Introduction
Methods
2016 | 2017 | 2018 | 2019 |
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Introduction to Ultrasound Cardiac Anatomy Abdomen and Pelvis Anatomy Neck Anatomy Neurovascular Ultrasound Cardiac Function 1 and 2 Hepato-Biliary Ultrasound Renal System Ultrasound | Musculoskeletal Ultrasound Endocrine Ultrasound Ultrasound Guided Vascular Access Ultrasound for Pregnancy Point-of-Care Ultrasound elective | Lung Ultrasound Point-of-Care Echocardiography Dedicated teaching sonographer added to curriculum | Ultrasound certificate program Ultrasound simulator |
Results
Scoping review of ultrasound curricula in the US
Institution | Reference | Duration (years) | Format of information delivery | Instructional method | Curricular structure | Mode of Integration | Preclinical years | Clinical years | Instructors | Student-to-Instructor Ratio |
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Touro University College of Osteopathic Medicine | Hendriksz, Markman, and Pera [27] | 4 | Hands-on sessions | Not addressed | Staged/ Organ-systems based | Concurrently with anatomy and clinical courses | Anatomy system blocks Cardiac and blood vessel Liver, gallbladder, and kidneys Ocular Fetal FAST examination Cardiac, vasculature, renal, lung | Small-group hands-on learning sessions Expanded radiology | Faculty | 8: 1 |
University of California, Los Angeles University of California, Davis University of California, San Francisco University of California, San Diego University of Southern California Stanford University Loma Linda University | Chiem et al. [10] | 4 | Online materials (lectures, textbook chapters, simulated cases, and journal articles) + hands-on sessions | Flipped classroom | Staged/Organ-systems based | Concurrently with anatomy and physical examination courses | Ultrasound Image Acquisition of Normal Anatomy and Physiology Basic Ultrasound Pathology Ultrasound Identification of Pathologic Conditions | Pre-Senior Year Course Clerkships | Peer educators | Not addressed |
University of California, Irvine | Fox et al. [28] Wilson et al. [29] | 4 | Open-access podcast lectures + hands-on sessions | Not addressed | Staged/Organ-system based | Expanded medical program of study | Knobology Cardiovascular 1 and 2 GI Physiology Respiratory Musculoskeletal Genitourinary Head and Neck Review/Practice Ultrasound for Evaluation of Fever Focused Assessment of the Thorax Exam (FATE) Lung Ultrasound Gastrointestinal and Genitourinary Ultrasound Cumulative Skills | Two-hour workshop for identification of pathology prior to rotations | Peer educators with faculty assistance | 4: 1 |
Wayne State University School of Medicine | Rao et al. [12] | 1 | Didactics, hands-on experience, clinical correlation components | Flipped classroom | Vertical | Expanded medical program of study | Introduction to Ultrasound Musculoskeletal Ultrasound Vascular and Cardiac Ultrasound Ultrasound of the Abdomen Genitourinary Ultrasound Ultrasound and Procedural Skills | Not applicable | Peer educators with faculty assistance | Not addressed |
University of South Carolina Medical School | Hoppmann et al. [4] Hoppmann et al. [1] | 4 | Web-based learning modules, video assignments, hands-on lab session | Not addressed | Vertical | Concurrently with anatomy, problem-based learning, clinical skills | Anatomy Physiology Neuroanatomy Problem-Based Learning Introduction to clinical medicine: pathophysiology Pathology Physical diagnosis | Emergency medicine "selective" Emergency medicine elective Critical care "selective" Radiology elective Clerkships (Internal Medicine, Family Medicine, Surgery, OB-GYN, Pediatrics) Ultrasound independent 1-month study elective Capstone ultrasound course selective Acting internship with ultrasound access | Faculty | Not addressed |
West Virginia University School of Medicine | Mindari et al. [23] | 4 | Lectures, online videos, workshops, and practical hands-on sessions | Flipped classroom | Longitudinal | Concurrently as a "thread" with anatomy, basic science lectures, and physical examination courses | Human Structures (6 modules, including introduction to ultrasound) Microbiology and Immunology Pathology Pharmacology Physical Diagnosis/Clinical Integration | Clerkships (OB-GYN, Surgery, Internal Medicine, Family Medicine, Pediatrics, Psychiatry, Anesthesia, Critical Care) Emergency and Critical Ultrasound Elective Radiology Elective | Faculty | 2: 1 |
Ohio State University College of Medicine | Bahner et al. [11] Bahner and Royall [7] | 4 | Lectures + hands-on sessions | Not addressed | Vertical + longitudinal | Concurrently with anatomy and clinical reasoning course | Musculoskeletal Anatomy Ultrasound Thorax, Abdomen and Pelvis Anatomy Ultrasound Head and Neck Anatomy Ultrasound Introduction to Focused Ultrasound Elective Basic Course in Focused Ultrasound Protocols Elective Ultrasound-Guided Vascular Access | Specialty-Based Hands-On Ultrasound Experience Core Focused Ultrasound Protocols Emergency Focused Ultrasound Specialty-Based Hands-On Ultrasound Experience | Faculty | Not addressed |
