University of South Carolina School of Medicine Integrated ... · iUSC Richard Hoppmann. The...
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University of South Carolina
School of Medicine
Integrated Ultrasound Curriculum
iUSC
Richard Hoppmann
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The Integrated Ultrasound Curriculum
Initiated 2006
First (M1) and Second (M2) Year Medical Students
• Didactic classroom lectures
• Web-based learning modules
• Scheduled hands-on laboratory scanning sessions
• Open ultrasound laboratory practice sessions
• Integration of ultrasound into gross anatomy,
physiology, and physical diagnosis.
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Longitudinal Scan (Upper)
32
Cep
hal
ic e
nd C
aud
al end
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M1 Student Practical Exam Fall Semester
All first year students are individually evaluated
for their ability to scan a standardized patient.
They were also evaluated by an observer
regarding their interaction with the standardized
patient and attentiveness to patient comfort and
modesty.
Each student had 15 minutes to capture, identify
structures and save the images.
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Images
RUQ Pelvis LUQ Neck
Rt Kidney Bladder Lt Kidney Carotid Artery
Liver Spleen Internal Jugular Vein
Diaphragm
M. pouch
Parasternal Long Axis Heart
Lt Atrium
Lt Ventricle
Mitral valve
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Results of M1 Practical
All students easily completed the exercise within
the allotted time of 15 minutes.
Maximum possible score for the OSCE = 50 points
Mean score for the class = 49.1 points
Range for the class = 39.0 - 50.0 points
Students with a perfect score of 50.0 = 65 (78%)
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Physiology Ultrasound Labs
• Three ultrasound labs have been integrated into the physiology course for M1 students
• Cardiac lab: normal heart function (4-chamber apical view). Wall and valve motion; flow through the cardiac chambers
• Hemodynamics lab: doppler principles, pulse wave forms (venous / arterial systems)
• Cardiogenic Shock: gross LV/RV function, pericardial effusion, RV strain from a PE
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M2 Ultrasound Curriculum: Coordinated with
Physical Diagnosis and Pathophysiology
• Focused ultrasound examinations, clinical
scenarios, and ultrasound guided procedures
– Cardiac views: parasternal long and short axis, 4-
chamber apical, subcostal
– Abdomen: organ size, abdominal fluid, AAA screen
– Vascular: DVT screen, IVC and volume status,
central line placement
– Neck: thyroid, carotid, and jugular exam
– Pelvic ultrasound (female gynecology)
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M3 Clerkship OSCEs
Internal Medicine:
– thyroid scan
– central line placement with ultrasound guidance
Family Medicine:
– Abdominal Aortic Aneurysm (AAA) screen
OB/GYN:
– third trimester pregnancy with bright red vaginal bleeding -
transabdominal scan
Pediatrics:
– Assess volume status of a 9 year old using the aorta / IVC ratio
• Surgery:
– Trauma patient – FAST exam
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ICU Ultrasound
• Role for Bedside Ultrasound in the ICU:
– Quick cardiac exam: global function, pericardial
effusion, severe valvular dysfunction
– Assessment of volume status: IVC, JVD
– Abdominal bleeding, AAA
– Pneumothorax
– Pulmonary embolus (effects on heart, IVC, detect
DVT)
– Pleural effusion
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Fourth Year (M4) Students
• Four week Emergency Medicine Ultrasound
Elective
• Hands-on ultrasound experience added to
Radiology Elective
• Two day Capstone course to prepare for
residency: FAST for trauma, RUSH for shock,
ultrasound guided procedures
• Ultrasound Independent Study: research, further
develop US skills, help with M1/M2 labs
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Recent Additions to the Curriculum
• Introduced pocket devices into the curriculum
• Web-based Portal for evaluation and archiving all
ultrasound images for students
• Physiology pilot with EKG and Ultrasound
• Heart sounds and ECHO on IM clerkship
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Lessons Learned Years 1-4
• Start small – work with course/clerkship directors
and identify a limited number of ultrasound
objectives for the course/clerkship
• Timing – introduce during M1 orientation
• Open laboratory sessions
• Faculty – must have champions in multiple
specialties
• Student feedback – regular and ongoing, its their
curriculum too
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• Student-patient interaction: using patients and
standardized patients creates more “clinical time”
in the first two years
• Content: do not need to develop all teaching
material in-house
• Equipment: try to keep ratios low – students-
machines-patients-instructors
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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.