Date Published: March 27, 2019
Publisher: Public Library of Science
Author(s): Alon Ben-Sasson, Yotam Lior, Jonathan Krispel, Moshe Rucham, Noah Liel-Cohen, Lior Fuchs, Sergio L. Kobal, Samy A. Azer.
Teaching cardiac ultrasound (CU) image acquisition requires hands-on practice under qualified instructors supervision. We assessed the efficacy of teaching medical students by their previously trained classmates (teaching assistants [TAs]) compared to teaching by expert trainers (cardiologists or diagnostic medical sonographers.
Sixty-six students received 8-hour CU training: 4-hour lectures on ultrasound anatomy and imaging techniques of 6 main CU views (parasternal long [PLAV] and short axis [PSAV]; apical 4-chamber [4ch], 2-chamber [2ch], and 3-chamber [3ch]; and sub costal [SC]) followed by 4 hours of hands-on exercise in groups of ≤5 students under direct supervision of a TA (group A: 44 students) or a qualified trainer (group B: 22 students). Students’ proficiency was evaluated on a 6-minute test in which they were required to demonstrate 32 predetermined anatomic landmarks spread across the 6 views and ranked on a 0–100 scale according to a predetermined key.
The 6-minute test final grade displayed superiority of group A over group B (54±17 vs. 39±21, respectively [p = 0.001]). This trend was continuous across all 6 main views: PLAV (69±18 vs. 54±23, respectively), PSAV (65±33 vs. 41±32, respectively), 4ch (57±19 vs. 43±26, respectively), 2ch (37±29 vs. 33±27, respectively), 3ch (48±23 vs. 35±25, respectively), and SC (36±27 vs. 24±28, respectively).
Teaching medical students CU imaging acquisition by qualified classmates is feasible. Moreover, students instructors were superior to senior instructors when comparing their students’ capabilities in a practical test. Replacing experienced instructors with TAs could help medical schools teach ultrasound techniques with minimal dependence on highly qualified trainers.
The cardiovascular physical examination is a cardinal part of the classical patient assessment process; however, its diagnostic yield is limited [1–3]. Therefore, physicians often rely on complementary studies for the diagnosis of cardiac diseases. The use of bedside cardiac ultrasound (CU) was shown to significantly improve cardiac diagnostic ability of cardiologists and non-cardiologists physicians [4,5]. Furthermore, increased diagnostic yield was also observed among medical students after brief training and was shown to surpass that of traditional physical examination based mainly on auscultation by board-certified cardiologists .
A total of 88 students were enrolled in the study and successfully completed the course. Twenty-two (25%) students (13 of the student TA group and 9 of the cardiologist TA group) did not attend the final 6-minute examination and were subsequently excluded from the study as lost to follow up, despite best efforts made by the research staff (Fig 1).
In this study, we have shown that a short hands-on CU course, led by medical students as teaching assistants, provided novice participants the ability to perform basic cardiac ultrasound studies. While these results are similar to results presented in previous studies such as those of Gradl-Dietsch et al. , when compared to the group taught by board certified cardiologists and diagnostic medical sonographers, students taught by their peers demonstrated better image-acquisition ability in 31 out of the 32 predetermined anatomical landmarks evaluated in this study, 14 of which were statistically significant.
Teaching cardiac ultrasound to medical students by their classmates is feasible and effective. Furthermore, students taught by their classmates displayed superior CU acquisition skills compared to counterparts trained by experienced tutors. The use of students as mentors may be a practical strategy to overcome some of the impediments existing in integration of ultrasound technique teaching to medical school curriculum.