medical Education (2015) SUSME. . Accessed 1 September 2015
    1. World Interactive Network Focused on Critical Ultrasound (2015) WINFOCUS. . Accessed 1 September 2015
    1. Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, Pirotte T, Karakitsos D, LeDonne J, Doniger S, Scoppettuolo G, Feller-Kopman D, Schummer W, Biffi R, Desruennes E, Melniker LA, Verghese ST. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med. 2012;38:1105–1117. doi: 10.1007/s00134-012-2597-x.
    1. Via G, Hussain A, Wells M, Reardon R, ElBarbary M, Noble VE, Tsung JW, Neskovic AN, Price S, Oren-Grinberg A, Liteplo A, Cordioli R, Naqvi N, Rola P, Poelaert J, Guliĉ TG, Sloth E, Labovitz A, Kimura B, Breitkreutz R, Masani N, Bowra J, Talmor D, Guarracino F, Goudie A, Xiaoting W, Chawla R, Galderisi M, Blaivas M, Petrovic T, Storti E, Neri L, Melniker L (2014) International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr 27(7):683.e1–683.e33. doi:10.1016/j.echo.2014.05.001
    1. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–591. doi: 10.1007/s00134-012-2513-4.

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