Can first year medical students carry out cardiac ultrasound examinations? Recent graduates publish results of recent trial.

Two former Queen’s medical students, Thomas R. Cawthorn, MD and Curtis Nickel, MD, of the recently graduated class of Meds 2013 conducted ultrasound education research during their time as students at Queen’s School of Medicine.   They worked with Dr. Michael O’Reilly, Dr. Henry Kafka, and Dr.  Amer M. Johri, of Queen’s and Dr. James W. Tam, of Winnipeg.  Their results have been recently published in the Journal of the American Society of Echocardiography, in the article Development and Evaluation of Methodologies for Teaching Focused Cardiac Ultrasound Skills to Medical Students.

There are several noteworthy aspects about this:   One is that our students embarked on this research during their time at Queen’s UGME, and worked on medical education in echocardiography as their field.

Secondly, the Journal of the American Society of Echocardiography published an article on medical education.  It’s uplifting to see focus on education in medicine as well as continuing professional development and new issues in medicine in a scholarly medical journal.

Thirdly, the article outlines an excellent, innovative education program that the authors developed, using sound pedagogy to assist learning of a key skill in medical education.

And for me, their conclusion is most exciting:

Third-year medical students were able to acquire FCU image acquisition and interpretation skills after a novel training program.  Self-directed electronic modules are effective for teaching introductory FCU interpretation skills, while expert-guided training is important for developing scanning technique. (Cawthorne, et al, 302)

The authors emphasize the importance and benefits of teaching/learning via self-directed electronic modules:

  • reduction of overall resource costs
  • provision of readily available resource easily accessed by students for future reference
  • opportunity to learn at the pace and setting desired by the learner
  • provision of standardized educational material to centres where specialists may not be found (Cawthorne, et al.  307)

They cite Ruiz et al. (2006) for literature about the benefits of this type of learning.  Ruiz’ excellent article is worth a read as well. (See Sources below.)

The other telling aspect of their findings  is the importance of  “practical small-group instruction under the supervision of experienced sonographers and echocardiographers.”  They recommend that supervised simulation training be combined with practical instruction sessions on volunteer patients (Cawthorne et al,  308).

The key to Drs. Cawthorne’s and Nickel’s recommendations  is the combination of demonstration, practice, and feedback.  And educational literature emphasizes that these are key aspects of learning skills as well.  It’s also intuitive:  just think back to learning to play a sport.  These three facets of skills-based learning helped you learn that sport;  without one of them, you would have found the learning challenging.

Educational literature calls this  “deliberate practice” where the following are involved:

  • repetitive performance of intended cognitive or psychomotor skills in a focused domain, coupled with
  • rigorous skills assessment, that provides learners with
  • specific, informative feedback, that results in increasingly
  • better skills performance, in a controlled setting. (Issenberg et al, 2005)

What does that mean for teachers?  It means that despite the savings and other benefits of online learning, it’s important to pair that type of learning with practice and feedback from experts, especially in skills-based learning.  That has implications for us all–online, independent, self-regulated learning works best when there is an additional face-to-face demonstration, practice/feedback component, especially when new skills are being taught.  (I’ve written before about the importance of  feedback–without feedback, “it’s like learning archery in the dark.”)

So rather than saving wholly on faculty’s time by building online modules for student independent learning, what this suggests is that we use faculty in other ways. Not only do faculty lecture and facilitate group work, they are instrumental in providing feedback on skills, as happens in our Clinical and Communication Courses.  In clerkship this emphasis on independent learning complemented by practice and feedback becomes crucial.

Congratulations to our students for their hard work and success, and that of their mentors and colleagues as well!  Dr. Sanfilippo writes,

It’s rather remarkable for medical students to produce work that would be accepted for presentation at a national meeting, and then be published in the leading Canadian cardiovascular journal.  It’s also rather unique to see a study that combines cardiac and educational components.  This is quite a tribute to Tom and Curtis, and to Dr. Johri who mentored and guided them through the process.

Would you like to read the article (and accompanying editorial!) yourself?  Here is the link:

http://www.onlinejase.com/article/S0894-7317%2813%2900964-4/fulltext

References
Cawthorne, T.R., Nickel, C.  O’Reilly, M., Kafka, H., Tam, J. W., Jackson, L., Sanfilippo, A. J., Johri, A.M.  (2014).  Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students.  Journal of the American Society of Echocardiography, 27(3), 302-309.

Ruiz, et al.  (2006).  Impact of e-learning in medical education. Academic Medicine, 81, 207-212

Issenberg, B. et al. (2005).  Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review:  BEME guide 4.  Medical Teacher, 27(1), 10-28.

 

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