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Overview

A Novel Ultrasound Curriculum For Teaching The Focused Assessment With Sonography In Trauma Exam To Undergraduate Medical Students. Trevor Gessel , BS, Daniel Cieslak , BS, BA, Richmond Doxey , BS, Mary Beth Phelan, MD, RDMS, Caroline Pace, MD. Overview. Introduction

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Overview

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  1. A Novel Ultrasound Curriculum For Teaching The Focused Assessment With Sonography In Trauma Exam To Undergraduate Medical Students Trevor Gessel, BS, Daniel Cieslak, BS, BA, Richmond Doxey, BS, Mary Beth Phelan, MD, RDMS, Caroline Pace, MD

  2. Overview • Introduction • Materials and Methods • Results • Conclusion

  3. Introduction • Ultrasound curriculum needed in Medical School • Ubiquity among specialties • Operator-dependent skill • Students have shown interest • Undergraduate medical education ultrasound training • Quantity? • Components?

  4. FAST exam http://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Bugatti_Veyron_16.4_–_Frontansicht

  5. Right upper quadrant Subxiphoid Suprapubic Left upper quadrant

  6. 2nd Year Medical Students http://upload.wikimedia.org/wikipedia/commons/2/2c Inside_a_classroom_of_a_school_in_Kabul.jpg

  7. Materials and Methods • Online Modules • Society for Ultrasound in Medical Education (SUSME) • Didactic Sessions • 2 one-hour sessions • Training Session • Live model • Normal exam

  8. Materials and Methods • Simulation Session • UltraSim® from MedSim • Abnormal exam (positive findings) • Final Competency Exam • Simulator (abnormal) exam • Live (normal) exam

  9. Materials and Methods • Data Collection • Participant surveys • Previous experience and Interest • Satisfaction and Confidence • Analysis • Surveys • Performance on Final Competency Exam

  10. Recruitment n=208 Did not Respond, n=182 Declined to Participate, n=3 Introductory Session n=23 No-Showed, n=10 Declined to Participate, n=0 Online Modules n=13 Completed Modules, n=12 Lost to Follow-up, n=1 FAST Didactic Sessions n=12 Training Session for the Normal FAST Exam n=12 Completed Session, n=12 Did Not Complete Session, n=0 Simulation Session for the Abnormal FAST Exams n=12 Final Competency Exam n=12 Results

  11. FinalExam Didactic Session 1 Didactic Session 2 Hands-On Session Simulation Session Results

  12. Didactic Session 1 Didactic Session 1 Didactic Session 1 Didactic Session 1 Didactic Session 2 Didactic Session 2 Didactic Session 2 Didactic Session 2 Hands-On Session Hands-On Session Hands-On Session Hands-On Session Simulation Session Simulation Session Simulation Session Simulation Session Final Exam Final Exam Final Exam Final Exam Results - Confidence

  13. PGY1 PGY2 PGY3 Results - Competence Live Model Exam Simulator Exam

  14. Conclusions • Successfully taught basic sonography skills • Students generally satisfied with the curriculum • Multiple strategies successful in ultrasound curricula • Hands-on experience is vital

  15. Questions?

  16. Thank you!

  17. References • PredanicM, Cho A, Ingrid F, Pelletieri J. Ultrasonographic estimation of fetal weight: acquiring accuracy in residency. J Ultrasound Med 2002; 21:495-500. • International Society of Ultrasound in Obstetrics & Gynecology Education Committee. Sonographic examination of the fetal central nervous system: guidelines for performing the ‘basic examination’ and the ‘fetal neurosonogram’. Ultrasound ObstetGynecol 2007; 29: 109-116. • Steno A, Karlik M, Mendel P, Steno J. Navigated three-dimensional intraoperative ultrasound-guided awake resection of low-grade glioma partially infiltrating optic radiation. ActaNeurohir 2012;154:1255-1262. • Hamann MF, Hamann C, Schenk E, et al. Computer-aided (histoscanning) biopsies versus conventional transrectal ultrasound-guided prostate biopsies: do targeted biopsy schemes improve the cancer detection rate? Urology 2013; 81:370-375. • Gravvanis A, Tsoutsos D, Delikonstantinou I, Dimitriou V, Katsikeris N. Impact of portable duplex ultrasonography in head and neck reconstruction. J CraniofacSurg 2012; 23:140-144. • Balki M. Locating the epidural space in obstetric patients-ultrasound a useful tool: continuing professional development. Can J Anaesth 2010; 57:1111-1126. • Antonakakis JG, Ting PH, Sites B. Ultrasound-guided regional anesthesia for peripheral nerve blocks: an evidence-based outcome review. Anesthesiology Clin 2011; 29:179-191.

