The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–2, 2015 Copyright Ó 2015 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
AAEM CPC AMERICAN ACADEMY OF EMERGENCY MEDICINE POSITION STATEMENT: ULTRASOUND SHOULD BE INTEGRATED INTO UNDERGRADUATE MEDICAL EDUCATION CURRICULUM Zachary P. Soucy, DO, FAAEM and Lisa D. Mills, MD, FAAEM Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California Reprint Address: Zachary P. Soucy, DO, FAAEM, Department of Emergency Medicine, University of California Davis School of Medicine, 4150 V Street, PSSB #2100, Sacramento, CA 95817
POLICY STATEMENT
health-care institutions struggle to meet the growing educational needs of faculty and residents to obtain standardized US training. In addition, multiple specialties have POCUS fellowships and specialized POCUS training during other fellowships. Leaders in the field of US technology in medical education have implemented longitudinal US training programs into the core medical school curriculum. Early research demonstrates that the technology is viewed by students as enjoyable and useful in various specialties (9–14). In addition, studies demonstrate better student understanding of complex core anatomic and physiologic concepts and improved physical examination skills with the incorporation of US into the curriculum (10,13,15–20). Practical application of POCUS also provides early clinical correlates, which further engages the students (9,11). Given the broad and diverse use of US in contemporary medical practice, multiple medical societies have supported the incorporation of US into the core medical school curriculum. The American Institute for Ultrasound in Medicine, a multidisciplinary society, has advocated for the integration of US training into core medical school curricula. In 2013, at the 2nd World Congress on US in Medical Education, >85 medical schools convened to discuss US in medical education.
It is the position of the American Academy of Emergency Medicine that ultrasound should be integrated into the core curriculum of undergraduate medical education. BACKGROUND Medical diagnostic ultrasound (US) has been used by various specialties since the 1950s. Contemporary point of care ultrasound (POCUS) was first researched and utilized by emergency physicians in the mid 1980s. Emergency physicians have formally defined and pioneered POCUS during the past 2 decades. Research in a broad array of applications indicates improved patient care via procedural safety and success, improved diagnostic accuracy, decreased procedural pain, decrease time to critical interventions, and decreased time to discharge (1–8). DISCUSSION The practice of POCUS continues to grow. In the most recent decade, there has been an expanding role for POCUS across many specialties in medicine. As hospital-wide US applications have increased, many
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Z. P. Soucy and L. D. Mills
RECOMMENDATIONS Incorporation of US into the core medical school curriculum enhances learning of core concepts, improves understanding of the physical examination, engages students in active learning, and is viewed as useful and enjoyable by students. Early integration of US in medical training incorporates a key, broadly used, and growing medical technology, which better prepares current students for practice they will encounter as the next generation of physicians. REFERENCES 1. Keyes LE, Frazee BW, Snoey ER, et al. Ultrasound guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med 1999;34:711–4. 2. Miller AH, Roth BA, Mills TJ, et al. Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med 2002;9:800–5. 3. Rothschild JM. Ultrasound guidance of central vein catheterization: making healthcare safer: a critical analysis of patient safety practices [Agency for Healthcare Research and Quality Web site]. Publication No. 01–E058. Available at: http://www.ahrq.gov/ clinic/ptsafety. Accessed December 14, 2013. 4. Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005;12:601–6. 5. Tayal VS, Hasan N, Norton HJ, et al. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med 2006;13:384–8. 6. Tayal V, Graf C, Gibbs M. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med 2003;10:867–71. 7. Constantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonographyguided peripheral intravenous access versus traditional approach in patients with difficult access. Ann Emerg Med 2005;46:456–61.
8. Blaivas M, Harwood RA, Lambert MJ. Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med 1999;6:1020–3. 9. Brunner M, Moeslinger T, Spieckermann P. Echocardiography for teaching cardiac physiology in practical student courses. Am J Physiol 1995;268:S2. 10. Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of ultrasound into gross anatomy curriculum: perceptions of medical students. J Emerg Med 2012;43:1098–102. 11. Hoppmann RA, Rao VV, Poston MB, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011;3:1–12. 12. Rao S, van Holsbeeck L, Musial JL, et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med 2008;27: 745–9. 13. Tshibwabwa ET, Groves HM. Integration of ultrasound in the education programme in anatomy. Med Educ 2005;39:1148. 14. Afonso N, Amponsah D, Yang J, et al. Adding new tools to the black bag—introduction of ultrasound into the physical diagnosis course. J Gen Intern Med 2010;25:1248–52. 15. Swamy M, Searle RF. Anatomy teaching with portable ultrasound to medical students. BMC Med Educ 2012;12:99. 16. Butter J, Grant TH, Egan M, et al. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination? Med Educ 2007;41:843–8. 17. Decara JM, Kirkpatrick JN, Spencer KT, et al. Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses. J Am Soc Echocardiogr 2005;18: 257–63. 18. Kobal SL, Trento L, Baharami S, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol 2005;96:1002–6. 19. Mouratev G, Howe D, Hoppmann R, et al. Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone. Teach Learn Med 2013;25:84–8. 20. Panoulas VF, Daigeler AL, Malaweera AS, et al. Pocket-size handheld cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging 2013;14:323–30.
