Abstract
Point-of-care ultrasonography has been shown to have pervasive clinical and educational utility in medicine. The need to provide medical students with training in point-of-care ultrasonography has been recognized by an increasing number of osteopathic and allopathic medical schools. A 4-year integrated ultrasonography curriculum was implemented at Rocky Vista University College of Osteopathic Medicine in 2015. A review of the curriculum design, content, educational methods, and student feedback are described. Barriers to curriculum implementation and lessons learned, unique to integrating point-of-care ultrasonography into the osteopathic curriculum, are also discussed.
Point-of-care ultrasonography (POCUS) is increasingly used by clinicians across numerous specialties to aid in both diagnosis and procedural guidance.
1 As portable ultrasound technology continues to advance, it becomes ever more readily available to providers in increasingly diverse clinical settings.
1 In addition to the early acquisition of clinically relevant POCUS skills and techniques, ultrasonography in medical education (USMED) has been shown to improve medical student learning of anatomy, physiology, and physical examination.
1-4 Given the pervasive clinical and educational utility of POCUS, the need for USMED integration into medical school curricula has been recognized and implemented by a growing number of medical schools in the United States and internationally.
4-9 In a 2016 survey of all 173 US medical schools, only 48 schools, 45 allopathic and 3 osteopathic, reported having a required integrated ultrasonography curriculum.
10 Although there is a growing body of literature describing USMED in allopathic education, literature specifically related to USMED in osteopathic education is lacking. Kondrashova et al
3 found that a clinical ultrasonography elective in the second year of osteopathic medical school was effective in providing students with a review of key anatomical concepts. Syperda et al
11 showed that preclinical osteopathic medical students can attain a limited degree of proficiency with POCUS after performing 40 hours of organ-specific scanning spread over 20 weeks. Although several osteopathic medical schools have used USMED in a limited capacity, few have developed an integrated curriculum.
10
In 2015, Rocky Vista University College of Osteopathic Medicine (RVUCOM) began to integrate USMED into the Gross Anatomy (year 1) and Principles of Clinical Medicine (year 2) courses. The purpose of this article is to describe the first- and second-year USMED curriculum at RVUCOM and the experience gained thus far. To our knowledge, this is the first description of a 4-year vertical USMED curriculum implemented at an osteopathic medical school.
One of the weaknesses of the initial implementation of USMED at RVUCOM was a lack of measured outcomes. Although students were observed to obtain a limited degree of proficiency with POCUS, individual scanning proficiency was not measured objectively. The students were tested directly in the form of written questions containing ultrasonographic images that were included in their systems tests.
Qualitative feedback regarding the USMED curriculum was obtained from students after each systems course. Some of the course evaluation questions were specific to the new USMED content. Common themes in students’ feedback were a desire for smaller work groups to allow increased individual hands-on practice; additional teaching assistants to provide feedback and instruction; an admiration of the early exposure to ultrasonography techniques before clinical training; appreciation for the repetition of concepts resulting from the integration of hands-on ultrasonography with anatomy concurrently covered in the systems courses; and enjoyment of the clinical correlations provided by the instructor.
In the future, more quantitative analysis will be used to continue enacting beneficial changes and will be framed in a more succinct format. Additionally, we hope that as the RVUCOM program grows and finds additional resources, objective evaluation of scanning proficiency will be implemented.