Teaching musculoskeletal ultrasound in the undergraduate medical curriculum

Context and setting Although a wide range of resources is available to teach anatomy to medical students using the problem-based learning (PBL) approach, resources were needed to help them understand the dynamic living anatomy of the musculoskeletal (MSK) system. Using ultrasound imaging, students can visualise MSK dynamics. Its advantages include availability, non-invasiveness, quick scan-time and real-time imaging. The equipment is located in the anatomy laboratory, where students have immediate access to anatomical specimens. Why the idea was necessary The purpose was to determine the effectiveness of ultrasound as a teaching/learning tool for topographical and dynamic anatomy, and to provide an introduction to its technology and the opportunity to develop basic skills in image interpretation through independent practice. Although this educational resource is simply adjunctive, it is not commonly used to teach MSK anatomy. One of the difficulties in introducing a new or modified curriculum is a tendency to ask: ‘What’s extraordinary about it? What's new?' In this study, we assessed the ‘evolution’ of what may have been a good but ordinary curriculum. Although our approach may not be extraordinary, we needed data to evaluate it as it relates to the MSK curriculum in undergraduate medical education. To the best of our knowledge, no other study applying and evaluating this approach has been published. What was done Approximately 420 Year 2 medical students (19 groups of 6 students over 4 consecutive years) were involved. Staff time was not an issue as each staff member expects to teach approximately 52 hours/year (210/4). This is an acceptable workload (our faculty members devote 80 hours per unit as tutors, and as clinical preceptors a minimum of 52 hours per year for the locomotor/nervous system/brain unit). Students learn from hands-on ultrasound experience, using Toshiba SSA-220A machines with 7.5-MHz linear probes, on a normal control model. CD-ROMs of specific normal aspects and pathologies were progressively viewed and discussed. The group's ultrasound/anatomy learning objectives related to health care problems covered in the locomotor unit, primarily the assessment of the integrity and abnormalities of specific structures (shoulder, elbow, hand, hip, knee, ankle). The students negotiated how they would approach their problems, and integrated the practical applications. At the end of each session, students were evaluated on a 5-point scale by a faculty rater using standardised criteria. Students and faculty provided written feedback within the sessions. Scores were not provided to students or incorporated into their formal evaluation. Evaluation of results and impact Average scores at the end of the first and second sessions were 3.31 ± 0.11 and 4.28 ± 0.13, respectively; P > 0.005. Feedback on the tutorial sessions consistently rated them as excellent and the CD-ROMS were highly valued as a means of reinforcing learning. The results show that the use of hands-on MSK ultrasound examinations in anatomy facilitates learning, significantly enhances knowledge and understanding of the living system, and teaches students physical examination skills. In addition, not only do students acquire the skills to perform and interpret ultrasound, they also analyse and apply this knowledge to surgical, physiological and diagnostic imaging concepts. Challenging students in these different contexts is an essential component of the PBL approach.