Point-of-Care Clinical Ultrasound for Medical Students

Abstract

Purpose: Our institution has recently implemented a point-of-care (POC) ultrasound training program, consisting of an e-learning course and systematic practical hands-on training. The aim of this prospective study was to evaluate the learning outcome of this curriculum.

Materials and methods: 16 medical students with no previous ultrasound experience comprised the study group. The program covered a combination of 4 well-described point-of-care (POC) ultrasound protocols (focus assessed transthoracic echocardiography, focused assessment with sonography in trauma, lung ultrasound, and dynamic needle tip positioning for ultrasound-guided vascular access) and it consisted of an e-learning course followed by 4 h of practical hands-on training. Practical skills and image quality were tested 3 times during the study: at baseline, after e-learning, and after hands-on training.

Results: Practical skills improved for all 4 protocols; after e-learning as well as after hands-on training. The number of students who were able to perform at least one interpretable image of the heart increased from 7 at baseline to 12 after e-learning, p<0.01, and to all 16 students after hands-on-training, p<0.01. The number of students able to cannulate an artificial vessel increased from 3 to 8 after e-learning and to 15 after hands-on training.

Conclusion: Medical students with no previous ultrasound experience demonstrated a considerable improvement in practical skill after interactive e-learning and 4 h of hands-on training.

Keywords: abdomen; heart; ultrasound; vascular.

Fig. 1

Study timeline. Prior to the study, each student received a number from 1–16, and they were divided into groups of 4 (1–4, 5–8, 9–12, and 13–16). As displayed, they were tested 3 times during the study period: at baseline, after the e-learning course (intermediate test), and after the 4-h HOT session (endpoint test). Day 0: The students received an introduction of 15 min, which included the practical arrangements and general information about the study, including the hypothesis and aim. No ultrasound theory was taught at this stage. Immediately after the introduction, the baseline test was conducted. Day 1–5: Electronic access codes to the e-learning course were distributed after all students had completed the baseline test. Day 6: After initial registration, no instructions were given prior to the intermediate test. Before the handson-training session, the students were briefly informed about the rotation scheme, but no ultrasound theory was taught. The endpoint test was carried out immediately after the hands-on training session.

Fig. 2

Development in practical exercise scores and image quality. Online evaluation of practical skills a, b and offline evaluation of image quality c, d. a Scores as percentage of highest possible score for each protocol, p<0.001 (ANOVA) for all 4 protocols. b Example of development in practical skills; vascular access performed within 90 s, at the 3 tests, p<0.001 (ANOVA). c Number of interpretable images as percentage of highest possible number for each protocol, p<0.001 (ANOVA) for FATE, FAST, and LUS; d Image score from FATE presented as percentage of the highest possible score, p<0.001 (ANOVA). *Significantly different from previous test, p<0.001. ANOVA: one-way analysis of variance.

Fig. 3

Example of image quality development. Apical 4-chamber view from the 3 tests (student no. 15). a Baseline test; b Intermediate test; c Endpoint test.

Appendix 1

Posters. Posters presented to students during test sessions. a Cardiac and pleural ultrasound; b Abdominal ultrasound; c Lung ultrasound; d Vascular ultrasound.