Teaching physical examination of the adult liver with use of real-time sonography

Abstract

Rationale and objectives: The authors developed and evaluated an approach to teaching examination of the liver that incorporates real-time ultrasound (US) imaging as immediate feedback to improve diagnostic accuracy.

Materials and methods: Second-year medical students participating in a course in physical examination were assigned to receive instruction in measuring liver span without (group 1) or with (group 2) real-time sonography. Students from each group attended a practice session given by one of two physicians who were board certified in radiology and internal medicine with special expertise in US. During the practice session for group 2, students were shown the boundaries of the liver of the practice patient with real-time US. Both groups of students then made three measurements each of the liver span of a healthy practice patient and a single healthy test patient without US. The vertical liver span reference standard was determined by one of the authors.

Results: Students in group 2 showed greater accuracy in measuring liver span during both the practice and the test sessions than did students in group 1. The differences were significant for the third practice measurement and all three test measurements (P < .05).

Conclusion: The use of real-time US as an aid in teaching physical examination improves students' accuracy in measuring liver size.