Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools: A Discussion of Common Challenges and Strategies From the UMeCali Experience.

Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.

Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users?

OBJECTIVES: To assess whether easy access to medical information of the emergency department's (ED) frequent users would be useful to patient care in the ED and at primary healthcare centres (PHCs), and if resource utilization in the following year would be affected. METHODS: During a 6-month period, frequent users presenting to the ED of Karolinska University Hospital Huddinge, Sweden, were randomized by the electronic database system into an intervention (n=834) or control group (n=965), the definition being three or more visits in 12 months before the index visit. Printout case notes, from the intervention patients' last three visits, were made accessible to the ED physicians and optionally forwarded to the patient's PHC physician. Usefulness of this enhanced information was measured by questionnaires, whereas healthcare utilization was compiled from the electronic database. RESULTS: The case notes of 59 (7.1%) intervention patients were forwarded to the respective PHCs. Of these, access to the enhanced patient information was deemed useful in 82% cases in the ED, versus 76% in PHCs. The mean number of ED visits in the following year did not differ significantly in the total intervention group as compared with the controls: 4.0 and 3.9, respectively (P=0.49). Nor were there any differences in utilization of other care resources. CONCLUSION: Although only a small subgroup's information was shared, yielding no decrease in overall healthcare utilization, the study indicated benefits of the enhanced information at the respective care level and also had important clinical and organizational implications.

Bedside ocular ultrasound for the detection of retinal detachment in the emergency department.

OBJECTIVES: Acute retinal detachments (RD) can be difficult to diagnose and may require emergent intervention. This study was designed to assess the performance of emergency department ocular ultrasound (EOUS) for the diagnosis of RD. METHODS: This was a prospective, observational study using a convenience sample of emergency department (ED) patients. Physicians performed EOUS for the diagnosis of RD prior to evaluation by an ophthalmologist. The criterion standard was the diagnosis of a RD by the ophthalmologist who was blinded to the results of EOUS. RESULTS: Fifteen physicians evaluated 48 patients with acute visual changes. Eighteen patients (38%) had RDs and all were correctly identified (true positives). Of the 30 patients (62%) without RD, 25 patients were correctly identified (true negatives), and five patients with vitreous hemorrhages were misidentified as having RDs (false positives). Therefore, the sensitivity and specificity of EOUS for RD were 100% (95% confidence interval [CI] = 78% to 100%) and 83% (95% CI = 65% to 94%), respectively. CONCLUSIONS: Emergency department ocular ultrasound is sensitive for the diagnosis of RD and may have a role in excluding RD in patients presenting to the ED.