Our findings support the hypothesis that osteopathic medical students can accurately measure abdominal aortic dimensions using a handheld US device after brief hands-on training. Based on the t test results, no statistically significant difference was found in aortic measurements between the osteopathic medical students and the US technologist.
Our findings reflect those of similar investigations. Bonnafy et al
4 conducted AAA screenings on hospitalized patients in France using handheld US devices operated by medical students and found the mean difference between the measurements to be 0.1 cm, with an intraclass correlation coefficient of greater than 0.91. A study in New Zealand by Nguyen et al
9 trained 3 novices (a medical student, a newly employed vascular technologist, and a physical education graduate) to conduct AAA screenings and found that these novices obtained coronal measurements within 0.5 cm of the measurements of experienced vascular US technologists 85% to 97% of the time. Although the French study mentioned using a handheld US device, the study in New Zealand used a laptop-based machine. Also, in the French study, 2 patients were found to have an AAA, which the medical students detected in concordance with the experts.
4 Thus, considering both the current cohort and the French cohort of medical students were able to obtain measurements with no statistically significant difference, we would expect the osteopathic medical students in our cohort to accurately identify AAAs.
Additionally, our cohort is unique because, to our knowledge, no similar studies have been conducted using osteopathic medical students as AAA investigators. The integration of US in medical education in the United States is highly variable. Bahner et al
14 conducted a survey in 2014 and found that of 134 allopathic medical schools, 79% of schools agreed that US should be part of the medical school curriculum, but few respondents (18.6%) reported that it was a priority at their institutions, with lack of space and lack of financial support being barriers to integration of US. Furthermore, Dinh et al
15 conducted a survey in 2016 of 173 US medical schools (both allopathic and osteopathic) and revealed that 48 schools (28%) reported having a required integrated US curriculum. The Rocky Vista University College of Osteopathic Medicine created a 4-year integrated US curriculum in 2015, and a review of the curriculum was conducted in 2016.
16 Their review revealed students’ feedback to be positive, including an appreciation for the early exposure to US. Students also appreciated the repetition of concepts through the integration of hands-on US connecting with anatomy currently covered in systems courses.
16 However, this study lacked quantitative measures of directly testing students’ proficiency aside from written questions containing US images.
16 More quantitative measures could be a focus for future studies that evaluate the implementation of US into the medical school curriculum.
Rural and county clinics have to refer patients to facilities with radiology capabilities to accomplish AAA screenings, which could result in lack of follow-up and missed screening opportunities. If medical students and primary care physicians were trained to conduct in-office aortic diameter measurements, it could result in increased screening opportunities and possibly reduced AAA-related mortality.