Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students

doi:10.5847/wjem.j.1920-8642.2017.04.006

Abstract

Abstract:

BACKGROUND: The purpose of this study was to assess the short-term efficacy of a 4-week ultrasound curriculum taught by American first-year medical students to general practitioners working in public health care clinics, or puskesmas, in Bandung, Indonesia.

METHODS: We performed a prospective, observational study of Indonesian health care practitioners from public clinics in Bandung, Indonesia. These practitioners were enrolled in a 4-week ultrasound training course taught by first-year American medical students. A total of six sessions were held comprising of 38 ultrasound milestones. A pre-course and post-course written exam and practical exam was taken by each participant.

RESULTS: We enrolled 41 clinicians in the course. The average pre-course exam score was 35.2% with a 2.4% pass rate, whereas the average post-course exam score was 82.0% with a 92.7% pass rate. The average practical score at the completion of the course was 83.2% (SD=0.145) with 82.9% of the class passing (score above 75.0%).

CONCLUSION: Our data suggests that first-year medical students can effectively teach ultrasound to physicians in Indonesia using a 4-week intensive ultrasound training course. Future studies are needed to determine the amount of training required for proficiency and to evaluate the physicians' perceptions of the student-instructors' depth of knowledge and skill in point of care ultrasound.

Key words: Ultrasound education, Ultrasound teaching, Indonesia

Jonathan B. Lee, Christina Tse, Thomas Keown, Michael Louthan, Christopher Gabriel, Alexander Anshus, Bima Hasjim, Katrina Lee, Esther Kim, Luke Yu, Allen Yu, Shadi Lahham, Steven Bunch, Maili Alvarado, Abdulatif Gari, John C. Fox. Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students[J]. World Journal of Emergency Medicine, 2017, 8(4): 281-286.

