Analysis: Self-learning of point-of-care cardiac ultrasound — Can medical students teach themselves?

Self-learning POCUS by Medical Students

Training of Point of Care Ultrasound (POCUS) is challenging, time-consuming and requires large amount of resources. This study evaluated if the training process can be simplified by using a combination of eLearning software and self-practice using pocket ultrasound device (PUD).

The past decade brought about new and exciting technological advancement leading to the development of the PUDs. These devices were rapidly adopted by the medical community and are now used routinely to supplement the bedside physical examination. A growing number of medical schools around the world integrate POCUS teaching into their curriculum. Proper incorporation of ultrasound education into medical training requires planning and resources, both capital and human. One of the biggest challenges in POCUS training is time to teach and POCUS expertise in an organization to allow for teaching large number of students.

In this study, the authors tested the hypothesis that adequate training in image acquisition of the Focused Cardiac Ultrasound (FOCUS) views can be self-learned by medical students. A total of 29 medical students took part in the study. They were divided into eLearning and control groups.

The eLearning group consisted of nine 3^rd year medical students (in a six-year program). They were given unlimited access to “eViews for Focused Cardiac Ultrasound”, one of four online learning courses offered by eMedical Academy. This web-based course contains modules teaching image acquisition and optimization of the FOCUS views in an interactive and engaging way.

In addition to having unlimited access to the eLearning platform, students were given PUDs and were encouraged to take them home and practice on their own. Throughout the study period students in the eLearning group did not receive any kind of formal training nor were they taught how to perform the FOCUS exam.

The control group consisted of twenty 4^th-year medical students (in a six-year program), creating a ratio of 2:1 control to intervention groups. Students in this group participated in a formal course focused on obtaining the standard cardiac transthoracic ultrasound views and consisted of four hours of formal lectures with an additional four hours of hands-on practice under supervision of cardiologists and sonographers. This course was shown to be feasible for training medical students and has been previously described by the authors. 

The six-minute exam:

Following completion of the study period, students from both groups were evaluated using the six-minute exam. The goal of this exam was to assess the students’ ability to perform a FOCUS exam by obtaining the basic FOCUS. This exam has been previously described by the authors.  Each student was given six minutes to obtain the main FOCUS views in a predetermined order using a PUD: Parasternal long axis view (PLAX), Parasternal short axis view (PSAX) including aortic, mitral and mid-papillary level views, Apical 4- chamber view and subcostal view standard and focusing on the IVC.

Views obtained by students were captured as video files, randomly scrambled and rated by two expert echocardiography physicians who were blinded to the students’ group for evaluation.

Findings

The median test score for the eLearning group was higher than the control group, but this difference did not reach statistical significance (p = 0.508). This study demonstrated that medical students are able to independently learn how to acquire the FOCUS views by using an eLearning platform in combination with self-practice using a PUD.

The authors concluded that learning cardiac ultrasound independently using a combination of eLearning platform and self-practice is feasible, and may serve as an important, cost-effective, modern adjunct to heavily resource-consuming traditional cardiac ultrasound teaching.

In the era of the COVID-19 pandemic, shifting POCUS learning from hands-on courses to online training may be invaluable in teaching the new generation of clinicians.