Physician and Resident Perspectives on Ultrasound Curriculum Development for Medical Students: A Survey Study
Creators: name: Obeid, Sara
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2015

description: Background: To date, the ACGME (Accreditation Council for Graduate Medical Education) has not yet set guidelines for training medical students on the safe and effective use of diagnostic ultrasound (US) in the clinical and pre-clinical years. Thus, we sought to determine when and if current residents and physicians have received prior training in US. Also, we sought to determine which US competencies are pertinent to various specialties both to the current practice of residents, fellows and attendings in comparison to the future practice of medical students. Our future aim is to apply our findings to the current US elective offered to UNC- CH (University of North Carolina at Chapel Hill) medical students with implications for future national guideline development for training medical students in focused US. Methods: A one-time cross sectional observational study consisting of an online survey instrument comprising 34 questions administered via Qualtrics® survey software. Survey items were developed with the aid of two accredited emergency medicine physicians. All statistical analysis was conducted via STATA® Software using mean, standard deviation, t test, and chi-square where appropriate. A total of 79 out of 80 responses were included for analysis. One medical student response was excluded. Inclusion criteria were resident, fellow and attending physicians at UNC and Wake Med Hospitals in Chapel Hill and Raleigh NC. Exclusion criteria included medical students and other healthcare providers other than physicians. Also, physician responders from the departments of radiology and psychiatry were excluded because of specialized training in ultrasound or infrequent use in clinical duties respectively. All free response data were not included in this analysis for the purposes of this master's paper submission. Results: A total of 79 resident, fellow, and attending physicians participated in this survey study with an overall response rate ranging from 7.9% (79 out of 1000) to 15.8% (79 out of 500). The majority of participants were female 45 (61.6%) vs male 27 (36.9%), attending physicians 52 (65.8%) vs resident physicians 38 (48.1%). The majority of participants were from the departments of family medicine 26 (32.9%), internal medicine 19 (24.0%) and pediatrics 21 (26.5%). Most of the participants in the study 46 (63%) had never received formal US training and those who received prior training 27 (36.9%) reported that it was more likely mandatory 16 (61.54%), and have occurred during residency 16 (61.5%) the duration of which is less than one day 9 (34.62%). 57 (81.4% out of 70) respondents thought that training medical students to apply basic ultrasound techniques will be an important requirement for the future practice of medicine in their respective fields. In five US based procedures, the future practice of medical students was compared to the current US based proficiency requirement of residents and fellows: basic cardiac exam 32 (46.4%) vs 4 (7.27%), central line placement 33 (47.8%) vs 35 (54.7%), peripheral line placement 39 (56.5%) vs 4 (6.06%), basic abdominal pathology identification 39 (55.7%), and Deep Venous Thrombosis Identification 23 (33.8) vs 1 (2.33%). A total of 43 participants reported that they would need a mean of 44.3 (95% CI 36.2-52.3) repetitions in order to interpret an US image for a specific condition without assistance as compared to a mean of 38.7 (95% CI 31.4- 45.9) to obtain an US at bedside without assistance for a specific condition. Conclusions: The majority of respondents felt that focused US education for medical students will be essential in their field of practice regardless of whether they have received prior US training themselves. The majority of respondents did not receive US training themselves and if they did, it was of a short duration. We have also gained insights as to which US based procedures are currently meaningful to practicing clinicians with some indication of challenges to a vertical US curriculum including time constraints, faculty development as well as hospital wide availability of hand held US devices.