Figures/Tables 3

References 31

1	Tshibwabwa-Tumba E, Mwinga A, Pobee JO, Zumla A. Radiological features of pulmonary tuberculosis in 963 HIV-infected adults at three Central African Hospitals. Clin Radiol. 1997; 52(11):837-41. doi: 10.1016/s0009-9260(97)80078-5 pmid: 9392461
2	World Health Organization. Human Resources for Health Country Profile: INDONESIA. 2011.
3	Unicef. At a glance: Indonesia Statistics. 2013.
4	Widyahening IS, Thuraiappah DM, Han TM, Vidiawati D. Indonesian primary care physicians profile in 2011: Did practicing hours and conversion program for family medicine differentiate their services and continuing medical education activities? Asia Pac Fam Med. 2014; 13(1):16. doi: 10.1186/s12930-014-0016-x pmid: 25598700
5	Badea R. Medical education of students and residents--a new paradigm? Med Ultrason. 2012; 14(3):175-6. pmid: 22957319
6	Hoppmann R, Cook T, Hunt P, Fowler S, Paulman L, Wells J, et al. Ultrasound in medical education: a vertical curriculum at the University of South Carolina School of Medicine. J S C Med Assoc. 2006; 102(10):330-4.
7	Genc A, Ryk M, Suwała M, Żurakowska T, Kosiak W. Ultrasound imaging in the general practitioner's office--a literature review. J Ultrason. 2016; 16(64):78-86. pmid: 27104005
8	Mindel S. Role of imager in developing world. Lancet. 1997; 350(9075):426-9. pmid: 9259668
9	Mets T. Clinical ultrasound in developing countries. Lancet. 1991; 337(8737):358. pmid: 1671245
10	Steinmetz JP, Berger JP. Ultrasonography as an aid to diagnosis and treatment in a rural African hospital: a prospective study of 1 119 cases. Am J Trop Med Hyg. 1999; 60(1):119-23. doi: 10.4269/ajtmh.1999.60.119 pmid: 9988334
11	Wordsworth S, Scott A. Ultrasound scanning by general practitioners: is it worthwhile? J Public Health Med. 2002; 24(2):88-94. doi: 10.1093/pubmed/24.2.88 pmid: 12141591
12	Alisjahbana B, Susanto H, Roesli R, Yusuf H, Hinduan Z, Mase JC, et al. Prevention, control and treatment of HIV-AIDS among injecting drug use in Bandung, Indonesia. Acta Med Indones. 2009; 41 Suppl 1: 65-9.
13	Meijerink H, Tacke S, Indrati A, Wisaksana R, Alisjahbana B, van der Ven A. Decreased whole blood RNA expression of cathelicidin in HIV-infected heroin users in Bandung, Indonesia. Viral Immunol. 2014; 27(10):551-5. doi: 10.1089/vim.2014.0060 pmid: 25379836
14	World Health Organization. Global tuberculosis report 2014.
15	Mets T. Clinical ultrasound in developing countries. Lancet. 1991; 337(8737):358. doi: 10.1016/0140-6736(91)90981-t pmid: 1671245
16	García de Casasola Sánchez G, González Peinado D, Sánchez Gollarte A, Muñoz Aceituno E, Peña Vázquez I, Torres Macho J. Teaching of clinical ultrasonography to undergraduates: students as mentors. Rev Clin Esp. 2015; 215(4):211-6. pmid: 25583252
17	Shah SP, Epino H, Bukhman G, Umulisa I, Dushimiyimana JM, Reichman A, et al. Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008. BMC Int Health Hum Rights. 2009; 9:4. pmid: 19327157
18	Shah S, Noble VE, Umulisa I, Dushimiyimana JM, Bukhman G, Mukherjee J, et al. 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(3):193-6. doi: 10.1007/s12245-008-0053-z pmid: 19384515
19	Kurjak A, Breyer B. The use of ultrasound in developing countries. Ultrasound in Medicine & Biology 1986; 12:611-621. doi: 10.1016/0301-5629(86)90182-1 pmid: 3532475
20	Adler D, Mgalula K, Price D, Taylor O. Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania. Int J Emerg Med. 2008; 1(4):261-6. doi: 10.1007/s12245-008-0074-7 pmid: 19384640
21	Barsky M, Kushner L, Ansbro M, Bowman K, Sassounian M, Gustafson K, et al. A feasibility study to determine if minimally trained medical students can identify markers of chronic parasitic infection using bedside ultrasound in rural Tanzania. World J Emerg Med. 2015; 6(4):293-8. doi: 10.5847/wjem.j.1920-8642.2015.04.008 pmid: 26693265
22	Miner B, Purdy A, Curtis L, Simonson K, Shumway C, Baker J, et al. Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama. World J Emerg Med. 2015; 6(3):191-5. doi: 10.5847/wjem.j.1920-8642.2015.03.005 pmid: 26401179
23	Ahn JS, French AJ, Thiessen ME, Kendall JL. Training peer instructors for a combined ultrasound/physical exam curriculum. Teach Learn Med. 2014; 26(3):292-5. pmid: 25010242
24	Naeger DM, Conrad M, Nguyen J, Kohi MP, Webb EM. Students teaching students: evaluation of a "near-peer" teaching experience. Acad Radiol. 2013; 20(9):1177-82. doi: 10.1016/j.acra.2013.04.004 pmid: 23810649
25	Baw B, Chan T, Upadhye S. Clinical education guideline creation by residents for junior learners in emergency medicine: a novel educational experience. CJEM. 2014; 16(6):490-3. doi: 10.1017/s1481803500003511 pmid: 25358281
26	Maru DS, Schwarz R, Jason A, Basu S, Sharma A, Moore C. Turning a blind eye: the mobilization of radiology services in resource-poor regions. Global Health. 2010; 6:18. doi: 10.1186/1744-8603-6-18 pmid: 20946643
27	Montales MT, Chaudhury A, Beebe A, Patil S, Patil N. HIV-associated TB syndemic: A growing clinical challenge worldwide. Front Public Health. 2015; 3:281. pmid: 26779470
28	Heller T, Goblirsch S, Bahlas S, Ahmed M, Giordani MT, Wallrauch C, et al. Diagnostic value of FASH ultrasound and chest X-ray in HIV-co-infected patients with abdominal tuberculosis. Int J Tuberc Lung Dis. 2013; 17(3):342-4. doi: 10.5588/ijtld.12.0679 pmid: 23321507
29	Bélard S, Tamarozzi F, Bustinduy AL, Wallrauch C, Grobusch MP, Kuhn W, et al. Point-of-care ultrasound assessment of tropical infectious diseases--A review of applications and perspectives. Am J Trop Med Hyg. 2016; 94(1):8-21. doi: 10.4269/ajtmh.15-0421 pmid: 26416111
30	Heller T, Wallrauch C, Goblirsch S, Brunetti E. Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J. 2012; 4(1):21. doi: 10.1186/2036-7902-4-21 pmid: 23171481
31	Heller T. Focused assessment with sonography for HIV/TB--a practical manual. TALC-Teaching-Aids at Low Cost, 2013.

Scans	Mean comfort level	Standard deviation	df	T Stat	P value
Pre-course knobology	1.59	1.75	55.3	-7.58	<0.001
Post-course knobology	3.85	0.77	55.3	-7.58	<0.001
Pre-course FAST	1.56	1.73	52.7	-7.52	<0.001
Post-course FAST	3.76	0.70	52.7	-7.52	<0.001
Pre-course FASH	1.41	1.76	53.9	-7.11	<0.001
Post-course FASH	3.54	0.74	53.9	-7.11	<0.001
Pre-coursecardiac	1.40	1.60	63.0	-7.60	<0.001
Post-course cardiac	3.56	0.90	63.0	-7.60	<0.001
Pre-course pulmonary	1.54	1.79	54.4	-7.53	<0.001
Post-course pulmonary	3.83	0.77	54.4	-7.53	<0.001
Pre-course abdominal	1.78	1.97	54.9	-6.46	<0.001
Post-course abdominal	3.95	0.86	54.9	-6.46	<0.001
Pre-course pathology	1.51	1.72	55.6	-7.68	<0.001
Post-course pathology	3.78	0.77	55.6	-7.68	<0.001

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