Ultrasound assisted clinical examination is here!
Physician-performed point of care (at the patient’s bedside) ultrasound to enhance clinical examination is established in anaesthesia, critical care and emergency medicine clinical practice and is becoming increasingly adopted by other medical craft groups.
Ultrasound adds to clinical examination, improving the accuracy and speed of definitive diagnosis of cardiac and respiratory disorders and has the potential for the same for abdominal, musculoskeletal and other organ systems.
Ultrasound is also used to improve precision and safety of percutaneous medical procedures such as insertion of intra-venous and intra-arterial catheters.
Point of care ultrasound is becoming increasingly taught in medical schools and is already estimated to be integrated in around two-thirds of medical schools in the USA.1
In 2005 Kobal et al. reported that a medical student with only 18 hours of training in transthoracic echocardiography out-performed a consultant cardiologist armed with a stethoscope in cardiac diagnosis of 61 patients with a wide range of cardiac disorders.2
Currently there are very few medical schools in Australia teaching point of care ultrasound.
This year Dr David Canty (Department of Surgery - Royal Melbourne Hospital, University of Melbourne) and Dr Kyle Brooks (Department of Medical Education, University of Melbourne) commenced a pilot teaching program at the Austin Clinical School.
The program will teach 120 second and fourth year medical students how to perform and interpret transthoracic echocardiography, lung ultrasound and ultrasound-guided vascular cannulation.
The enthusiasm and feedback from the first group of second year students has so far been exceptional.
You might be wondering how two busy clinician-academics can perform this as it takes an average of three years full-time study to become a qualified sonographer.
Dr Canty and the team from Mobile Learning Unit, co-directed by Professor Colin Royse and Professor Alistair Royse (Department of Surgery – Royal Melbourne Hospital), are world leaders in ultrasound education.
They have recently developed and refined a system that increases the efficiency of ultrasound teaching using computer automation, online eLearning and high-fidelity simulators, resulting in a course that is predominantly self-directed.
In a recent publication in Journal of Critical Care,3 Dr Canty and his team compared learning outcomes of transthoracic echocardiography in physicians who completed the simulator course compared to a conventional supervised workshop.
Not only were the simulator course participants better at transthoracic echocardiography than the conventional workshop participants, but the course required one sixth the number of instructor time and was less than half the cost.
The Mobile Learning Unit are lending the Austin Medical School some simulators for the pilot program this year.
Dr Kyle Brooks has been teaching ultrasound for some time to medical students rotating through his intensive care unit at The Epworth Hospital Richmond and has recently commenced a PhD on this topic with Dr Canty as his supervisor.
Dr Brooks and Dr Canty are performing a research study on the second year Austin medical students aimed to determine whether the face-to-face teaching by experienced ultrasound instructors can be substituted with an online series of short instructional videos.
If the learning outcomes of the participants completing the entirely self-directed course are as good as the supervised workshop then the course could be rapidly set up and delivered to any medical school that obtains an ultrasound simulator.
References
1.Bahner DP, Goldman E, Way D, Royall NA, Liu YT: The state of ultrasound education in US medical schools: results of a national survey. Academic Medicine 2014; 89: 1681-1686
2.Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, Neuman Y, Mirocha J, Kar S, Forrester JS: Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. The American journal of cardiology 2005; 96: 1002-1006
3.Canty D, Barth J, Yang Y, Peters N, Palmer A, Royse A, Royse C: Comparison of learning outcomes for teaching focused cardiac ultrasound to physicians: A supervised human model course versus an eLearning guided self-directed simulator course. Journal of Critical Care 2019; 49: 38-44