10 Steps to Developing a Medical School Ultrasound Program
December 2, 2021
Developing a new or existing ultrasound program for a medical school can feel daunting. So we spoke to three prominent ultrasound educators – Dr. David Bahner, Dr. Wilma Chan, and Dr. Richard Hoppmann to outline the 10 critical steps to consider when developing your ultrasound education program.
The following is an edited transcript of the doctor’s interviews. You can view a video of the interviews here.
1. What are the factors to consider when involving stakeholders for launching an ultrasound program?
One way to involve stakeholders could be to send out an announcement of the idea of starting an ultrasound curriculum and see what response you get from it. Then, meet with those individuals and get a sense of what they think about ultrasound and what they think their role may be – if you can get a champion across several courses and clerkships, I think that puts you in a very good position. Get your whole group together and get a sense of how interested stakeholders are in moving forward with this, and you can also get a sense of what role they want to play.
I think the same thing would be true with the medical students. Medical students can be a driving force in getting an ultrasound curriculum going. One of the things that we did early on was to send out a similar sort of announcement and say, we’re looking at this, we want your input, we want you to feel ownership in this because it does belong to the medical students. The next step would be to get those leaders among the medical students and form an interest group. The interest group can be very important in terms of feedback, and they can help teach as well. Identifying the stakeholders, bringing stakeholders together, and having everybody feel like they are a part of this program is very important.
2. What are the factors to consider when securing financial support when launching an ultrasound program?
Trying to find funding is a matter of talking to your direct reports, your chairs to see if there are ways that your department can help fund these efforts into medical education. You can try to talk with your medical school to see if some of the efforts and skill sets you have are consistent with what they are trying to teach the students and find funding from the college of medicine. You can try to write research grants and educational grants, but those are a little bit harder. There are different programs within the industry, but I think that when you’re trying to budget for funding, it’s essential that this is something you have the time to try to overcome because the budgetary issues are complex. There’s a lot of time on the front end that you have to put in, where there is no funding, but as you progress and have a product, you can work with the medical school, your department, or the industry.
It’s a different landscape than 20 years ago because there’s been a lot more literature produced. There’s a lot more momentum, and the ultrasound machines have gotten a lot smaller. So, ultrasound in medical education is not as big of a stretch as it was perhaps in 1999 when I started. Perseverance and allocating time to put in your budget does pay off in the end. When you’re trying to find funding, it’s crucial to develop that budget, work with your department, and then work with the college to find support for the things you’re teaching that goes along with their curricula.
3. What are the factors to consider when recruiting experts to teach ultrasound?
We also have a sonographer educator. She has had decades of experience with the radiology departments doing ultrasound as a technician, and she has been invaluable in the way we deliver ultrasound education. She is there as technical support, equipment support, and someone to bounce ideas off for curriculum and content development.
4. What are the factors to consider when designing/curating content to teach ultrasound?
That part is unfortunate because there’s so much good content out there that has been done and redone and edited. My philosophy is that you don’t need to reinvent the wheel. There’s a lot of great content out there. As the instructor and director of a course, you can review this content and make sure it is appropriate for your level of learner, and the length of the content is suitable for the learner’s attention span.
The scope of topics is so broad that I think people tend to become overwhelmed. For anyone who’s starting off, choose less than a handful of topics that you think are important and vital to your institution and stick with it. Just because someone else at a different institution teaches 16 topics doesn’t mean you need to go with 16 topics. You can teach four topics well and make sure that the content is very well curated and updated often to ensure its quality. So that would be my recommendation – keep it narrow and focused, prioritize what your institution needs to deliver, and don’t reinvent the wheel.
5. What are the factors to consider when selecting devices to teach ultrasound?
In terms of multiple devices, you get a broader experience. And then the final part is AI. AI will play a significant role in medicine, especially in education. I think anytime you can get devices that allow self-directed learning, such as with real-time labeling of anatomy, the direction of probe manipulation, image quality, all those things will help because the key will be how much instruction you can turn over to the self-learner.
6. What are the factors to consider when requesting time to teach ultrasound?
7. What are the factors to consider when assessing competency while teaching ultrasound?
We have a series of courses that we have put together, and one of the best ways we assess is with an oral exam, where they present their portfolio. They deliver their presentations in a group of three, and then we go over the images and ask questions on those. If the first student doesn’t know the answer, we go to the second student. So, there’s group learning during this assessment. They may not all know the same things, but it gives us a way to look at their images, give them critique/feedback, and then see where their other classmates are with some of the same objectives.
8. What are the factors to consider when selecting locations for teaching ultrasound?
The pandemic has caused issues for everybody, and certainly, ultrasound being a contact examination, we’ve had to change many things. We have a great deal of material that we are doing virtually. For example, we’re fortunate to have an ultrasound studio, so we do a live demonstration in the studio. Then we break up into small groups with discussion, review questions, and look at images. And that’s worked very well. The students love the hands-on learning, so we have done some scheduling to spread classes far apart where students come, and they scan themselves. Let’s say they’re going to scan the knee. They’ll wear masks, gloves, distancing, disinfect, and all those sorts of things. But I think during the pandemic, students need to get a little bit of hands-on learning to keep things going, so that’s what we’ve done.
9. What are the factors to consider when acquiring feedback while teaching ultrasound education?
10. How do you deal with the legal issues that may arise due to teaching ultrasound?
The students would serve as models, and the paper that we wrote was TSUP – as model learner and teacher. So first, they’re a model. They learn by osmosis, by sitting there as people scan them. Then, they become teachers. Students participate voluntarily in the program; they sign a contract that says they are okay with the scanning and will speak up if anybody does any scanning that they feel uncomfortable with.
We have a safety monitor in every session, so the TSUP will sign off with the safety monitor that they are okay to model through the session. When issues come up, such as incidental findings, we have a handbook in our simulation center with a policy that talks about incidental findings where the student is responsible for working with the faculty that’s present to save that image. They then take that to their primary care physician and try to get further answers if there is any concern.
The first step is we save the images. The second is talking with the faculty that’s present, and the third is putting the onus on the student as the patient to try to contact their primary care physician and follow up. I think it’s essential when you think of some of the legal aspects and to really do your ultrasound in a way that people understand what is going on in the simulation setting. In the clinical setting, the findings go into the chart. If it happens to be an educational scan where the images are not going into the chart, and there’s an incidental finding, we will follow up with the direct team that’s taking care of that patient and inform them so they can get the appropriate testing or have the patient follow up.
Dr. Richard Hoppmann – Clinical Professor of Internal Medicine, Director of the Ultrasound Institute/Dean Emeritus, Ultrasound Institute, School of Medicine Columbia
Dr. David Bahner – Professor of Emergency Medicine, Ultrasound Division Chief, Department of Emergency Medicine, The Ohio State University
Dr. Wilma Chan – Assistant Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania