Background: Point-of-care ultrasonography (POCUS) is a real-time, diagnostic modality increasingly utilized by clinicians at bedside to obtain critical, potentially life-saving information. The benefits of becoming familiar and facile with POCUS have become so clear in recent years that numerous residency programs across specialties have intentionally incorporated ultrasound-focused education into their standard curricula. Furthermore, some medical schools have committed to creating a longitudinal, multi-year ultrasound-focused curricula to enhance their educational benefit. The objective of this study is to evaluate whether ultrasound education via simulation can improve the skills, knowledge and confidence of medical students during their clinical training.

Methods: A prospective cohort study of third year medical students from a large academic institution was divided into two groups in order to assess the efficacy of ultrasound simulation. The curriculum was implemented during the students’ six-week Internal Medicine clerkship rotation over a total five-month period. The control group only received ultrasound education based on their faculty and resident participation on rounds. The experimental group received access to the ultrasound simulator for two five-hour sessions per week in addition to the baseline faculty and resident participation of ultrasound use on rounds. Before and after the intervention, all participants were asked to complete an electronic confidence and knowledge-based assessments that reviewed the material reviewed through simulation software. Differences in confidence and knowledge from pre- and post-intervention assessments were then compared between the two groups. This program and study received exempt status from The Medical University of South Carolina Institutional Review Board.

Results: Of the 61 participants selected, 50 participants completed each question on the pre- and post-intervention assessments. The control group showed no significant differences in perceived knowledge or confidence amongst all Likert scale questions before or after the intervention. However, the experimental group showed statistically significant improvements in confidence of their ultrasound knowledge and performing a procedure with the guidance of ultrasound (Figure 1). While there was no difference between individual pre- and post-intervention knowledge-based questions, there was an overall statistically significant improvement in correct responses in the experimental group (pre 46.8% vs. post 58.7%, p< 0.05) when compared to the control group (pre 50.5% vs. post 50.8%, p< 0.94).

Conclusions: POCUS education via the use of simulation led to significant increases in both perceived ultrasound knowledge and confidence in ultrasound use to perform procedures amongst third-year medical students despite no individual improvement in knowledge-based questions. Lessons learned from our implementation should be used to encourage wider integration of ultrasound simulation amongst medical schools. Moving forward, resident-led workshops will be used to enhance individual ultrasound education in conjunction with simulation.

IMAGE 1: Differences between perceived confidence and use of ultrasound between control and experimental groups pre- and post-intervention.

IMAGE 2: Total correct responses in control and experimental groups pre- and post-intervention