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

Ultrasound timeline Summer 2006 – USCSOM and GE develop partnership to establish vertical ultrasound curriculum January 2007 – Ultrasound machine made available to Department of Family Medicine – –Clerkships asked to incorporate ultrasound July 2007 – Ultrasound first incorporated into third-year Family Medicine clerkship August 2008 – First OSCE involving ultrasound

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

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

Benefits of Ultrasound in our 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 Easy to learn Easy to learn Non-invasive Non-invasive Inexpensive modality Inexpensive modality Increases imaging accessibility for our pts Increases imaging accessibility for our pts Immediate results Immediate results

Components of clerkship ultrasound curriculum Workshop Workshop Clinical application Clinical application

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

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

Evaluation of clerkship ultrasound curriculum Pre- and post-intervention survey Pre- and post-intervention survey Short answer final exam questions Short answer final exam questions Objective Structured Clinical Exam (OSCE) Objective Structured Clinical Exam (OSCE) Written and verbal student feedback Written and verbal student feedback

Pre- and Post-intervention survey Assesses knowledge of common ultrasound procedures and indications Assesses knowledge of common ultrasound procedures and indications Assesses attitudes about usefulness and comfort with ultrasound Assesses attitudes about usefulness and comfort with ultrasound

Survey results Total pre- surveys Total post- surveys Comfort (average score) Understanding (average score) Importance (average score) Knowledge (# correct of 14)             8.4

Final Exam Questions Short answer questions are included on in-house written exam Short answer questions are included on in-house written exam Assesses knowledge of common ultrasound procedures Assesses knowledge of common ultrasound procedures

Final Exam Question Results—% correct

Ultrasound OSCE Imbedded in a health maintenance visit scenario Imbedded in a health maintenance visit scenario Students required to ultrasound the abdominal aorta and record an AP diameter Students required to ultrasound the abdominal aorta and record an AP diameter Assesses knowledge and skill Assesses knowledge and skill

Feedback Workshop evaluations excellent Workshop evaluations excellent Students appreciate getting procedure experience Students appreciate getting procedure experience Verbal feedback indicates some difficulty in completing clinical requirement Verbal feedback indicates some difficulty in completing clinical requirement

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

Future Plans Measure additional variables Measure additional variables –Ability to identify appropriate patients –Improvement in students’ skills Train and require additional procedures Train and require additional procedures