Quantitative Assessment of Skill Acquisition by Medical Students After Bedside Ultrasound Instruction
Peter Steinmetz MD1,2,3*, Sharon Oleskevich PhD3, and John Lewis1 MD
1Department of Family Medicine, McGill University, Canada
2Arnold and Blema Steinberg Medical Simulation Centre, McGill University
3St. Mary’s Research Centre, St. Mary’s Hospital Centre-McGill University, Montreal, Canada
Undergraduate teaching of bedside ultrasound improves a medical student’s knowledge of basic anatomy and physiology, and diagnostic accuracy. Here we assess skill acquisition in the new undergraduate bedside ultrasound course at McGill University, the first comprehensive four-year undergraduate ultrasound course in Canada. The course textbook, objectives, and evaluations were aligned to maximize skill acquisition. Course objectives and pre-course reading material were distributed to Year 1 medical students (n=195) prior to six clinically based one-hour practical teaching modules evenly spaced during the academic year (approach to dyspnea, hypotension, rule-out AAA, rule-out free abdominal fluid, kidney injury, swollen leg). The bedside ultrasound course was evaluated using a quantitative assessment of student skills and student perspectives. Skill acquisition was evaluated by the students’ ability to meet course objectives (n=6-8 objectives per module centered on image generation and interpretation) and rated using anonymous evaluation forms containing a Likert-type rating scale with four categories (strongly disagree, disagree, agree, strongly agree). Evaluation forms were completed by instructors (n=8) and students (n=126-195) immediately following each teaching module. According to instructor evaluations, the mean percentage of students assigned a scale of ‘strongly agree’ or ‘agree’ for their ability to successfully meet all objectives in all modules was 98 ± 0.4% (Strongly agree = 52 ± 3%, Agree = 46 ± 3%). According to student self-evaluations, the mean percentage of students assigned a scale of ‘strongly agree’ was significantly greater than the percentage assigned by instructors for all modules (mean of 86 ± 2% versus 52 ± 3%; P<0.0001). Skill acquisition for the dyspnea module was retained after 8 months with 91 ± 2% of students assigned a scale of ‘strongly agree’ or ‘agree’. A high percentage of students agreed that bedside ultrasound improved their understanding of anatomy for all modules (mean=95 ± 0.01%). Acquisition of bedside ultrasound skills in first-year medical students was excellent for all modules, suggesting that course objectives were set at an achievable level for the teaching time alloted. Student self-evaluations indicated an over-estimate of skill acquisition, concurrent with previous reports of over-confidence in self-assessments. Skills were retained by academic year’s end and students consistently reported an improved understanding of basic anatomy following completion of this new undergraduate course in bedside ultrasound.