The integration of a POCUS curriculum in undergraduate medical education is a topic of significant interest and discussion.  This blog delves into the insights shared during a recent webinar on the subject, featuring Global Ultrasound Institute founders, Dr. Kevin Bergman and Dr. Mena Ramos, alongside an esteemed group of POCUS experts and educators from various medical schools from across the United States.  

 

The Evolution of POCUS in Medical Education

POCUS, or Point-of-Care Ultrasound, has been a part of medical education since the early 2000s. Initially, it was focused on specific applications to reinforce clinical skills and anatomical understanding. The University of South Carolina pioneered a comprehensive four-year integrated ultrasound curriculum in 2006. Survey results showed that over 90% of students felt it enhanced their grasp of basic sciences. Despite progress, a 2022 survey revealed that only 57% of U.S. medical schools have a formal ultrasound curriculum, with a mere 10% offering a fully integrated four-year program.

 

Challenges in Integrating POCUS

Implementing a POCUS curriculum involves navigating several challenges which can be categorized into three main groups: medical students, faculty, and administration.

Medical Student Engagement

One of the primary challenges is engaging students who might not immediately see the relevance of POCUS to their chosen specialty. Students often prioritize exam-related content, and without formal assessment, POCUS sessions may be overlooked.

Faculty Training and Support

The “donut effect” describes the gap between students’ exposure to POCUS and faculty’s proficiency in using and teaching it. Many faculty members lack training, which can hinder effective implementation and student learning.

Administrative and Resource Limitations

Administrative support is crucial for providing resources such as equipment and faculty time. However, securing this support can be difficult, especially if leadership is unfamiliar with POCUS and its benefits.

 

Strategies for Successful Implementation

Despite these challenges, several strategies have proven effective in integrating POCUS into medical education.

Medical Students

Engaging Students and Encouraging Ownership

Student-driven initiatives, such as forming ultrasound interest groups, med student POCUS ambassador groups, can increase engagement. Encouraging students to advocate for POCUS in their curriculum can also sway administrative decisions, as student feedback is often a key factor in curriculum development.

From Pain Points to POCUS Solutions

POCUS can be used to address pain points in the existing medical school curriculum.  Instead of contributing an additional learning topic to an already saturated curriculum, POCUS can be framed as a way to address challenging learning topics such as the rotator cuff anatomy.  

Introducing POCUS in the Basic Sciences Years

POCUS can be introduced in anatomy to build interest early in medical education.  Furthermore, anatomists can serve as excellent faculty allies to support POCUS education.  

 

Faculty

Building Faculty Expertise

Training faculty across specialties is essential. Institutions can start by identifying and supporting POCUS champions who can lead and train others. Collaboration with departments that already use POCUS can also help build a comprehensive training program.

Incorporating POCUS into Existing Curricula

Instead of adding separate POCUS courses, integrating it into existing modules can reinforce learning. For instance, using POCUS to teach complex anatomical concepts can enhance understanding and retention.

 

Administration

Securing Administrative Support

Demonstrating the clinical and educational benefits of POCUS can help secure administrative support. Highlighting its potential to improve patient outcomes and reduce costs can be persuasive arguments for investment in POCUS resources.  Furthermore, positive feedback from medical students exposed to POCUS education helps to recruit administrative support.  

 

The Role of Medical Students

Medical students play a pivotal role in the adoption and success of POCUS curricula. Their enthusiasm and demand can drive institutional changes, making them key stakeholders in this educational shift. Encouraging student involvement in teaching and research can further cement POCUS as an integral part of medical education.

Conclusion

Implementing a POCUS curriculum in undergraduate medical education is a complex but rewarding endeavor. By addressing challenges related to student engagement, faculty training, and administrative support, medical schools can successfully integrate this powerful tool into their programs. The insights shared by experts highlight the importance of collaboration, strategic planning, and leveraging existing resources to build a sustainable POCUS curriculum that enhances medical education and prepares students for the future of healthcare.

 

 

Webinar Participants

Dr. Russ Horowitz, MD,RDMS

          Director, Emergency and Critical Care Ultrasound

          Lurie Children’s Hospital

          Director of Ultrasound Education, 

          Feinberg School of Medicine, Northwestern university

 

Dr. Beryl Greywoode

           Associate Clinical Professor of Pediatrics

           Perelman School of Medicine at the University of Pennsylvania

           General Pediatrics Point of Care Ultrasound Director

           Children’s Hospital of Philadelphia (CHOP)

 

Dr. Nicholas LeFevre

          Family Physician and Faculty 

          University of Missouri-Columbia School of Medicine

          Co-Authored AAFP POCUS Residency Curriculum Guidelines

 

Dr. Sally Graglia (she/her)

           Associate Clinical Professor of Emergency Medicine

          Director of Medical Student Ultrasound Education 

          University of California San Francisco (UCSF) School of Medicine

 

Dr. Rob Ferre 

          Emergency Physician and POCUS Division Chief 

          Dept of Emergency Medicine, Indiana University School of Medicine (IUSM)

          POCUS Curriculum Program Director IUSM

 

Webinar Hosts

Dr. Mena Ramos

          Family Physician 

          Co-Founder, Co-CEO

          Global Ultrasound Institute

          Co-Authored AAFP POCUS Residency Curriculum Guidelines

 

Dr. Kevin Bergman

          Family Physician 

          Co-Founder, Co-CEO

          Global Ultrasound Institute

          Co-Authored AAFP POCUS Residency Curriculum Guidelines

 

References 

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Lane N, Lahham S, Joseph L, Bahner DP, Fox JC. Ultrasound in medical education: listening to the echoes of the past to shape a vision for the future. Eur J Trauma Emerg Surg. 2015 Oct;41(5):461-7. doi: 10.1007/s00068-015-0535-7. Epub 2015 May 5. PMID: 26038053.

Dietrich CF, Hoffmann B, Abramowicz J, Badea R, Braden B, Cantisani V, Chammas MC, Cui XW, Dong Y, Gilja OH, Hari R, Nisenbaum H, Nicholls D, Nolsøe CP, Nürnberg D, Prosch H, Radzina M, Recker F, Sachs A, Saftoiu A, Serra A, Sweet L, Vinayak S, Westerway S, Chou YH, Blaivas M. Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. Ultrasound Med Biol. 2019 Feb;45(2):271-281. doi: 10.1016/j.ultrasmedbio.2018.09.017. Epub 2018 Nov 27. PMID: 30497768.

Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, Paulman LE, Wells JR, Richeson NA, Catalana PV, Thomas LK, Britt Wilson L, Cook T, Riffle S, Neuffer FH, McCallum JB, Keisler BD, Brown RS, Gregg AR, Sims KM, Powell CK, Garber MD, Morrison JE, Owens WB, Carnevale KA, Jennings WR, Fletcher S. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J. 2011 Apr;3(1):1-12. doi: 10.1007/s13089-011-0052-9. Epub 2011 Feb 1. PMID: 21516137; PMCID: PMC3064888.