1. Ultrasound in the Family Medicine Clerkship Rachel S. Brown, MD Assistant Professor Brian D. Keisler, MD Assistant Professor Department of Family and Preventive Medicine University of South Carolina School of Medicine

2. Ultrasound Training in Medical Schools Very limited, with little formal curriculum Very limited, with little formal curriculum Florida State University College of Medicine, Tallahassee Florida State University College of Medicine, Tallahassee University of South Carolina School of Medicine, Columbia University of South Carolina School of Medicine, Columbia Wayne State University School of Medicine, Detroit Wayne State University School of Medicine, Detroit

3. Uses of Ultrasound in Primary Care Cardiovascular screening Cardiovascular screening Musculoskeletal visualization Musculoskeletal visualization Bladder scanning Bladder scanning Gallbladder assessment Gallbladder assessment Gynecological exam Gynecological exam Obstetrics Obstetrics Procedures Procedures

4. Benefits of Ultrasound in the Family Medicine Center Good modality for teaching Good modality for teaching Fosters hands-on learning Fosters hands-on learning Complements learning the physical exam Complements learning the physical exam Increases imaging accessibility for our pts Increases imaging accessibility for our pts Easy to learn Easy to learn Non-invasive Non-invasive Inexpensive Inexpensive Immediate results Immediate results

5. Components of USCSOM Family Medicine clerkship ultrasound curriculum Workshop Workshop Clinical application Clinical application Short answer final exam questions Short answer final exam questions

6. Ultrasound Workshop Three common outpatient procedures chosen: Three common outpatient procedures chosen: –AAA screening –Ankle joint –Post void residuals (PVR) Begins with a brief didactic portion Begins with a brief didactic portion Student small groups practice the three procedures on standardized pts Student small groups practice the three procedures on standardized pts

7. Clinical Application Required to do each procedure during a real patient encounter at least once Required to do each procedure during a real patient encounter at least once Preceptor signs off on procedure Preceptor signs off on procedure

8. Final Exam Questions One short answer question is included on each of the three versions of the final exam. One short answer question is included on each of the three versions of the final exam. The question is not counted in final exam grade. The question is not counted in final exam grade. Assesses students’ knowledge. Assesses students’ knowledge.

9. Final Exam Question Results—% correct

10. Limitations in Implementing Curriculum Initial cost is high Initial cost is high Ultrasound machines only guaranteed at FMC Ultrasound machines only guaranteed at FMC Not all preceptors are comfortable with ultrasound Not all preceptors are comfortable with ultrasound Time is limited in the FMC for students to perform required ultrasounds Time is limited in the FMC for students to perform required ultrasounds Choice of procedures may be difficult to complete if indications are too specific Choice of procedures may be difficult to complete if indications are too specific

11. Curriculum Evaluation End of rotation evaluation forms End of rotation evaluation forms Verbal feedback Verbal feedback Test question results Test question results –Is it working?

12. Currently Implementing Survey to assess pre and post intervention knowledge, attitudes, and behavior Survey to assess pre and post intervention knowledge, attitudes, and behavior –Pending IRB approval Faculty Development Faculty Development –Ultrasound workshop held on 1/17

13. Future Plans Measure additional variables Measure additional variables –Ability to identify appropriate patients –Improvement in students’ skills Develop ultrasound OSCE station with standardized patients Develop ultrasound OSCE station with standardized patients Train and require additional procedures Train and require additional procedures