A comparison of handheld and standard ultrasound in Swiss medical students

doi:10.5847/wjem.j.1920-8642.2022.017

Abstract

Abstract:

BACKGROUND: The use of ultrasound (US) within healthcare has inspired the development of new US technology. There have been few studies comparing the use of handheld US to standard US for medical education. This research aims to determine whether a handheld US device can provide a comparable primary learning experience to that of a standard US machine.
METHODS: Over two days of instruction, participants were taught and evaluated on core US fundamentals. The standard group received instruction on standard US machines, while the handheld group received instruction on handheld US devices. Participants completed a qualitative survey regarding their experience. Six hundred and four images were obtained and graded by two emergency medicine physicians.
RESULTS: A total of 119 Swiss medical students were enrolled in our study. There was no statistically significant difference in the US assessment measurements, except for faster endpoint septal separation (EPSS) vascular setup time in the handheld group (P=0.001). There was no statistically significant difference in participants’ perceived difficulty of US learning (P=0.198), comfort level (P=0.188), or self-estimated capability to perform US in the future (P=0.442). There was no statistically significant difference in the percentage of correctly obtained images (P=0.211) or images that were clinically useful (P=0.256). The median quality score of images obtained by the standard group was eight compared to seven in handheld group (P<0.01).
CONCLUSION: Our data suggest a handheld US machine can perform as well as a standard US machine as an educational tool despite sacrifices in image quality.

Key words: Handheld ultrasound, Ultrasound education, Switzerland, Medical education

Mark Slader, Hayley Young, Margot Barker, Kylie Prentice, Katherine Bogaard, Charlene Yuan, Soheil Saadat, Shadi Lahham. A comparison of handheld and standard ultrasound in Swiss medical students[J]. World Journal of Emergency Medicine, 2022, 13(2): 85-90.

