METHODS
Wireless Portable Ultrasound Accessibility Improves the Learning
of Integrated Basic Sciences (Anatomy, Physiology, Pathology)
Fauzia Nausheen, Rajunor Ettarh, Sherif Hassan,
Robert Suskind, Alfred Tenore
Department of Medical Education, California University of Science and Medicine,
At California University of Science and Medicine, School of Medicine, we have
designed a clinical presentation-driven, system-based, fully integrated, active learning
curriculum. The integrated active-learning sessions are conducted by teams of students
that belong to specific learning units referred to as “colleges”. This curriculum is an
amalgam of different pedagogical methods which also include modified versions of
traditional team-based and problem-based learning. To complement the active, team-
based learning pedagogy, ultrasound laboratory sessions are incorporated to support the
learning of integrated anatomy, physiology and pathology by the interpretation of normal
images during the system-based courses in year 1 and 2. The ultrasound anatomy
laboratory sessions held each Friday will be aligned with the clinical presentations,
clinical skills and case sessions of the week. Anatomy will also be taught on prosections,
models, multimedia, online anatomy as well as radiology images. The objective of this
study is to evaluate the student and instructor perception of teaching and learning of
integrated basic sciences (Anatomy, Physiology and Pathology) with the use of wireless
portable ultrasound scanners that will work on computer tablets provided to each team in
the anatomy laboratory.
The inaugural class have 60 students, who is divided into 6 colleges. Each college is
composed of 10 students divided into two teams of 5. The members of each team work
together during lecture discussions in flipped classrooms, clinical case analysis and clinical
skills activities which include role playing sessions and integrated laboratory sessions.
Because of the increasing role of ultrasound in the clinical evaluation of patients, almost
all system-based courses have developed and incorporated hands-on ultrasound
experience. In each anatomy session, each team have 2 wireless portable ultrasound
scanners to perform ultrasound on each other or simulated patients and identify the
structures at different plane of sections for that specific lab as described in lab manual.
The lab manual includes a guide to use ultrasound on each table .
The scanners have linear, phased and convex array with the ability to scan superficial and
deep structures in different systems of the body. They are required to identify the structures
for the specific session and have their findings confirmed by the facilitators. To achieve the
designated learning outcomes, the ultrasound lab activities have been divided in three
sessions: 1) information gathering and independent self-directed learning: self-study from
resources. 2) identification of structures on ultrasound and confirmation by instructors: 3)
interactivity and integration followed by presentation and discussion: the focus of this
session is on problem solving exercises, critical-thinking and presentation by the teams.
The problems focus on related anatomical appearances on ultrasound. During the
discussion the students are encouraged to justify their answers based on ultrasonographic
principals and extra bonus points will be given by identifying the abnormality or related
structures on ultrasound images
Wireless portable ultrasound scanners
accessibility in all system-based courses in
anatomy lab will be a bridging device between the
integrated basic sciences and clinical practice.
This early exposure of portable wireless ultrasound
imaging technique in all organ systems will
prepare our medical students for later ultrasound
encounters of clinical years.
Years 1 and 2 have 11 system-based courses and each course has multiple ultrasound
sessions depending on the weekly clinical presentation theme. Live ultrasound scanning
is synchronized with the anatomy curriculum of each system by anatomic sections and
location of different body parts that form the system. The following is an example of
sessions and overall outcomes for ultrasound hands-on lab session in some of our
systems-based courses; In “The Scientific Foundation of Medicine:” course , we have
ultrasound sessions on introduction to medical imaging, doppler ultrasound, knobology,
ultrasound physics and basics of ultrasound imaging. The learning outcome is : to
differentiate the hyperechoic organs from the hypoechoic organs and explain the reason
INTRODUCTION
RESULTS
of their appearance based on ultrasound imaging principals. In “The Structural Integrity
of the Human Body”; (i.e., Integumentary and musculo-skeletal systems), we will have
session on ultrasound of shoulder, wrist, knee and ankle joints with identification of the
bones and ligament and muscles moving the joints. The learning outcome is : to
identify and differentiate the normal appearance of bones, muscles and tendons of
shoulder, elbow, knee, hip and ankle joints. In “The Sustenance of the Body “(i.e.,
Gastrointestinal system and nutrition), we will have session of ultrasound on major
abdominal vessels and organs including the Morison pouch, and introduction to FAST
exam. The learning outcome is : to locate liver, gall bladder, spleen, pancreas, aorta and
IVC on abdominal ultrasound and perform Doppler scan to show the direction of blood
blow. In “The Depurative Functions of the Body” (i.e., renal system), we will have
session on ultrasound of kidneys and urinary bladder. The learning outcome is : to locate
kidneys, and urinary bladder on abdominal ultrasound. In “The Transport and Delivery
of the Life’s Elements “(i.e., cardiorespiratory systems);we will have session on
ultrasound appearance of normal lungs, ribs and pleural cavities and cardiac ultrasound
four chamber view, cardiac cycle and valvular events. The learning outcome is : to
locate four chambers of heart and identify the valves on subcostal and parasternal
cardiac view. In “The Propagation of Life “(i.e., reproductive system), we have session
of ultrasound of the pelvic organs and breasts. The learning outcome is : to locate uterus
ovaries and prostates on pelvic ultrasound. In “The Foundation of Life’s Functions”
(i.e., endocrine system), we have session of ultrasound of neck (thyroid glands). The
learning outcome is : to locate thyroid gland on neck ultrasound. In “The Integration of
Life’s Processes” (i.e., neurosciences), we have session of ultrasound of major vessels in
the neck (carotids, jugular veins). The learning outcome is : to locate major neck vessels
and perform doppler scan to show the blood flow. In “The Continuum of Life” (i.e.,
from the beginning to the endo of life), we have ultrasound session of introduction to
POCUS (point of care ultrasound). The learning outcome is : to review the principals of
point of care ultrasound. The laboratory exam will assess the student’s skills to perform
ultrasound and locate the appropriate structure in the correct plane and identify the
anatomical relations on simulated patients. Students and faculty will be given evaluation
forms to get feedback about their perception of anatomy teaching and learning with
wireless portable ultrasound scanners at the end of each system-based course and their
suggestions to improve the sessions
CONCLUSIONS
CLARIUS IN THE CLASSROOMResults cont.
Students performing ultrasound with Clarius scanners on wrist and thyroid
Clarius guide specifically made for CUSM students