Icahn School of Medicine at Mount Sinai | Nelson et al. [30] | 1 | Lectures, demonstration, hands-on session | Not addressed | Staged/Organ-systems based | Concurrently with gross anatomy and physical examination courses | Basic ultrasound physics and instrumentation Focused cardiac ultrasound Focused thoracic ultrasound Focused abdominal ultrasound | Not applicable | Faculty + senior residents | Not addressed |
University of Sydney Medical School | Moscova et al. [31] | 1 | Hands-on sessions | Not addressed | Longitudinal | Incorporated into second year practical sessions | Imaging of abdomen, pelvis, and vascular ultrasounds | Note applicable | Specialists | Not addressed |
A.T. Still University-Kirksville College of Osteopathic Medicine | Kondrashova and Lockwood [32] and Kondrashova [33] | 2 | Video modules, hands-on sessions, and clinical correlation components | Flipped classroom | Staged/Organ-systems based | Integrated into gross anatomy and new Clinical Ultrasound Elective | Introduction to US Neck Upper Limb Musculoskeletal Abdomen Gastrointestinal Pelvis Urinary system Lower Extremities Ocular Ultrasound Echocardiography Vascular & Extremities Clinical Ultrasound Elective | Not applicable | Not addressed | Not addressed |
Rocky Vista University College of Osteopathic Medicine | Russ et al. [36] | 4 | Video modules, hands-on sessions, and clinical correlation components | Flipped classroom | Vertical | Integrated into gross anatomy and Principles of Clinical Courses | Ultrasound Physics and Introduction Musculoskeletal Parts I & II Cardiac Ultrasound Thoracic and Pulmonary Ultrasound Abdominal Ultrasound Head and Neck Ultrasound Cardiovascular Ultrasound Focused Abdominal Sonography in Trauma Ultrasound Abdominal Ultrasound Musculoskeletal Ultrasound Resuscitative Ultrasound | Ultrasonography and Procedure course Clinical Ultrasonography Rotation | Faculty + Peers | Not addressed |
Harvard Medical School | Rempell et al. [15] | 2 | Lectures, case-based examples, hands-on sessions | Not addressed | Staged/organ-systems based | Integrated into gross anatomy and physical diagnosis course | Anatomy lab curriculum Ultrasound Selectives | Not applicable | Faculty | 4: 1 |
Florida State University College of Medicine* | Not applicable | 3 | Large-group sessions/lectures, small group, and clinical learning center cases | Not addressed | Organ-systems Based | Not addressed | Not addressed | Not addressed | Faculty | |
University of South Carolina School of Medicine Greenville* | Not applicable | 4 | Online lectures + hands-on sessions | Flipped classroom | Organ-systems Based | Not addressed | Not addressed | Not addressed | Faculty | 5–7: 1 |
Bangladesh Institute of Health Technology* | Not available | 2 | Lectures, hands-on sessions, observation scanning sessions, field-hospital visits, case presentation | Not addressed | Organ-systems Based | Not addressed | Not addressed | Not addressed | Faculty Sonologist | 4: 1 |
College of Medicine – University of Sharjah* | Not applicable | 5 | Lectures + hands-on sessions | Not addressed | Problem-based learning | Not addressed | Not addressed | Not addressed | Faculty | 10: 1 |
University of Limerick* | Not applicable | 2 | Hands-on annual sessions | Not addressed | Problem-based learning | Not addressed | Not addressed | Not addressed | Faculty Sonographers Visiting POCUS instructors | 4–5: 1 |
Medical College of Georgia School of Medicine* | Not available | 4 | Lectures, hands-on sessions, independent scanning | Not addressed | Other/multi-track | Not addressed | Not addressed | Not addressed | Faculty Peer educators Sonographers | 30: 1 |
University of Texas Health Science Center – San Antonio* | Not applicable | 4 | Didactics + hands-on sessions | Not addressed | Discipline based | Integrated with Clinical Ultrasound Education, clinical rotations, and specialty electives | Not addressed | Not addressed | Faculty Peer educators Fellows and Residents | Variable |
Northwestern University Feinberg School of Medicine* | Not applicable | 4 | Hands-on workshops and sessions | Not addressed | Organ-systems based | Not addressed | Hands-on ultrasound workshops during the first two years, SonoSim ultrasound session (knobology and lung) | Optional hands-on sessions for students going into surgical specialties | Faculty | 3–5: 1 |
UNC School of Medicine – Carolinas Medical Center* | Lewis et al. [37] | 1 | Lectures + hands-on sessions | Not addressed | Organ-systems based | Not addressed | Not applicable | Imaging, Acquisition & Orientation The Cardiopulmonary Patient, The Acute Abdomen I, The Acute Abdomen II, The Pregnant Patient, Procedural Guidance, Ultrasound course wrap-up Clerkships | Faculty Residents | 4: 1 |
