A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students

doi:10.5847/wjem.j.1920-8642.2019.03.007

Abstract

Abstract:

BACKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum.
METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course.
RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean pre-course ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3% (P<0.01). The didactic group also showed statistically significant improvement on the physiology exam, improving from 59.3% to 70.0% (P<0.01).
CONCLUSION: Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically significant improvement in physiology learning when compared to standard didactic curriculum.

Key words: Ultrasound education, POCUS, Switzerland, Medical education

Sagar Shah, Steven Tohmasi, Emily Frisch, Amanda Anderson, Roy Almog, Shadi Lahham, Roland Bingisser, John C. Fox. A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students[J]. World Journal of Emergency Medicine, 2019, 10(3): 169-176.

Figures/Tables 3

References 15

1	Osei-Ampofo M, Tafoya MJ, Tafoya CA, Oteng RA, Ali H, Becker TK. Skill and knowledge retention after training in cardiopulmonary ultrasound in Ghana: an impact assessment of bedside ultrasound training in a resource-limited setting. Emerg Med J. 2018; 35(11):704-7. doi: 10.1136/emermed-2018-207716 pmid: 30154142
2	Liu RB, Suwondo DN, Donroe JH, Encandela JA, Weisenthal KS, Moore CL. Point-of-care ultrasound: does it affect scores on standardized assessment tests used within the preclinical curriculum? J Ultrasound Med. 2019; 38(2):433-40. doi: 10.1002/jum.14709 pmid: 30058124
3	Fox JC, Schlang JR, Maldonado G, Lotfipour S, Clayman RV. Proactive medicine: the “UCI 30,” an ultrasound-based clinical initiative from the University of California, Irvine. Acad Med. 2014; 89(7):984-9. pmid: 24826849
4	Wilson SP, Mefford JM, Lahham S, Lotfipour S, Subeh M, Maldonado G, et al. Implementation of a 4-year point-of-care ultrasound curriculum in a Liaison Committee on medical education-accredited US medical school. J Ultrasound Med. 2017; 36(2):321-5. pmid: 27943456
5	Jamniczky HA, McLaughlin K, Kaminska ME, Raman M, Somayaji R, Wright B, et al. Cognitive load imposed by knobology may adversely affect learners’ perception of utility in using ultrasonography to learn physical examination skills, but not anatomy. Anat Sci Educ. 2015; 8(3):197-204.
6	Griksaitis MJ, Sawdon MA, Finn GM. Ultrasound and cadaveric prosections as methods for teaching cardiac anatomy: a comparative study. Anat Sci Educ. 2012; 5(1):20-6.
7	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. pmid: 27286419
8	Wayne DB, McGaghie WC. Use of simulation-based medical education to improve patient care quality. Resuscitation. 2010; 81(11):1455-56.
9	McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. Effect of practice on standardised learning outcomes in simulation-based medical education. Medical Education. 2006; 40(8):792-7. doi: 10.1111/j.1365-2929.2006.02528.x pmid: 16869926
10	Lee JB, Tse C, Keown T, Louthan M, Gabriel C, Anshus A, et al. Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students. World J Emerg Med. 2017; 8(4):281-6. pmid: 29123606
11	Angtuaco TL, Hopkins RH, DuBose TJ, Bursac Z, Angtuaco MJ, Ferris EJ. Sonographic physical diagnosis 101: teaching senior medical students basic ultrasound scanning skills using a compact ultrasound system. Ultrasound Quarterly. 2007; 23(2):157-60. doi: 10.1097/01.ruq.0000263847.00185.28 pmid: 17538509
12	Denny SP, Minteer WB, Fenning RTH, Aggarwal S, Lee DH, Raja SK, et al. Ultrasound curriculum taught by first-year medical students: A four-year experience in Tanzania. World J Emerg Med. 2018; 9(1):33-40. doi: 10.5847/wjem.j.1920-8642.2018.01.005 pmid: 29290893
13	Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in U.S. medical schools. Academic Medicine. 2014; 89(12):1681-6. doi: 10.1097/ACM.0000000000000414 pmid: 25099238
14	Nelson CE. Teaching evolution (and all of biology) more effectively: Strategies for engagement, critical reasoning, and confronting misconceptions. Integr Comp Biol. 2008; 48(2):213-25. doi: 10.1093/icb/icn027 pmid: 21669785
15	Abdel Meguid E, Collins M. Students’ perceptions of lecturing approaches: traditional versus interactive teaching. Advances in Medical Education and Practice. 2017; 8:229-41. doi: 10.2147/AMEP.S131851 pmid: 28360541

