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Symington Report to the Anatomical Society of Great Britain and Ireland
on the ‘1st World Congress on Ultrasound in Medical Education
Conference’ (April 29 – May 1, 2011)
By Dr Debra Patten (Newcastle University)
Monday, 11 July 2011
Introduction
‘Point of care ultrasound’ (PoCUS) was first pioneered in the USA some ten years ago and
in that period its application has expanded into several medical specialities. The consensus
is that portable ultrasound can be a powerful tool to aid diagnosis when used in conjunction
with a physical examination of the patient, and particularly so in emergency medicine. The
benefits of PoCUS are also well documented in terms of improvements in service provision,
patient safety and cost effectiveness (1).
The potential exists for ultrasound to fundamentally change how medicine is practiced and
taught. After ten years of practice in the clinical arena, PoCUS, it is now being introduced
into the undergraduate medical curricula to varying degrees, in several countries.
Conference Report
The Symington Fund part funded Dr Debra Patten to attend and contribute to the ‘1st World
Congress on Ultrasound in Medical Education Conference’ (April 29 – May 1, 2011) in
Columbia, South Carolina, U.S.A. This conference was the first of its kind in bringing
together educators, healthcare practitioners and innovators, students and trainees of
ultrasonography.
The conference was intended to deliver a medical education perspective, which it did to
some degree, with several themed sessions reporting on undergraduate ultrasound
programmes and curriculum design. However, the predominant theme represented in
presentations and workshops was the practice of PoCUS. Thus it would appear the
practitioners of PoCUS are leading its introduction into undergraduate medical curricula.
Developments in the USA
There are several US universities who have made significant progress in developing their
undergraduate ultrasound curricula. Individuals from these institutions presented their work
during the conference, but how widespread the adoption of ultrasound was into
undergraduate curricula across the USA in general remained unclear.
The US Universities who appear to have led the development of undergraduate ultrasound
curricula are the University of South Carolina, California Irvine University, Wayne State
University, Ohio State University and George Washington University.
 University of South Carolina , California Irvine University and Wayne State University,
have developed full, integrated vertical ultrasound curriculum where students are using
portable ultrasound from the beginning, are assessed throughout and, in some cases,
use portable ultrasound on the wards from year 3 onwards.
 All the aforementioned curricula were developed with support from ultrasound
manufacturers who freely supplied sets of equipment to the medical schools.
 Two of the aforementioned curricula are described by Hoppman et al., (2011)(2) and
Rao et al., 2008 (3).
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In general, ultrasound instructors appear to be either clinicians or more senior medical
students, but not necessarily experts in sonography.
In the first instance (e.g. at the University of South Carolina), students learn how to use
the machine properly and then scan each other to examine the anatomy and physiology
of the chest, abdomen, limbs and neck.
Later in the curriculum students learn ‘point of care ultrasound procedures’ such as
FAST scanning to check for free fluid in the abdomen, basic echocardiography, scanning
to check for pleural and pericardial effusion and pneumothorax and ultrasound-guided
central venous catheterisation.
In all three aforementioned universities is taken for granted that in scanning each other
routinely, medical students will discover pathology using ultrasound. There are referral
procedures in place to ensure any abnormalities/ pathology can be investigated and
clinicians who deliver the sessions can write referrals as required. However, there is no
great concern about the ethical issues surrounding the public discovery of pathology in a
student volunteer within a teaching session (i.e. within a peer group); this is something
the 1CETL4HealthNE Ultrasound Group has been much more concerned about in the
U.K.
The students were very enthusiastic about the use of portable ultrasound (several
presented at the conference and were involved in the delivery of the curriculum.
Developments in the UK
 Newcastle and Durham Universities have been using portable ultrasound in their
undergraduate medical curricula within Phase 1 anatomy teaching since 2007.
 The CETL4HealthNE Ultrasound Group has provided a regional forum for medical
educators using ultrasound to develop policy around good practice and innovative
learning and teaching programmes using portable ultrasound technology.
 Several other U.K. medical schools are now using this technology including Northumbria,
Imperial College London, Peninsula, Aberdeen (personal communication) and
Cambridge, but there are few publications documenting ultrasound curriculum
development in the UK [(4-6)].
