Ultrasonography (US) is now used in some fashion by most specialties, and in graduate medical education, performing a US examination is now a routine expectation in the fields of emergency medicine, surgical critical care, diagnostic radiology, pulmonology, and gynecology. The American Medical Association has confirmed that physician‐performed US is within the scope of practice of appropriately trained physicians and recommend that training and education standards be developed by individual medical specialties.
In light of its clinical and education utility, it is reasonable to expect that US would be taught during medical school. Some national and international bodies, including the AIUM, have proposed curricula for medical students. While its level of use is variable, several schools have described integrated US into undergraduate medical education. Several studies have shown that students are able to and want to learn point-of-care US (POCUS) in medical school. Let’s review some tips for engaging medical students while teaching POCUS.
1. Hands-on timeAllow the medical student to have hands on the probe as much as possible. Limit lecture time to only that which must be done in lecture format. Make sure group learning time is done in small groups with maximal time for each student to use the probe. Give them time to work through different positions and views to help identify windows and quality images. Use your verbal commands to direct them instead of taking the probe. If you are going to take the probe, put your hand over theirs.
2. Engage the studentFind a use for ultrasound that is relevant to the student’s specialty of choice. Most specialties now have some use for ultrasound. IF you cannot identify a use for ultrasound in the specialty of choice, consider teaching general skills like US-guided IV insertion. Describe how US was or would have been useful during residency.
3. Make it funUse simulation liberally. Consider having a game or competition (see Sono-games, SonoSlam, or other similar competitions for potential ideas). Multiple homemade procedural models have been described and are inexpensive. Medical students, in general, love practicing procedures and are mostly competitive by nature. There are several ways for the more experienced student to improve their US skills in a fun manner. Some ideas include identifying inanimate objects blindly that are immersed in water, a competition like fastest FAST exam, or making a procedural simulation competition.
4. Short and sweetKeep sessions engaging by spreading practice out over time. Again, keep lectures as brief and need-to-know as possible. Most medical students will only need a brief physics review and do not, for example, need to know the Nyquist limit. They need to know how to answer focused questions with ultrasound. Students will lose interest if doing the same exam over many hours. Consider spreading sessions, especially image review sessions, out to 1 hour or less over several days. Intersperse different types of ultrasound (e.g., abdominal, cardiac, pulmonary, vascular) within the same session to keep students engaged.
5. Start earlyExpose students to US early on in medical school. Consider adding it to anatomy or physiology classes while students are still in their pre-clinical years. If you do not have the swing to add a formal session to preclinical years, consider having voluntary “anatomy review” sessions using US. Try to get enough interest to start an interest group for students that is student-run. This will allow them to take some of the responsibility for scheduling and promoting events and you can focus on what you do best, teaching US.
Ultrasonography is coming to medical education and will continue to grow in use. While students going into specialties like radiology and emergency medicine may instantly be engaged in US teaching, consider ways to engage other students. There is a role for US in nearly every specialty.
Sonographers can and should play a key role in teaching medical students techniques for US. Sonographers perform these exams every day for many years. They have tricks for obtaining quality images and many sonographers are also quite good at interpreting exams, as well.
Embrace medical students and engage them with your passion for ultrasound. Show them how it will be helpful to them in the future. Take an active role in medical student education and watch the use of ultrasonography in medical practice continue to grow.
Do you have suggestions for teaching POCUS to medical students? Comment below, or, AIUM members, continue the conversation on Connect, the AIUM’s online community.
Joshua J Davis, MD, is an Emergency Medicine Resident at Penn State Milton S. Hershey Medical Center.
If you attended the AIUM convention the past 2 years you may have heard mention of SonoSlam in passing. So what is it? SonoSlam is a medical student ultrasound competition and educational event. It was conceived as an idea to promote medical student ultrasound and was officially born in Orlando in 2015. A few members of the medical education committee were discussing how to get students more engaged in ultrasound at the national level. A national ultrasound student interest group had been formed and got behind the idea of nationalizing ultrasound activities for medical students. Many of us had been involved in regional events such as Ultrafest or had participated in Sonogames™, an emergency medicine resident ultrasound competition. As we brainstormed, SonoSlam came to fruition. We wanted this event to be more than a game, making sure to integrate education into the proceedings. Given the diversity of exposure to ultrasound in undergraduate medical education, the faculty wanted to ensure that this event would be appealing to students of all levels of experience. In addition, the unique offering of AIUM is that this event would be multidisciplinary. With these key components of education, competition, and a multidisciplinary approach SonoSlam was created. The inaugural SonoSlam was held in New York in 2016 with the winning team awarded the Peter Arger Cup, named after the famed radiologist who championed medical student ultrasound education at the AIUM. Seventeen teams from 12 different schools participated in this inaugural event with more than 30 faculty from across the country. This year in Orlando we grew to 23 teams from 17 schools from across the country—Oregon to New York to Florida and all in between. We had more than 50 faculty from a multitude of specialties, including emergency medicine, internal medicine, critical care, obstetrics and gynecology, radiology, and pediatrics. We plan to continue to host this event annually with the lofty goal of having representation from every medical school in the country. We hope to see you in New York March 24, 2018!