AAEM CPC AMERICAN ACADEMY OF EMERGENCY MEDICINE POSITION STATEMENT: ULTRASOUND SHOULD BE INTEGRATED INTO UNDERGRADUATE MEDICAL EDUCATION CURRICULUM Zachary P. Soucy, DO, FAAEM and Lisa D. Mills, MD, FAAEM Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California Reprint Address: Zachary P. Soucy, DO, FAAEM, Department of Emergency Medicine, University of California Davis School of Medicine, 4150 V Street, PSSB #2100, Sacramento, CA 95817
POLICY STATEMENT
health-care institutions struggle to meet the growing educational needs of faculty and residents to obtain standardized US training. In addition, multiple specialties have POCUS fellowships and specialized POCUS training during other fellowships. Leaders in the field of US technology in medical education have implemented longitudinal US training programs into the core medical school curriculum. Early research demonstrates that the technology is viewed by students as enjoyable and useful in various specialties (9–14). In addition, studies demonstrate better student understanding of complex core anatomic and physiologic concepts and improved physical examination skills with the incorporation of US into the curriculum (10,13,15–20). Practical application of POCUS also provides early clinical correlates, which further engages the students (9,11). Given the broad and diverse use of US in contemporary medical practice, multiple medical societies have supported the incorporation of US into the core medical school curriculum. The American Institute for Ultrasound in Medicine, a multidisciplinary society, has advocated for the integration of US training into core medical school curricula. In 2013, at the 2nd World Congress on US in Medical Education, >85 medical schools convened to discuss US in medical education.
It is the position of the American Academy of Emergency Medicine that ultrasound should be integrated into the core curriculum of undergraduate medical education. BACKGROUND Medical diagnostic ultrasound (US) has been used by various specialties since the 1950s. Contemporary point of care ultrasound (POCUS) was first researched and utilized by emergency physicians in the mid 1980s. Emergency physicians have formally defined and pioneered POCUS during the past 2 decades. Research in a broad array of applications indicates improved patient care via procedural safety and success, improved diagnostic accuracy, decreased procedural pain, decrease time to critical interventions, and decreased time to discharge (1–8). DISCUSSION The practice of POCUS continues to grow. In the most recent decade, there has been an expanding role for POCUS across many specialties in medicine. As hospital-wide US applications have increased, many
1
2
Z. P. Soucy and L. D. Mills
RECOMMENDATIONS Incorporation of US into the core medical school curriculum enhances learning of core concepts, improves understanding of the physical examination, engages students in active learning, and is viewed as useful and enjoyable by students. Early integration of US in medical training incorporates a key, broadly used, and growing medical technology, which better prepares current students for practice they will encounter as the next generation of physicians. REFERENCES 1. Keyes LE, Frazee BW, Snoey ER, et al. Ultrasound guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med 1999;34:711–4. 2. Miller AH, Roth BA, Mills TJ, et al. Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med 2002;9:800–5. 3. Rothschild JM. Ultrasound guidance of central vein catheterization: making healthcare safer: a critical analysis of patient safety practices [Agency for Healthcare Research and Quality Web site]. Publication No. 01–E058. Available at: http://www.ahrq.gov/ clinic/ptsafety. Accessed December 14, 2013. 4. Squire BT, Fox JC, Anderson C. ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med 2005;12:601–6. 5. Tayal VS, Hasan N, Norton HJ, et al. The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med 2006;13:384–8. 6. Tayal V, Graf C, Gibbs M. Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years. Acad Emerg Med 2003;10:867–71. 7. Constantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonographyguided peripheral intravenous access versus traditional approach in patients with difficult access. Ann Emerg Med 2005;46:456–61.
8. Blaivas M, Harwood RA, Lambert MJ. Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med 1999;6:1020–3. 9. Brunner M, Moeslinger T, Spieckermann P. Echocardiography for teaching cardiac physiology in practical student courses. Am J Physiol 1995;268:S2. 10. Brown B, Adhikari S, Marx J, Lander L, Todd GL. Introduction of ultrasound into gross anatomy curriculum: perceptions of medical students. J Emerg Med 2012;43:1098–102. 11. Hoppmann RA, Rao VV, Poston MB, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011;3:1–12. 12. Rao S, van Holsbeeck L, Musial JL, et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med 2008;27: 745–9. 13. Tshibwabwa ET, Groves HM. Integration of ultrasound in the education programme in anatomy. Med Educ 2005;39:1148. 14. Afonso N, Amponsah D, Yang J, et al. Adding new tools to the black bag—introduction of ultrasound into the physical diagnosis course. J Gen Intern Med 2010;25:1248–52. 15. Swamy M, Searle RF. Anatomy teaching with portable ultrasound to medical students. BMC Med Educ 2012;12:99. 16. Butter J, Grant TH, Egan M, et al. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination? Med Educ 2007;41:843–8. 17. Decara JM, Kirkpatrick JN, Spencer KT, et al. Use of hand-carried ultrasound devices to augment the accuracy of medical student bedside cardiac diagnoses. J Am Soc Echocardiogr 2005;18: 257–63. 18. Kobal SL, Trento L, Baharami S, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol 2005;96:1002–6. 19. Mouratev G, Howe D, Hoppmann R, et al. Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone. Teach Learn Med 2013;25:84–8. 20. Panoulas VF, Daigeler AL, Malaweera AS, et al. Pocket-size handheld cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging 2013;14:323–30.