Figures/Tables 3

References 24

1	So S, Patel RM, Orebaugh SL. Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis. Anat Sci Educ. 2017; 10(2):176-89. doi: 10.1002/ase.v10.2
2	Johri AM, Durbin J, Newbigging J, Tanzola R, Chow R, De S, et al. Cardiac point-of-care ultrasound: state-of-the-art in medical school education. J Am Soc Echocardiogr. 2018; 31(7):749-60. doi: 10.1016/j.echo.2018.01.014
3	Feilchenfeld Z, Dornan T, Whitehead C, Kuper A. Ultrasound in undergraduate medical education: a systematic and critical review. Med Educ. 2017; 51(4):366-78. doi: 10.1111/medu.13211 pmid: 28118684
4	Hoppmann RA, Rao VV, Bell F, Poston MB, Howe DB, Riffle S, et al. The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Crit Ultrasound J. 2015; 7(1):18. doi: 10.1186/s13089-015-0035-3 pmid: 26589313
5	Patel SG, Benninger B, Mirjalili SA. Integrating ultrasound into modern medical curricula. Clin Anat. 2017; 30(4):452-60. doi: 10.1002/ca.v30.4
6	Dinh VA, Fu JY, Lu S, Chiem A, Fox JC, Blaivas M. Integration of ultrasound in medical education at United States medical schools: a national survey of directors’ experiences. J Ultrasound Med. 2016; 35(2):413-9. doi: 10.7863/ultra.15.05073 pmid: 26782166
7	Tarique U, Tang B, Singh M, Kulasegaram KM, Ailon J. Ultrasound curricula in undergraduate medical education: a scoping review. J Ultrasound Med. 2018; 37(1):69-82. doi: 10.1002/jum.14333 pmid: 28748549
8	Ireson M, Warring S, Medina-Inojosa JR, O’Malley MT, Pawlina W, Lachman N, et al. First year medical students, personal handheld ultrasound devices, and introduction of insonation in medical education. Ann Glob Health. 2019; 85(1):123.
9	Chamsi-Pasha MA, Sengupta PP, Zoghbi WA. Handheld echocardiography: current state and future perspectives. Circulation. 2017; 136(22):2178-88. doi: 10.1161/CIRCULATIONAHA.117.026622 pmid: 29180495
10	Narula J, Chandrashekhar Y, Braunwald E. Time to add a fifth pillar to bedside physical examination: inspection, palpation, percussion, auscultation, and insonation. JAMA Cardiol. 2018; 3(4):346-50. doi: 10.1001/jamacardio.2018.0001 pmid: 29490335
11	Baltarowich OH, Di Salvo DN, Scoutt LM, Brown DL, Cox CW, DiPietro MA, et al. National ultrasound curriculum for medical students. Ultrasound Q. 2014; 30(1):13-9. doi: 10.1097/RUQ.0000000000000066 pmid: 24901774
12	Dreher SM, DePhilip R, Bahner D. Ultrasound exposure during gross anatomy. J Emerg Med. 2014; 46(2):231-40. doi: 10.1016/j.jemermed.2013.08.028
13	Swamy M, Searle RF. Anatomy teaching with portable ultrasound to medical students. BMC Med Educ. 2012; 12:99. doi: 10.1186/1472-6920-12-99
14	Cantisani V, Dietrich CF, Badea R, Dudea S, Prosch H, Cerezo E, et al. EFSUMB statement on medical student education in ultrasound. Ultraschall Med. 2016; 37(1):100-2. doi: 10.1055/s-0035-1566959 pmid: 26871409
15	Nielsen MB, Cantisani V, Sidhu PS, Badea R, Batko T, Carlsen J, et al. The use of handheld ultrasound devices - An EFSUMB position paper. Ultraschall Med. 2019; 40(1):30-9. doi: 10.1055/a-0783-2303
16	Prosch H, Radzina M, Dietrich CF, Nielsen MB, Baumann S, Ewertsen C, et al. Ultrasound curricula of student education in Europe: summary of the experience. Ultrasound Int Open. 2020; 6(1):E25-33. doi: 10.1055/a-1183-3009
17	Dietrich CF, Hoffmann B, Abramowicz J, Badea R, Braden B, Cantisani V, et al. Medical student ultrasound education: a WFUMB position paper, part I. Ultrasound Med Biol. 2019; 45(2):271-81. doi: 10.1016/j.ultrasmedbio.2018.09.017
18	Byrne C, Kahl N, Knight B, Lee M, Morley S, Lahham S, et al. A prospective evaluation of point of care ultrasound teaching in Switzerland. J Med Ultrasound. 2019; 27(2):92-6. doi: 10.4103/JMU.JMU_57_18
19	Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in US medical schools: results of a national survey. Acad Med. 2014; 89(12):1681-6. doi: 10.1097/ACM.0000000000000414 pmid: 25099238
20	Nicholas E, Ly AA, Prince AM, Klawitter PF, Gaskin K, Prince LA. The current status of ultrasound education in United States medical schools. J Ultrasound Med. 2021; 40(11):2459-65. doi: 10.1002/jum.v40.11
21	Breithardt OA. Hand-held ultrasound-the real stethoscope. Eur Heart J Cardiovasc Imaging. 2015; 16(5):471-2. doi: 10.1093/ehjci/jeu320 pmid: 25609778
22	Mjolstad OC, Dalen H, Graven T, Kleinau JO, Salvesen O, Haugen BO. Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Intern Med. 2012; 23(2):185-91. doi: 10.1016/j.ejim.2011.10.009
23	Greaves K, Jeetley P, Hickman M, Dwivedi G, Sabharwal N, Lim T, et al. The use of hand-carried ultrasound in the hospital setting - a cost-effective analysis. J Am Soc Echocardiogr. 2005; 18(6):620-5. doi: 10.1016/j.echo.2004.09.015
24	Galusko V, Khanji MY, Bodger O, Weston C, Chambers J, Ionescu A. Hand-held ultrasound scanners in medical education: a systematic review. J Cardiovasc Ultrasound. 2017; 25(3):75-83. doi: 10.4250/jcu.2017.25.3.75 pmid: 29093769

Parameters	Groups	n	Min	Max	Median	Mean	SD
Comfort level	Handheld	49	16.0	25.0	22.0	21.0	2.53
Comfort level	Standard	56	14.0	25.0	21.0	20.4	2.61
Difficulty	Handheld	49	29.0	52.0	42.0	42.2	5.32
Difficulty	Standard	56	29.0	53.0	40.0	41.1	4.84
Self-estimated capability	Handheld	49	13.0	24.0	20.0	19.7	2.68
Self-estimated capability	Standard	56	12.0	26.0	20.0	20.0	3.30

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