USEFUL: Ultrasound Exam for Underlying Lesions Incorporated into Physical Exam

Abstract

Introduction: The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training.Methods: Medical students with ranging levels of ultrasound training received a 25-minute presentation on our USEFUL followed by a 30-minute hands-on session. Following the hands-on session, the students were asked to perform a timed USEFUL on 2–3 standardized subjects. All images were documented as normal or abnormal with the understanding that an official detailed exam would be performed if an abnormality were to be found. All images were read and deemed adequate by board eligible emergency medicine ultrasound fellows.Results: Twenty-six exams were performed by 9 students. The average time spent by all students per USEFUL was 11 minutes and 19 seconds. Students who had received the University of California, Irvine School of Medicine's integrated ultrasound curriculum performed the USEFUL significantly faster (p< 0.0025). The time it took to complete the USEFUL ranged from 6 minutes and 32 seconds to 17 minutes, and improvement was seen with each USEFUL performed. The average time to complete the USEFUL on the first standardized patient was 13 minutes and 20 seconds, while 11 minutes and 2 seconds, and 9 minutes and 20 seconds were spent performing the exam on the second and third patient, respectively.Conclusion: Students were able to effectively complete all scans required by the USEFUL in a timely manner. Students who have been a part of the integrated ultrasound in medicine curriculum performed the USEFUL significantly faster than students who had not. Students were able to significantly improve upon the time it took them to complete the USEFUL with successive attempts. Future endpoints are aimed at assessing the feasibility and outcomes of an ultrasound-assisted physical exam in a primary care setting and the exam's effect on doctor-patient satisfaction. [West J Emerg Med. 2014;15(3):260–266.]

Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review

“…However, the careful integration into existing curricula has been demonstrated to enhance physical examination skills by providing real‐time feedback on examination findings . Steller et al demonstrated the feasibility of integrating point‐of‐care US with medical students' physical examinations through the performance of a timed US screening examination for underlying lesions (Kirkpatrick level 2).…”

A Scoping Review of Ultrasound Teaching in Undergraduate Medical Education

“…The educational interventions found here range from those that teach students to scan a wide range of anatomy [47,48] or regional anatomy [49] to more focused exams of the vascular [50][51][52], abdominal [53][54][55], head and neck [56], cardiac [57,58] and respiratory [59] systems. Some institutions taught students ultrasound-specific protocols such as FAST [60][61][62] or USEFUL [63] scans. Senior medical students, whose learning objectives have graduated to the diagnosing of disease in real-world patients, have demonstrated significant improvement in their ability to diagnose disease following brief, focused ultrasound teaching programs [64][65][66][67][68].…”

International consensus conference recommendations on ultrasound education for undergraduate medical students

“…rationale for curriculum D2.1 The curriculum prepares students for POCUS (point-of-care ultrasound use) in future clinical work[35,37,38,[67][68][69][70][71][72][73] characteristics of the curriculum D3.1 The ultrasound curriculum forms the foundation for ultrasound training along a continuum of medical education from undergraduate through graduate to continuing medical education[18,19,33,37,38,135,[152][153][154][155] The ultrasound curriculum prepares learners for future additional clinical training and/or practice opportunities[18,19,106,107,135,[152][153][154] 8.14…”