 At their annual conference, The British Medical Ultrasound Society (BMUS, September
2010) debated the notion that ‘All medics should be taught basic ultrasound as a core
clinical skill’ as part of a session on Professional Training issues entitled ‘Ultrasound –
the new stethoscope: impact on education and training’.
o Dr Leo Donnelly (Peninsula Medical School) represented the CETL4HealthNE
Ultrasound Group in this debate in favour of this notion. However, the consensus
amongst ultrasonographers was that although undergraduate ultrasound
competency was recognised as an ideal, the lack of available resource to
implement a proper training programme for this negated the possibility of it
happening any time soon, and therefore, ultrasound should not be included in the
undergraduate medical curriculum.
o In addition, the Royal College of Obstetricians and Gynaecologists, Royal College
of Radiologists and BMUS have recently released new requirements for
assessing competencies with ultrasound which is increasing the training
demands on radiologists and sonographers. The general feeling voiced was that
despite the need for training, there was no available time or money to implement
proper training or assessment for F1s, F2s & STs.
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CETL4HealthNE is a regional collaboration between four north-east of England universities and
several NHS partners; a subgroup of this collaboration, the Ultrasound Group, was established in
2007 to provide a regional community of practice for educators using portable ultrasound within their
undergraduate healthcare curricula.
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Moving forward with ultrasound in U.K. medical curricula - points to
consider
In the U.K., the National Institute of Clinical Excellence recommends that central venous
catheter insertion (a core competency of F2 doctors) should be performed under ultrasound
guidance, but at present there is no standardised training curriculum for this in the U.K. (or
indeed the USA) and access to ultrasound equipment may be limited in some Trusts (7).
BMUS for example, advocate that there should be such a standardised curriculum, but lack
resources to roll out their own training to other medical professions.
Given the growing integration of PoCUS across the medical specialities worldwide, it seems
likely that undergraduate medical students and other healthcare professionals will require
training in PoCUS procedures, most notably those used in emergency medicine such as
FAST scanning, Abdominal Aortic Aneurysm Screening and echocardiography. However, in
order to progress with this agenda there are some important questions for educators and
policy makers to consider:
Is there a need for a standardised core curriculum for ultrasound, specific to the
needs of each profession? If so,
 Who should design and deliver the curriculum?
 What lessons can we learn from our colleagues in the USA?
 Who should deliver and accredit the training? GMC? BMUS? Other professional
organisations?
 Who should fund the training? Individual institutions (HEI/NHS depending on timing
of training)? Government-funded?
What should the standardised core curriculum content include? Suggestions include:
 Knobology
 Science & technology
 Scanning technique and protocols
 PoCUS Procedures
 Governance & reporting issues
 Health and safety of operators and persons being scanned
 Assessments
N.B. notwithstanding students numbers, appropriate teaching, learning and assessment
strategies must be employed; this has considerable resource implications (e.g. current cost
for one portable ultrasound machine is in the order of ~£12k, minimum specification).
Who should deliver the standardised core curriculum content?
 Sonographers
 Radiologists
 Non-sonographers
The author welcomes comment from members of the Anatomical Society on the current
debate surrounding the need for and provision of a standardised core ultrasound curriculum
for undergraduate medical students.
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References
1.
Moore CL, Copel JA. Point-of-care ultrasonography. The New England journal of
medicine. [Review]. 2011;364(8):749-57.
2.
Hoppmann RA RV, Poston MB et al.,. An integrated ultrasound curriculum (iUSC) for
medical students: 4-year experience. Crit Ultrasound Journal. 2011;3:1-12.
3.
Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P, et al. A Pilot
Study of Comprehensive Ultrasound Education at the Wayne State University School of
Medicine. Journal of Ultrasound in Medicine. 2008 May 1, 2008;27(5):745-9.
4.
Patten D DL, Richards S. Studying living anatomy: the use of portable ultrasound in
the undergraduate medical curriculum. International Journal of Clincial Skills. 2010;4(2):72-7.
5.
Gogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P. Is basic
emergency ultrasound training feasible as part of standard undergraduate medical
education? Journal of surgical education. 2010;67(3):152-6.
6.
Ivanusic J, Cowie B, Barrington M. Undergraduate student perceptions of the use of
ultrasonography in the study of “Living Anatomy”. Anatomical sciences education.
2010;3(6):318-22.
7.
NICE. A survey measuring the impact of NICE guidance 49: The use of ultrasound
locating devices for placing central venous catheters. London, July 2004.
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