  18. References • Lamperti M, Bodenham AR, Pittiruti M, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 2012; 38:1105-1117. • Tirado A, Wu T, Noble VE, et al. Ultrasound-guided procedures in the emergency department–diagnostic and therapeutic asset. Emerg Med Clin N Amer 2013; 31:117-149. • Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound 2012; 40:135-141. • Yim ES, Gillis EF, Ojala K. Focused transthoracic echocardiography by sports medicine physicians: measurements relevant to hypertrophic cardiomyopathy. J Ultrasound Med 2013; 32:333-338. • Chiang YP, Wang TG Hsief SF. Application of ultrasound in sports injury. J Med Ultrasound 2013; 21:1-8. • Wolfman DJ, Allison SJ. Applications of ultrasound in gynecologic oncology. Ultrasound Clin 2010; 5:289-298. • Rove KO, Sullivan KF, Crawford ED. High-intensity focused ultrasound: ready for primetime. UrolClin N Am 2010; 37: 27-35. • Holland GA, Mironov O, Aubry JF, Hananel A, Duba JB. High-intensity focused ultrasound. Ultrasound Clin 2013; 8:213-226.

  19. References • Perito ER, Tsai PM, Hawley S, Lustig RH, Feldstein VA. Targeted hepatic sonography during clinic visits for detection of fatty liver in overweight children. J Ultrasound Med 2013; 32:637-643. • Xu ZS, Lee RJ, Chu SS, et al. Evidence of changes in brain tissue stiffness after ischemic stroke derived from ultrasound-based elastography. J Ultrasound Med 2013; 32:485-494. • Hwang J. Time to integrate ultrasound into medical school curricula. Emerg Med News 2010; 32: 3, 18. • Davis DP, Campbell CJ, Poste JC, Ma G. The association between operator and accuracy of ultrasonography performed by novice emergency physicians. J Emerg Med 2005; 29: 259-264. • Kessler C, Bhandarkar S. Ultrasound training for medical students and internal medicine residents – a needs assessment. J Clin Ultrasound 2010; 38:401-408. • Gogalniceanu P, Sheena Y, Kashef E, et al. Is basic emergency ultrasound training feasible as part of standard undergraduate medical education? J Surg Ed 2010; 67:151-156. • Hoppmann RA, Rao VV, Poston MB, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011; 3:1-12.

  20. References • Arger PH, Schultz SM, Sehgal CM, Cary TW, Aronchick J. Teaching medical students diagnostic sonography. J Ultrasound Med 2005; 24:1365-1369. • Benninger B, Corbett R, Delamarter T. Teaching a sonographically guided invasive procedure to first-year medical students using a novel finger transducer. J Ultrasound Med 2013; 32:659-664. • Fox JC, Chiem AT, Rooney KP, Maldonado G. Web-based lectures, peer instruction and ultrasound-integrated medical education. Med Educ 2012; 46:1109-1110 • Lanoix R, Baker WE, Mele JM, Dharmarajan L. Evaluation of an instructional model for emergency ultrasonography. AcadEmerg Med 1998; 5:58-63. • Knudson MM, Sisley AC. Training residents using simulation technology: experience with ultrasound for trauma.  J Trauma 2000; 48:659-665. • Damewood S, Jeanmonod D, Cadigan B. Comparison of a multimedia simulator to a human model for teaching FAST exam image interpretation and image acquisition. AcadEmerg Med 2011; 18:413-419 • Bahner DP, Jasne A, Boore S, Mueller A, Cortez E. The ultrasound challenge: a novel approach to medical student ultrasound education. J Ultrasound Med 2012; 31:2013-2016.

  21. Next Steps • Currently repeating the curriculum • Added quizzes • Board-style questions • Proper position/use • Images – negative and positive findings • Increased hands-on teaching • Increased # of sessions • more experience

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