Ultrasound in Medical Education Curriculum

Background

            The use of point of care ultrasound has become widespread across nearly every specialty in medicine. It is an accurate, noninvasive, portable diagnostic modality, which will only continue to expand as it becomes more cost effective and user-friendly. Bedside ultrasound augments the physical exam and the physician’s ability to safely, efficiently, and accurately diagnosis and treatment his or her patients without additional radiation or cost. In fact, the Agency for Healthcare Quality and Research recommends its routine use given its excellent safety profile. One of the challenges to routine ultrasound utilization is the lack of training.

            The goal of medical school is to train competent, compassionate physicians who effectively communicate and collaborate within a multidisciplinary system. In 2014, the AAMC released the 13 Core Entrustable Professional Activities for Entering Residency to help achieve these goals. Of those thirteen, ultrasound directly supplements the nine listed below.

• EPA 1: Gather a history and perform a physical examination

• EPA 2: Prioritize a differential diagnosis following a clinical encounter

• EPA 3: Recommend and interpret common diagnostic and screening tests

• EPA 7: Form clinical questions and retrieve evidence to advance patient care

• EPA 9: Collaborate as a member of an inter-professional team

• EPA 10: Recognize patients requiring urgent/emergent care & initiate evaluation & management

• EPA 11: Obtain informed consent for tests and/or procedures

• EPA 12: Perform general procedures of a physician

• EPA 13: Identify system failures and contribute to a culture of safety and improvement

Numerous studies have demonstrated that point of care ultrasound enhances traditional learning, student fulfillment, and confidence; improves diagnostic and procedural skills; fosters patient care, safety and satisfaction; and provides a foundation for advanced specialty specific ultrasound applications.

 The number of specialties utilizing ultrasound is expanding continuously. In fact, six specialties and subspecialties have formal ACGME requirements for ultrasound training. This number will continue to expand as ultrasound becomes more cost effective, portable, and user friendly; not to mention as studies continue to demonstrate its ability to augment the physical exam and other diagnostic modalities.

• Radiology*

• Cardiology*

• Obstetrics and Gynecology*

• Emergency Medicine*

• Urology*

• Critical Care Medicine*

• General Surgery

• Family Practice

• Anesthesiology

• Internal Medicine

• Ophthalmology

• Neurology

  *ACGME requirement

 Numerous medical organizations [DJK1] have organized subcommittees to champion the implementation of ultrasound education as a core competency within medical schools nationwide. These include the following:

• American Institute of Ultrasound in Medicine

• Society of Ultrasound in Medical Education & World Interactive Network Focused on Critical Ultrasound

  • International Consensus Conference on Ultrasound in Medical Education

  • Annual World Congress on Ultrasound in Medical Education (since 2011)

    • Over 100 medical schools participating

• Association of University Radiologists

  • Alliance of Medical Student Educators & Clinical Educators in Radiology

  • Society of Radiologists in Ultrasound

• American College of Emergency Physicians

• Society of Academic Emergency Medicine