University of Pittsburgh

Ultrasound at the Point of Care

Ultrasound at the Point of Care

Background

With the advent of compact and dependable ultrasound machines, point-of-care ultrasound has emerged as a valuable tool for clinicians in a range of settings. As a diagnostic tool, it can augment a basic physical exam and accelerate the diagnostic process.  Some experts have described the ultrasound machine as the “stethoscope of the future”.   Many therapeutic procedures are now performed with a greater degree of safety and efficiency when guided by ultrasound imaging.  Ultrasound imaging is now available for physician use in a range of patient care settings, including emergency departments, critical care units, procedure suites, inpatient floors, and ambulatory clinics.

Medical students have a range of opportunities to learn the skills of point-of-care ultrasound, and to use ultrasonography to gain a deeper understanding of core medical subjects such as anatomy, physiology, and physical diagnosis.  During clinical rotations, students learn how ultrasound is influencing patient care in a diverse array of settings and clinical disciplines and develop their own skills with this state-of-the art approach to patient care.

Implementation

The school is introducing instruction on the use of point-of-care ultrasound throughout the medical student curriculum.  Throughout the curriculum, the emphasis is on hands-on experiences that help students develop their skill with the equipment and a fundamental understanding of the images obtained.  The following examples illustrate how ultrasound is incorporated into the UPSOM curriculum.

Medical Anatomy - Year 1

During the course segment on musculoskeletal anatomy, students learn about the basic capabilities of ultrasound imaging.  Using peripheral nerve blocks as an example, students can see how the addition of real-time visualization of the target and surrounding structures dramatically transforms this procedure.  Students then have their first opportunity to practice ultrasound imaging on standardized patients.

As part of a new pilot program in fall 2016, medical anatomy students will perform additional ultrasound scanning that correlates with their coursework.  Sessions will include correlation of ultrasound with anatomy of the chest/heart, abdomen, and kidneys. 

Body Fluid Homeostasis - Cardiovascular - Year 2

In a small group echocardiography workshop, students supplement their learning about the cardiac cycle by observing it in action.  Additional sonography workshops are being developed for integration throughout the second year Organ Systems Block.

Ultrasound Mini-Electives

UPSOM offers a diverse menu of elective experiences to first and second year students. These electives provide students with the opportunity to pursue topics of personal interest to a depth that is beyond the usual curriculum. In year 1, students participate in two ultrasound mini-electives.

“Introduction to Ultrasound:  Anatomy from a Different Perspective”:  This four-session elective is offered in the fall of year 1 as a correlate to medical anatomy.  The elective is a combination of didactic presentations and hands-on ultrasound scanning of the abdomen, chest/heart, kidneys, and neck.   Through the ultrasound probe, the three-dimensional relationships are reinforced and placed in a clinical context.

“Ultrasound Basics:  Correlation with the Physical Examination”:  Offered in the spring of the first year, this four-session elective augments the coursework in the physical examination courses.  At this point in the core curriculum, students are becoming increasing skilled at basic physical examination procedures and are applying their skills during actual patient encounters. During this elective, students return to a workshop setting and use ultrasound to re-visit the anatomic underpinnings of the physical exam. 

Surgery and Perioperative Care Clerkship - Year 3

Surgery clerkship students see how ultrasound is used in the rapid bedside diagnosis of trauma patients using the FAST method (Focused Assessment with Sonography in Trauma).  New workshops are being developed where clerkship students will learn to perform the FAST examination themselves.  Clerkship students also learn how to place central intravenous lines using ultrasound guidance.  This guided approach has the benefits of reducing iatrogenic injuries and reducing the number of attempts needed to successfully place the IV catheter into a central vein.

Assessment Week - Year 3

This course integrates a series of summative assessments with focused skills workshops, as part of preparation for the fourth year curriculum.  All students participate in an ultrasound skills workshop during the clinical procedures segment of this course.

Integrated Point-of-Care Ultrasound Elective - Year 4

During this four week elective, senior medical students have intensive training in the use of point-of-care ultrasound. The integrated instructional approach combines small group workshops with extended clinical scanning sessions in emergency medicine, critical care, and obstetrics/gynecology settings.  Simulation training augments the clinical experiences. Students receive detailed feedback on their scanning skills by direct observation and through critique of their scanning results. 

Surgical Internship Prep Course - Year 4

This “boot camp” elective helps to prepare students for the transition to residency training in a surgical specialty.  As a component of this elective, students learn the extended Focused Assessment with Sonography for Trauma.

Outcomes

Students are gaining increasing experience with point-of-care ultrasound throughout the curriculum. The students’ early experiences are effectively preparing them for joining clinical teams where bedside ultrasound is routinely employed to support patient care decisions.  Additional instructional experiences in ultrasound are being developed for integration into the Organ Systems courses and clinical clerkships, including inpatient medicine, obstetrics and gynecology and emergency medicine.