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• W616984865 abstract "The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recently published a student edition of their course book for free download at http://www.efsumb.org. Technological advancements have made the equipment better and cheaper and several handheld ultrasound devices are now about the size of a smartphone <xref idref=JR000-1>1</xref>. Certified radiologists must master the imaging modality and many other medical specialists also use ultrasound in their daily practice. The easy accessibility and increased use dictate that all future physicians should have some knowledge of ultrasound. However, its place in the curriculum of medical schools has not been defined and is currently very varied. Ultrasound can be taught in theory and in practice but can also be used as an educational tool to teach anatomy, physiology, pathology, and traumatology. One of the first descriptions of this is from the Hannover Medical School where they combined the anatomy course with hands-on ultrasound workshops performed by medical students on other students <xref idref=JR000-2>2</xref>. The students liked the interactivity and felt that it improved their understanding of clinical anatomy. Several studies have confirmed that students like to use ultrasound <xref idref=JR000-3>3</xref> <xref idref=JR000-4>4</xref>, but more importantly it has also been shown that ultrasound anatomy sessions are “a highly effective method for facilitating student learning and significantly enhance knowledge of living clinical anatomy” <xref idref=JR000-5>5</xref>. Scanning of peers is easy to arrange unless it conflicts with the students’ boundaries of modesty or religious beliefs. However, only normal anatomy and physiology can be studied in this way and arranging the scanning of the right patients is logistically difficult and perhaps even unethical for large classes. Virtual-reality simulators deliver a multitude of different “standardized patients” that can be used for teaching pathology and traumatology although the simulators are costly and their fidelity is still not optimal <xref idref=JR000-6>6</xref>. Using ultrasound as an educational tool does not automatically make the students competent in performing ultrasound procedures. George Miller described the framework for acquiring competence as a four-layer pyramid <xref idref=JR000-7>7</xref>. Theoretical knowledge (“knows” and “knows how”) is the necessary foundation and base upon which clinical competence must be build. This can be acquired through books on ultrasound or be taught in traditional classes or at lectures. The third layer of the pyramid (“shows how”) relates to performance in a simulated environment, e. g. scanning of fellow students or simulators. This hands-on training is necessary before reaching the top level of competence (“does”): actual performance on patients. Unfortunately, it requires a lot more resources than traditional lectures and self-study. Expensive ultrasound training should be established according to best available evidence in order to ensure optimal learning output. An ultrasound machine or simulator per student provides maximum hands-on time but a recent study on the effects of simulator-based ultrasound training found that training in pairs (“dyad practice”) actually improved the efficacy of training and was not inferior to individual practice in terms of skills transfer <xref idref=JR000-8>8</xref>. The high instructor-to-trainee ratio is also a concern in hands-on ultrasound classes but it is important to realize that the instructor does not have to be constantly standing next to the trainee operating the probe. A single instructor can provide direction and feedback to four pairs of trainees on a rotating basis and the resulting “directed, self-regulated learning” has a potential long-term benefit <xref idref=JR000-9>9</xref>. Performing ultrasound assessment with established pass/fail standards at the end of ultrasound courses can also increase motivation and the retention of skills <xref idref=JR000-10>10</xref> <xref idref=JR000-11>11</xref>. It might be feasible to establish efficient ultrasound courses for medical students but is it possible to make all young doctors competent? A group from the UK successfully trained inexperienced undergraduate students to scan the abdominal aorta and concluded: “<i>It is time for the medical education community to address whether focused ultrasound training should accompany traditional clinical skills, such as using a stethoscope, in UK medical school curricula” </i> <xref idref=JR000-12>12</xref>. However, it is important to acknowledge that new junior physicians with limited, isolated skills in ultrasound must be very aware of their limitations. Incompetent operators could lead to inadequate investigation and treatment due to false-negative findings as well as unnecessary interventions due to false-positive findings. EFSUMB has defined minimum training requirements for specific areas of ultrasound <xref idref=JR000-13>13</xref>. Moreover, a recent survey among more than 600 young obstetricians/gynecologists found that “trainees required more than 24 months of clinical experience and 12 – 24 days of training in specialized ultrasound units in order to feel confident about performing transvaginal and transabdominal ultrasound scans independently” <xref idref=JR000-14>14</xref>. It is clear that it is not possible to fit either the official requirements or the expectations of young doctors into an already busy curriculum at medical schools. In conclusion, ultrasound should be used systematically as an easily accessible and exciting educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and any hands-on training should adhere to evidence-based principles. Achieving real clinical competence in ultrasound requires extensive (post-graduate) training and is outside the scope of medical schools." @default.
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• W616984865 title "Ultrasound in Pre-Graduate Medical Education" @default.
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