Abdominal ultrasound augments the medical students’ ability to identify free intraabdominal fluid

Abstract

OBJECTIVE: Free intra-abdominal fluid describes an accumulation of free fluid in the peritoneal cavity. It has different etiologies, but it frequently constitutes a meaningful clinical sign. In this study, the authors interrogate whether abdominal ultrasound augments the medical students' ability to identify free intra-abdominal fluid.METHODS: Thirty-one medical students without any previous formal ultrasound training were subjected to cognitive assessment before and after four and a half-hour of theoretical lecture and hands-on course about the diagnosis of free intra-abdominal fluid by physical examination and abdominal ultrasound. The hands-on sessions were done in healthy volunteers with a simulated peritoneal catheter and in patients treated with peritoneal dialysis with different amounts of dialysate in their cavity. RESULTS:The cognitive assessment before and after the course increased from 6.7±2.3 to 11.6±1.1 points (p<0.0001). The sensitivity, specificity, and accuracy in the diagnosis of free intra-abdominal fluid were higher when students used abdominal ultrasound. The students agree with the inclusion of abdominal ultrasound in the diagnose of free intra-abdominal fluid in the undergraduate curriculum. CONCLUSIONS:This study demonstrates that incorporating abdominal ultrasound is feasible and improves medical students' short-time competency in performing and interpreting the findings diagnostic of free intra-abdominal fluid.

Abdominal ultrasound, physical examination, and intraabdominal fluid

“…The questions are whether the physical examination can be taught to improve the examiner's performance and how these bedside maneuvers can be used in combination in order to further enhance the accuracy and reliability in detecting intraperitoneal fluid. The authors identified higher sensitivity, specificity, and accuracy of bedside ultrasound compared with the physical examination in diagnosing intraperitoneal fluid 1 . A prior study comparing these two modalities in first-year medical students found no differences in sensitivity, specificity, and accuracy between these two modalities 4 .…”

“…To the Editor, We read with interest the paper by Toledo et al titled "Abdominal ultrasound augments the medical students' ability to identify free intraabdominal fluid 1 ." Identifying a way to teach medical students' bedside abdominal ultrasound is paramount because of its known role in augmenting the physical examination.…”

“…In Toledo et al's study, medical students conducted a physical examination (flank dullness, percussion shifting dullness, and a fluid thrill or wave) and an ultrasound of the abdomen in the right and left upper abdominal quadrants and pelvic cavity 1 . Although the students received didactic and hands-on formal training using abdominal ultrasound, there is no mention of whether this occurred for the physical examination.…”

“…One study in medical students found high interobserver reliability suggesting high concordance in test performance 3 . Toledo et al's study adds to the growing body of literature regarding the relative ease of teaching and performing bedside ultrasound 1 . However, further studies are needed to assess the utility of the physical examination using a combination of tests and a more uniformed methodological approach when examining patients with variable amounts of ascites.…”

Introducing medical students to radiological anatomy: The importance of experiential learning during the Covid‐19 pandemic lockdowns

“…Finally, the teaching of ultrasound and its inclusion into anatomy courses should be noted. Camilo et al ( 2021 ), Toledo et al ( 2021 ), Lufler et al ( 2022 ), and Olivares‐Perez et al ( 2022 ) have all emphasized the importance of ultrasound in the teaching of students and physicians, which can even be done remotely.…”