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Ultrasound Should be Integrated into Undergraduate Medical Education Curriculum (5/30/2014)
Visit the Clinical Practice Statement page on the AAEM website.
Chair: Steven Rosenbaum, MD FAAEM
Authors: Lisa D Mills, MD FAAEM
Zachary Soucy, DO FAAEM
Reviewers: Ashley Bean, MD FAAEM
Jack Perkins, MD FAAEM
Reviewed and approved by the AAEM Board of Directors (5/30/2014).
Policy Statement:
It is the position of the American Academy of Emergency Medicine that ultrasound should be integrated into the core curriculum of undergraduate medical education.
Background:
Medical diagnostic ultrasound has been used by various specialties since the 1950s. Contemporary point of care ultrasound (POCUS) was first researched and utilized by emergency physicians in the mid 1980s. Emergency physicians have formally defined and pioneered POCUS over the past two decades. Research in a broad array of applications indicate improved patient care via procedural safety and success (11,13,17), improved diagnostic accuracy (20,21,22), decreased procedural pain (8), decrease time to critical interventions (11, 22), and decreased time to discharge (3). The practice of POCUS continues to grow. In the most recent decade there is an expanding role for POCUS across many specialties in medicine. As hospital wide ultrasound application has increased many healthcare institutions struggle to meet the growing educational needs of faculty and residents to obtain standardize ultrasound training. In addition, multiple specialties have POCUS fellowships and specialized POCUS training during other fellowships.
Leaders in the field of US technology in medical education have implemented longitudinal ultrasound training programs into the core medical school curriculum. Early research demonstrates that the technology is viewed by students as enjoyable (4,6,10,16,23) and useful in various specialties (1,6,16). Furthermore studies demonstrate better student understanding of complex core anatomic and physiologic concepts (6,19,23) and improved physical exam skills (7,9,12,14,15) with the incorporation so US into the curriculum. Practical application of POCUS also provides early clinical correlates, thus further engaging the students (4,10).
Given the broad and diverse use of US in contemporary medical practice, multiple medical societies have supported the incorporation of US into the core medical school curriculum. The American Institute for Ultrasound in Medicine (AIUM), a multidisciplinary society, has advocated for the integration of US training into core medical school curricula. In 2013, at the 2nd World Congress on US in Medical Education, over 85 medical schools convened to discuss US in medical education.
Incorporation of US into the core medical school curriculum enhances learning of core concepts, improves understanding of the physical exam, engages students in active learning, and is viewed as useful and enjoyable by students. Early integration of US in medical training incorporates a key, broadly used, and growing medical technology thus better preparing current students for practice they will encounter as the next generation physician.
References and Literature Grading
1) Afonso N, Amponsah D, Yang J, Mendez J, Bridge P, Hays G, Baliga S, Crist K, Brennan S, Jackson M, Dulchavsky S.Adding new tools to the black bag-- introduction of ultrasound into the physical diagnosis course.J Gen Intern Med. 2010 Nov;25(11):1248-52. Grade E, Adequate
2) Berrington de Gonzales A, Mahesh M, Kim K, Bhargavan M, Lewis R, Mettler F, et al. Projected cancers risks from computed Tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-77. Grade B, Good.
3) Blaivas M, Harwood RA, Lambert MJ. Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med 1999;6:1020–3. Grade C, Good.
4) Brunner M, Moeslinger T, Spieckermann P. "Echocardiography for teaching cardiac physiology in practical student courses." The American journal of physiology 268.6 Pt 3 (1995): S2. Grade F, Poor
5) Brenner DJ, Hall EJ. Computed tomography - An increasing source of radiation exposure. New Eng J Med. 2007;357:2277-84.
6) Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of Ultrasound into Gross Anatomy Curriculum: Perceptions of Medical Students The Journal of Emergency Medicine, Volume 43, Issue 6, December 2012, Pages 1098-1102. Grade E, Adequate
7) Butter J, Grant TH, Egan M, Kaye M, Wayne DB, Carrión-Carire V, McGaghie WC. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination? Med Educ. 2007 Sep;41(9):843-8. Grade E, adequate.
8) Constantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approach in patients with difficult access. Ann Emerg Med. 2005;46:456-461. Grade B, good.
9) Decara JM, Kirkpatrick JN, Spencer KT, Ward RP, Kasza K, Furlong K, LangRM.Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses.J Am Soc Echocardiogr. 2005 Mar;18(3):257-63. Grade E, adequate.
10) Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, Paulman LE, Wells JR, Richeson NA, Catalana PV, Thomas LK, Britt Wilson L, Cook T, Riffle S, Neuffer FH, McCallum JB, Keisler BD, Brown RS, Gregg AR, Sims KM, Powell CK,Garber MD, et al.An integrated ultrasound curriculum (iUSC) for medical students:4-year experience.Crit Ultrasound J. 2011 Apr;3(1):1-12. Epub 2011 Feb. Grade E, adequate.
11) Keyes LE, Frazee BW, Snoey ER, et al. Ultrasound guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med. 1999;34:711-714. Grade E, adequate.
12) Kobal, SL., et al. “Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination.” The American Journal of Cardiology, v. 96 issue 7, 2005, p. 1002-6. Grade E, adequate
13) Miller AH, Roth BA, Mills TJ, et al. Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med. 2002; 9:800-805. Grade B, Good
14) Mouratev G, Howe D, Hoppmann R, Poston MB, Reid R, Varnadoe J, Smith S, McCallum, B, Rao V, DeMarco P. Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone.Teach Learn Med. 2013 Jan;25(1):84-8. Grade C, adequate
15) Panoulas VF, Daigeler AL, Malaweera AS, Lota AS, Baskaran D, Rahman S, Nihoyannopoulos P. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging. 2013 Apr;14(4):323-330. Grade D, adequate
16) Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, Jackson M, Dulchavsky SA. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med. 2008 May;27(5):745-9. Grade E, adequate
17) Rothschild JM. Ultrasound guidance of central vein catheterization: making healthcare safer: a critical analysis of patient safety practices [Agency for Healthcare Research and Quality Web site]. Publication No. 01-E058. Available at: http://www.ahrq.gov/clinic/ ptsafety. Accessed December 14, 2013. Grade E, good
18) Syperda, VA., et al. “Ultrasonography in preclinical education: a pilot study.” JAOA: Journal of the American Osteopathic Association, v. 108 issue 10, 2008, p. 601-5. Grade D, adequate
19) Swamy M and Searle RF. Anatomy teaching with portable ultrasound to medical students. BMC Med Educ. 2012; 12: 99. Grade D, adequate
20) Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med. 2005;12:601Y606. Grade C, good
21) Tayal VS, Hasan N, Norton HJ, et al. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med. 2006;13:384Y388. Grade C, good
22) Tayal V, Graf C, Gibbs M. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med 2003;10:867–71. Grade C, good
23) Tshibwabwa, E. T. and Groves, H. M. (2005), Integration of ultrasound in the education programme in anatomy. Medical Education, 39: 1148. doi: 10.1111/j.1365-2929.2005.02288.x Grade E, adequate
24) Wittich CM, Montgomery SC, Neben MA, Palmer BA, Callahan MJ, Seward JB, Pawlina W, Bruce CJ. Teaching cardiovascular anatomy to medical students by using a handheld ultrasound device. JAMA. 2002 Sep 4;288(9):1062-3. Grade D, good
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