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Sonography and hypotension: a change to critical problem solving in undergraduate medical education

Authors Amini R, Stolz L, Hernandez N, Gaskin K, Baker N, Sanders A, Adhikari S

Received 1 October 2015

Accepted for publication 29 October 2015

Published 14 January 2016 Volume 2016:7 Pages 7—13

DOI https://doi.org/10.2147/AMEP.S97491

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Shakila Srikumar

Peer reviewer comments 2

Editor who approved publication: Dr Anwarul Azim Majumder


Richard Amini, Lori A Stolz, Nicholas C Hernandez, Kevin Gaskin, Nicola Baker, Arthur Barry Sanders, Srikar Adhikari

Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA

Study objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises.
Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions.
Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00).
Conclusion: At our institution, we successfully integrated ultrasound and critical problem-solving instruction, as part of a 1-day workshop for undergraduate medical education.

Keywords: point-of-care ultrasound, undergraduate medical education, protocol-driven education, problem-based learning

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