Participant year in medical school	Male (n=39)	Female (n=76)
Year 1	17	30
Year 2	12	22
Year 3	0	0
Year 4	5	11
Year 5	2	6
Year 6	3	7

[1]	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.
[2]	Xin Lu, Shi Feng, Shi-gong Guo, Mu-bing Qin, Xiang-ning Liu, Shi-yuan Yu, Li-na Zhao, Zeng-zheng Ge, Jing-jing Chai, Sheng-yong Xu, Di Shi, Ji-hai Liu, Hua-dong Zhu, Yi Li. Development of an intensive simulating training program in emergency medicine for medical students in China [J]. World Journal of Emergency Medicine, 2022, 13(1): 23-26.
[3]	Robert D. Willmore, Damjan Veljanoski, Feray Ozdes, Bethan Stephens, James Mooney, Seamus G. Crumley, Arpan Doshi, Philippa Davies, Shreya Badhrinarayanan, Emily Day, Kristian Tattam, April Wilson, Nathan Crang, Lorna Green, Craig A. Mounsey, Howell Fu, Joseph Williams, Michelle S. D'souza, Dhanya Sebastian, Liam A. Mcgiveron, Matthew G. Percy, James Cohen, Imogen J. John, Alice Lethbridge, Imogen Watkins, Omar Amin, Mubasher A. Qamar, John Gerrard Hanrahan, Emily Cramond-Wong. Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support? [J]. World Journal of Emergency Medicine, 2019, 10(2): 75-80.
[4]	Genevieve Mazza, Carina Mireles Romo, Marlene Torres, Ali Duffens, Annasha Vyas, Katherine Moran, Joshua Livingston, Savannah Gonzales, Shadi Lahham, Inna Shniter, Maxwell Thompson, John Christian Fox. Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama [J]. World Journal of Emergency Medicine, 2019, 10(1): 46-50.
[5]	Kelly Williamson, Jeremy Branzetti, Navneet Cheema, Amer Aldeen. Emergency medicine residencies structure of trainees’ administrative experience: A cross-sectional survey [J]. World Journal of Emergency Medicine, 2018, 9(3): 187-190.
[6]	Annasha Vyas, Katherine Moran, Joshua Livingston, Savannah Gonzales, Marlene Torres, Ali Duffens, Carina Mireles Romo, Genevieve Mazza, Briana Livingston, Shadi Lahham, John Christian Fox. Feasibility study of minimally trained medical students using the Rural Obstetrical Ultrasound Triage Exam (ROUTE) in rural Panama [J]. World Journal of Emergency Medicine, 2018, 9(3): 216-222.
[7]	Sean P. Denny, William B. Minteer, Reece T.H. Fenning, Sahil Aggarwal, Debora H. Lee, Shella K. Raja, Kaavya R. Raman, Allison O. Farfel, Priya A. Patel, MarkLieber, Megan E. Bernstein, Shadi Lahham, John C. Fox. Ultrasound curriculum taught by first-year medical students: A four-year experience in Tanzania [J]. World Journal of Emergency Medicine, 2018, 9(1): 33-40.
[8]	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.
[9]	Brianna Miner, Amanda Purdy, Laura Curtis, Kevin Simonson, Caleb Shumway, Jessa Baker, Jessica Vaughan, Kara Percival, Olivia Sanchez, Shadi Lahham, Linda Joseph, J Christian Fox. Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama [J]. World Journal of Emergency Medicine, 2015, 6(3): 191-195.
[10]	Richard Amini, Jeffrey Z Kartchner, Lori A Stolz, David Biffar, Allan J Hamilton, Srikar Adhikari. A novel and inexpensive ballistic gel phantom for ultrasound training [J]. World Journal of Emergency Medicine, 2015, 6(3): 225-228.