Integration of ultrasonography course in the students’ curriculum. Is it always useful?

We congratulate Kondrashov et al. (2015) for their work entitled “Impact of the Clinical Ultrasound Elective Course on Retention of Anatomical Knowledge by Second-year Medical Students in Preparation for Board Exams,” published in the second issue of the 28th volume of Clinical Anatomy. We found the article interesting and highly relevant. Ultrasonography is an easy, noninvasive method that is widely used in the medical world. The authors raised an interesting issue concerning the use of clinical ultrasound during anatomy courses for medical students. This proposal was described for the first time 25 years ago by Erkonen et al. (1990) but it remains controversial. Stringer et al. (2012) discussed a variety of problems with ultrasonography in anatomy courses, such as logistic difficulties with over-large student groups, small numbers of skilled teachers, scarcity of equipment or simply lack of time during medical studies. However, Arger et al. (2005) noticed that the teaching of sonography by experienced medical staff has a crucial educational role, ultrasonography classes during early years of study preventing the inculcation of bad habits. The main controversy discussed by Brown et al. (2012) was the limited time available for didactic ultrasonography sessions. It therefore seems crucial to create an adequate teaching program. Except for Knobe et al. (2012), who compared the effectiveness of anatomy teaching courses using arthroscopy versus ultrasonography, there are no studies assessing the value of sonography as an effective educational tool. Despite the aforementioned challenges, incorporating ultrasonography into anatomy courses has numerous unquestionable advantages. Blehar et al. (2015) demonstrated that reliable ultrasound examinations need much experience, especially if the results are to be interpreted correctly. It has been proved that in many medical fields only a few protocols are needed for initial diagnosis and for starting the right treatment (Frederiksen et al., 2012; Wisniewski and Garnier, 2015), but ultrasonography is one of the easiest-tolearn radiological methods. Indeed, Chiao et al. (2005) showed that ultrasonography is easy to teach to crew members of the International Space Station, who had no medical education. Moreover, as the authors mentioned, more studies have demonstrated the utility of ultrasonography in students’ anatomy courses and for their subsequent work. On the basis of previously-published studies, Mircea et al. (2012) offered 10 reasons for introducing sonography into the medical curriculum. Taking all those arguments into consideration we can conclude that notwithstanding the overcrowded curriculum, ultrasonography should be added to the anatomy course during medical studies. We feel doubtful about the conclusions by Kondrashov et al. (2015) concerning the effectiveness of their course: it is not surprising that the students’ knowledge was improved in its immediate aftermath. An important question is: how well and how durably do students retain this information? A follow-up several months later rather than a postcourse survey (when the students will still remember the correct answers) would provide a more useful assessment. A reference to the Kirkpatrick and Kirkpatrick (2005) levels for assessing educational interventions would greatly enhance the academic standard of this article. The authors evaluated their research at Kirkpatrick Level 2 (change in knowledge), but to provide a basis for recommending changes in the curriculum it would be necessary to consider at least Level 3 evidence (change in behavior or ability). Ultrasonography is nowadays called a “stethoscope of the 21st century” (Lichtenstein et al., 2014) and has become part of patient examination during the everyday ward round. Yet it is still not a part of the medical students’ curriculum. More studies concerning the integration of ultrasonography courses and its effects on clinical practice are needed. We believe that the authors will improve their project and conduct further research in this area in the future.