A pilot project to study the use of ultrasonography for teaching physical examination to medical students

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Abstract

The purpose of this study was to study the use of ultrasound as an aid to teaching physical examination. Five medical students were given a 1-week course in ultrasound, and were then assigned to clinical rotations to perform ultrasound and physical examinations on patients. Basic ultrasound skills were assessed by having each student scan the same normal model at the conclusion of the first week and at the conclusion of the project. Clinical cases were presented to a preceptor, and the ultrasound images were graded on a five-point scale. At the end of the first week, the mean grade of ultrasound examinations performed on the control model was 3.2, improving to 4.4 at the end of the project. Grading of ultrasound exams performed during the first clinical week averaged 4.1, improving to 4.5 at the end of the project. An exit survey indicated a favorable response to using ultrasound as an educational tool.

Introduction

Bedside examination of patients is the traditional method of teaching physical examination to medical students. Numerous studies have shown a decline in the physical examination skills of medical students, interns, and residents [1], [2], [3], [4], [5], [6], [7], [8]. This decline has been attributed to many factors, including lack of supervised bedside instruction and increased reliance on high technology diagnostic tests [8], [9], [10]. Ultrasound is unique among imaging modalities in that it permits visualization of anatomic and pathologic structures within the body in a relatively inexpensive and completely non-invasive manner. This makes ultrasound an attractive tool for teaching physical examination to medical students. To investigate the value of ultrasonography in teaching physical examination, we performed a pilot project in which medical students received instruction in ultrasonography and then had the opportunity to perform both ultrasound and physical examinations on patients. The results of the project are described in this report.

Section snippets

Materials and methods

Five medical students between the second and third years participated in this 6-week project. The study was performed with the approval of the institutional review board. During the first week, the students received an intensive instructional course in ultrasound. The instructional course included scanning sessions on live models. For the following 4 weeks, the students were assigned to rotations in the Emergency and Ultrasound Departments where they performed both ultrasound and physical

Results

At the end of the first week, the mean grade of ultrasound examinations performed on a normal control patient was 3.2. At the conclusion of the course, the mean grade of ultrasound examinations performed on the same normal control patient improved to 4.4 (p=0.005) (Fig. 1).

A total of 116 clinical cases were reviewed. Grading of ultrasound exams performed on patients during the first clinical week averaged 4.1. Grading of ultrasound exams performed on patients during the final clinical week

Discussion

The changing nature of medicine requires the innovative use of new techniques and technologies in medical education. Teaching physical examination to medical students has traditionally been based on the time-honored technique of bedside examination of the patient. Numerous studies have shown a decline in the physical examination skills of physicians in training [1], [2], [3], [4], [5], [6], [7], [8]. A study of third year medical students’ physical examination skills reported that correct

Summary

In summary, a pilot project was conducted to study the feasibility and value of using ultrasonography to teach physical examination to medical students. We found that basic ultrasound skills could be taught to medical students in a short time frame. Results of a student survey showed a favorable response to using ultrasonography as an aid to teaching physical examination. Further studies are needed to document actual improvements in physical examination skills using this modality.

Robert S. Shapiro, MD is an Associate Professor of Radiology and Director of Body Imaging at Mount Sinai Medical Center. He attended Columbia College and the Mount Sinai School of Medicine. He also completed a residency in Diagnostic Radiology at Mount Sinai. Dr. Shapiro has performed research on new ultrasound imaging techniques including harmonic imaging and real-time compound imaging.

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Robert S. Shapiro, MD is an Associate Professor of Radiology and Director of Body Imaging at Mount Sinai Medical Center. He attended Columbia College and the Mount Sinai School of Medicine. He also completed a residency in Diagnostic Radiology at Mount Sinai. Dr. Shapiro has performed research on new ultrasound imaging techniques including harmonic imaging and real-time compound imaging.

Patrick P. Ko, MD is a Clinical Assistant Professor of Emergency Medicine. He is interested in emergent bedside sonography and heads the Ultrasound Division of the Emergency Department.

Sheldon Jacobson, MD is Professor and Chairman of the Emergency Medicine Department at Mount Sinai Medical Center. He attended City College in New York. Dr. Jacobson received his medical training at the Albert Einstein College of Medicine. His current areas of interest include medical administration and medical education.

This project was supported by a grant from the Gaisman Teaching Enhancement Fund of the Office of the Dean of Mount Sinai School of Medicine.

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