Evaluating Ultrasound Practical Examinations Used to Assess Sonographic Skills of Medical Students
Authors: Petty Jennifer L , Kondrashov Peter , Johnson Jane , Kondrashova Tatyana 
Published: November 2023

Medical use of ultrasonography provides healthcare practitioners with rapid, noninvasive techniques for visualizing internal anatomy and diagnosing patients; therefore, future doctors should become proficient in its use. However, few medical schools have included ultrasonography in their curricula, and there is no current standard for assessing the sonographic skills of medical students. The current study focused on evaluating ultrasound practical examinations as a method of measuring the ultrasonography knowledge and proficiency of medical students. The study institution has integrated ultrasonography education into the first 2 years of its 4‐year medical school curriculum, and a required ultrasound course was taken by first‐ and second‐year medical students in the graduating classes of 2016, 2017, and 2018. Because this ultrasonography curriculum is developing and expanding each year, recent classes had more expanded opportunities for ultrasonography training, such as increased instruction and practice time, than the previous classes. For all classes, student performance in the ultrasound course was evaluated by a practical examination graded by faculty and academic fellows (senior medical students). Students were paired to perform a focused ultrasound examination on each other and instructed to find specific structures chosen by an assigned grader from a list of laboratory objectives. Students were given 2 minutes per structure and could earn up to 3 points per structure. Students were also assessed on their sonographic skills. Student perceptions of the practical examinations were evaluated by a survey to the class of 2018. The validity of the practical examinations was evaluated retrospectively by analyzing grader performance and levels of question difficulty. Ninety five percent of the class of 2018 liked the exam format and 96% felt comfortable performing the practical examination on a peer. Furthermore, 80% felt the examination was graded fairly. Students found the cardiac and neck‐carotid Doppler ultrasound the most difficult to master but were successful in the course even in these regions with mean (SD) grades on these areas of 95% (19%) for the cardiac laboratory and 90% (22%) for the neck‐carotid Doppler. Significant differences were found between the graders: faculty graded more stringently and gave lower grades than the academic fellows for 2 of the 3 classes (2016 and 2018, both P<.001; 2017, P=.10), which suggests examinations need to be standardized across graders. Additional analysis suggested differences between graders may be due to the grader's choice of laboratory objective rather than the type of grader as there was no significant difference in the grades of the subjective sonographic skills. To eliminate grader bias and improve interrater reliability, random selection of ultrasound practical examination objectives for each student will be implemented for the class of 2020. These changes in our ultrasonography curriculum should improve the evaluation of student performance and student satisfaction, while providing a model for other medical educational institutions to incorporate a proven ultrasound assessment method into their current curriculum.