Bringing Anatomy to Life: Evaluating an Ultrasound Curriculum in Medical Clinical Anatomy
Authors: Davis Margaret L. , Croft Peter , Afifi Linda , Willson Robert , Lufler Rebecca S. 
Published: April 2020

Introduction

Ultrasound (US) has become more prevalent across medical specialties and therefore requires training earlier in the undergraduate medical curriculum. Given the difficulty of handling, acquiring and interpreting US, early exposure is imperative. Integrated learning has been shown to be beneficial and has led to integrated curricula in medical schools across the country. Finding the right place to integrate US remains a challenge.

Aim

The purpose of this study is to evaluate the effectiveness of an US curriculum based on students’ perceptions of US, confidence in interpreting and acquiring US images, and performance on US exam questions.

Methods

An US curriculum was developed and incorporated into 1st year medical clinical anatomy at Tufts University School of Medicine. Student participation was voluntary and the study was granted exempt status (IRB 12737). Students completed a validated pre‐survey evaluating their confidence in using and perceptions of US on an 11‐point Likert scale. Students were asked to watch US video primers to prepare for lab. Students rotated through an US station during 5 labs, correlating with 5 different regions during the anatomy course. Students watched US being performed and gained hands on experience acquiring US images. US questions were included on written and practical exams. Students completed a post‐survey evaluating changes in confidence and perceptions of US, and open responses to questions about the quality of the US curriculum. Mean ratings on pre‐ and post‐ surveys were compared using a Mann‐Whitney U test. Performance on US based exam questions were expressed as percent correct. Narrative responses were coded by two independent evaluators and qualitative analysis was done using NVivo software to identify common themes across students’ responses.

Results

211 students completed the US curriculum. 93% of students had no prior exposure to US. Students reported significantly higher mean confidence ratings on understanding US, ability to operate US, obtain US images, recognize artifacts, and interpret normal anatomy images (p<0.0001) after completing the US curriculum. Students also reported that US reinforced anatomy concepts and clinical correlates (9.56, ± 0.97 SD; 9.60, ± 1.05). Students disagreed with items stating learning US is too difficult for a student (1.2, ± 2.2 SD) and that it interfered with learning anatomy (0.68, ± 1.7 SD). The average percent correct on US questions for each exam was 94.2 (Back/Lower Extremity), 91.6 (Upper Extremity/Thorax), 80.6 (Abdomen/Pelvis), and 96.7 (Head/Neck). Qualitative analysis of narrative survey responses identified seven major themes and additional subthemes (see figure
).

Conclusions

Limited integration of US has proven to bolster students’ perceptions of bedside US and has given them confidence in image acquisition. Students scored well above passing rate on US knowledge questions, supporting confidence and perceptions data. Qualitative and quantitative analyses found that anatomy is a good setting to teach US, and anatomy concepts and clinical applications of US reinforce each other through the combined curriculum. There is strong desire from students for more US training.

Support or Funding Information

Funded by TUSM Innovations in Education Grant

The seven themes and subthemes identified from thematic analysis of first‐year students' narrative comments on the effectiveness of the US curriculum.

Figure 1