Rutgers New Jersey Medical School* | Not applicable | 4 | Lectures, online lectures, hands-on sessions | Not addressed | Organ-systems based | Not addressed | Not addressed | Not addressed | Faculty Emergency medicine residents | 5: 1 |
Virginia Commonwealth University* | Not applicable | 4 | Online lectures + hands-on sessions | Not addressed | Organ-systems based | Not addressed | Not addressed | Not addressed | Peer educators | 7–8:1 |
University of California Riverside School of Medicine* | Not applicable | 4 | Didactics + hands-on sessions | Not addressed | Student-driven | Integrated with gross anatomy and clinical skills courses | Gross Anatomy modules Clinical Skills with Point-of-Care Selective | Point-of-care ultrasound sessions | Faculty Peer educators | 3: 1 |
Idaho College of Osteopathic Medicine* | Not applicable | 4 | Didactics, hands-on sessions, podcasts | Not addressed | Organ-systems based | Not addressed | Not addressed | Not addressed | Sonographers | 20:1 |
Texas A&M University* | (Texas A&M University, AY 2016–2017) | 2 | SonoSim, hands-on with SP and ultrasound machine | Not addressed | Longitudinal elective | Ran parallel to clerkships | Not applicable | Fundamentals of Ultrasound Clerkship modules (General Surgery, Emergency Medicine, Critical Care, Family Medicine, Internal Medicine, and OBGYN) | Faculty Peer educators | 4–6: 1 |
Università di Pavia* | Not applicable | 6 | General lectures + small group hands-on sessions | Not addressed | Other/multi-track | Integrated into anatomy and physiology courses | Not addressed | Not addressed | Faculty Peer educators Radiology and Emergency Residents | 4: 1 |
Duration/curricular structure
Mode of integration
Instructional formats
Instructors
Evaluation of program
Integrated ultrasound curriculum development at wake forest school of medicine
Curricular structure prior to implementation of ultrasound curriculum
MS 1 Ultrasound curriculum | ||||
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Course learning objective | Method of assessment (if applicable): | Institutional objective domain | Institutional objective subdomains | Entrustable professional activities (EPA) |
1. Anatomy I—Intro to Ultrasound: Describe the basic scientific principles of diagnostic ultrasound Describe the basic principles of ultrasound image acquisition Identify the median nerve, tendons of the forearm muscles, and the carpal tunnel | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1.Knowledge for Practice 2. Interpersonal and Communication Skills 3. Patient Care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
2. Anatomy II—The Heart: Identify the major chambers of the heart Identify the aortic, tricuspid, and mitral valves Correlate the heart sounds with valve motions | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam–Institutionally Developed, Laboratory, Practical | 1. Knowledge for Practice 2. Interpersonal and Communication Skills 3. Patient Care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
3. Anatomy III – The Abdomen and Pelvis: Obtain images of and identify the liver, spleen and kidneys in two anatomic planes (1.0, 1.1) Identify the major potential spaces in the abdomen (1.0. 1.1) Image and identify the uterus, prostate, bladder (1.0, 1.1) Identify the pelvic potential space (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1. Knowledge for Practice 2. Interpersonal and Communication Skills 3. Patient Care 4.Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
4. Anatomy IV – The Neck: Identify the trachea, thyroid gland, common carotid artery, and internal jugular vein Describe the characteristics of simple cysts | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam–Institutionally Developed, Laboratory, Practical | 1. Knowledge for Practice 2. Interpersonal and Communication Skills 3. Patient Care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
5. Anatomy V – Musculoskeletal/Shoulder: Identify the biceps tendon Describe the sonographic appearance of muscle, tendon, and bone Identify the major components of the rotator cuff | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam–Institutionally Developed, Laboratory, Practical | 1. Knowledge for practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
6. Neuroscience–Carotid: Perform color Doppler imaging of common carotid flow. (1.0, 1.1) Brain: Image the MCA with transcranial Doppler techniques. (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1. Knowledge for practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
7. Gastroenterology—Biliary Anatomy: Assess liver span and correlate with palpation of the liver edge (1.0, 1.1) Identify the portal vein and vena cava (1.0, 1.1) Measure the size of the gallbladder (1.0, 1.1) Identify the common bile duct (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam–Institutionally Developed, Laboratory, Practical | 1. Knowledge for practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
8. Pulmonology – Lung: Assess lung slide (1.0, 1.1) Assess diaphragm – excursion (1.0, 1.1) Identify diaphragm in ultrasound image (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam–Institutionally Developed, Laboratory, Practical | 1. Knowledge for Practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
9. Cardiopulmonary – The Heart I Identify and Assess mitral valve motion (1.0, 1.1) Identify diastole and systole on echocardiographic images (1.0, 1.1) Associate heart sounds with cardiac motion (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1. Knowledge for practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
10. Cardiopulmonary – Cardiac Functional Assessment: Measure the E-point septal separation (1.0, 1.1) Measure the ejection fraction in the LV 2 chamber view and the Apical 4 chamber view (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1. Knowledge for practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
11. Renal – The urinary tract: Identify the right and left kidneys (1.0, 1.1) Measure the size of a kidney (1.0, 1.1) Measure the volume of the bladder (1.0, 1.1) Identify ureteral jets in the bladder (1.0, 1.1) | AM09: Multisource Assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1. Knowledge for practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA 10 EPA 12 |
12. Endo—Thyroid: Identify the thyroid gland (1.0, 1.1) Identify the trachea (1.0, 1.1) Measure the volume of the thyroid gland (1.0, 1.1) | AM09: multisource assessment AM12: Participation AM17: Self-Assessment AM19: Exam – Institutionally Developed, Laboratory, Practical | 1. Knowledge for Practice 2. Interpersonal and communication skills 3. Patient care 4. Professionalism | 1.0 1.1 2.0 2.4 3.0 3.4 4.0 | EPA 1 EPA 3 EPA10 EPA 13 |
Exam | Rotation | Learning Objectives |
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Bedside echo | Internal medicine | 1. Describe indications for a bedside echocardiogram 2. Describe ultrasound findings related to intravascular volume status 3. Describe the sonographic characteristics of tamponade on 2D imaging 4. Describe ultrasound findings related to systolic dysfunction 5. Demonstrate the standard echocardiographic views for the exam |
Focused assessment with sonography in trauma | Surgery | 1. Describe indications for a FAST exam 2. Describe implications for downstream patient care based on exam findings 3. Describe the appearance of abdominal free fluid in each sonographic window 4. Describe the sonographic characteristics of tamponade on 2D imaging 5. Demonstrate the standard ultrasound views for the exam |
Ultrasound in pregnancy | Obstetrics and gynecology | 1. Describe the indications for obstetric ultrasound 2. Optimize quality of fetal images 3. Determine fetal lie and presentation 4. Identify the fetal heads, spine, extremities, abdomen, and thorax 5. Visualize anatomic structures in more than one orthogonal plane |
Ultrasound guided procedures | Emergency medicine | 1. Describe the differences between in plane and out of plane needle guidance 2. Describe general principles of ultrasound guided procedures 3. Describe the procedural steps for an ultrasound guided IV catheter placement 4. Perform in plane and out of plane needle guidance on an ultrasound phantom |
Implementation
Machines | Initial grant funding 4 cart-based machines, each with a phased array, curvilinear and linear probe One owned by the institution machine on permanent loan from the manufacturer The success of the curriculum allowed additional machine purchases possible, to a total of 9 cart-based machines, each with a 3-probe setup |
Physical space requirements | A room large enough for 1 to 3 instructors to supervise 5–6 groups of students Stretchers or exam tables are needed so that students or standardized models can lie recumbent for exams The lab sessions initially were held in an available large meeting room in the medical school building. In 2017 we moved to a new building and held ultrasound laboratory sessions in a large multipurpose room |
Audiovisual | We have found it is also very helpful to have large secondary displays for group members to observe that can be repositioned so that student models can also see the image At curriculum launch, we purchased gurneys for use during ultrasound lab sessions and two large LCD displays on portable mounts 2017 converted to with 5 mounted displays as well as our exiting mobile displays |
Personnel requirements | Faculty/sonographer hours per session 4–16 h (yearly estimate) |