Ultrasonography in Undergraduate Medical Education: A Systematic Review.

OBJECTIVES: The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students. METHODS: A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full-text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors. RESULTS: Ninety-five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US-related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non-US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed. CONCLUSIONS: There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.

Peer nominations as related to academic attainment, empathy, personality, and specialty interest.

PURPOSE: To test the hypotheses that peer nomination is associated with measures of (1) academic performance, (2) empathy, (3) personality, and (4) specialty interest. METHOD: In 2007-2008, 255 third-year medical students at Jefferson Medical College were asked to nominate classmates they considered the best in six areas of clinical and humanistic excellence. The authors compared students who received nominations with those who did not, analyzing differences in academic performance, personality factors (empathy as measured by the Jefferson Scale of Empathy and personality qualities as measured by the Zuckerman-Kuhlman Personality Questionnaire), and specialty interests. RESULTS: A comparison of the 155 students who received at least one peer nomination with the 100 students who received none found no significant difference in scores on objective examinations; nominated students, however, were rated significantly higher in clinical competence by faculty in six core third-year clerkships. Nominated students were also significantly more empathic and "active." In addition, a larger proportion of nominated students choose "people-oriented" (rather than "technology- or procedure-oriented") specialties. CONCLUSIONS: These results confirmed the hypotheses that peer nomination can predict clinical competence, empathy and other positive personal qualities, and interest in people-oriented specialties. Thus, in the assessment of medical students, peer nomination holds promise as a valid indicator of positive dimensions of professionalism.

USMLE Step 2 performance and test administration date in the fourth year of medical school.

PURPOSE: To determine whether the time interval between completing the third-year curriculum and test administration affects a student's USMLE Step 2 score. METHOD: Scores for 846 students in the classes of 2000-2004 were grouped in ten time periods depending on test date. A linear regression model to predict performance on Step 2 using gender, Step 1, and grades in medicine, pediatrics and obstetrics-gynecology was developed based on the class of 1999. Analysis of covariance was used to test the effect of time on scores, adjusting for predicted performance. RESULTS: Step 2 scores decreased significantly (p <.001) across time. Students' mean scores were four points higher than predicted in the early months and five to eight points lower near the end of the senior year. CONCLUSIONS: Students who scheduled Step 2 early in the senior year achieved higher scores, on average, than those who waited until later in the year.

The impact of cobedding on sleep patterns in preterm twins.

Interest in cobedding multiple-gestation infants has grown as focus has increased on the developmental approach to the care of the neonate. Little data, however, exist on the infants' response to cobedding. It is important to evaluate the safety, efficacy, and physiologic impact of this practice. Cobedding was offered to parents of twin infants < 37 weeks gestation, without arterial lines or ventilator requirements, by the health care team according to standard practice in our nursery. After parental informed consent, infants were placed on an event-recording cardiorespiratory monitor for 12 hours before cobedding and for the first 12 hours of cobedding. Recordings were evaluated by an investigator blinded to the bedding status of the infant. Apnea (a pause of respiration > 10 seconds, central apnea), bradycardia (a decline in heart rate to < 80 beats per minute), periodic breathing (a respiratory pattern in which there are > or = 3 pauses in respiration of > or = 3 seconds with < 20 seconds of breathing between pauses), adverse events (changes in medication, changes in oxygen requirements, temperature instability, the need for sepsis evaluation, or death) were evaluated. Other physiologic parameters were obtained through the use of standard bedside monitoring. Eleven sets of preterm infants, n = 22, with a mean gestation of 31.8+/-2.9 weeks and a mean birth weight of 1,698.7+/-552.0 grams were studied. Infants were evaluated at a corrected gestational age of 33.5+/-1.9 weeks and a mean weight of 1,713.2+/-484.0 grams. The number of events of central apnea before cobedding (57) was greater than those recorded during cobedding (18), p<0.05. There was no difference found in any of the other parameters compared. The numbers of events recorded before and during cobedding were compared by Student's t-test and significance was determined by p < 0.05. No adverse events (AE) were noted, and all infants remained cobedded throughout the study. This preliminary study suggests that cobedding of healthy preterm twins showed no increase in adverse events. Of the physiologic parameters studied, only the occurrence of central apnea changed with cobedding. This decrease in central apnea may reflect a change in sleep pattern due to more frequent arousal by the twin. Alternatively, a more regular breathing pattern may reflect a positive physiological response to contact between twins.

Automatic Border Detection for Assessment of Left Ventricular Diastolic Function Among Normal Neonates: Comparison with Doppler Echocardiography.

Doppler echocardiography is the standard noninvasive method to assess left ventricular (LV) diastolic function. Recently, automatic border detection (ABD), a method based on analysis of integrated ultrasonic backscatter, has been introduced permitting real-time, on-line assessment of LV diastolic function. A comparison of these methods in normal, full-term neonates has not been performed. Therefore, the objectives of this study were to evaluate the usefulness of ABD in the assessment of LV diastolic function among normal neonates, to compare parameters obtained with the ABD method with standard Doppler-derived indexes of diastolic function, and to assess the reproducibility of ABD measurements. We studied 17 consecutive normal neonates during natural sleep with both methods shortly after birth (mean 17.4 +/- 3.9 h) and approximately 2 weeks later (mean 14.8 +/- 2.2 days). An average of five consecutive cardiac cycles were performed. Similar to Doppler indexes, no significant change in any ABD parameter of diastolic function occurred between the early and later studies. A complete ABD study could be performed within 5 minutes. Mean interobserver variation for individual ABD measurements ranged from 0% to 11%. Compared with Doppler, rapid filling fraction was greater and atrial filling fraction was less with ABD. Regression analysis showed poor correlation of these parameters between methods, but their ratio by each method remained constant between studies. A similar poor correlation existed between peak E wave velocity by Doppler and peak rapid filling rate by ABD and between peak A wave velocity by Doppler and peak atrial filling rate by ABD. These differences may be explained by technical factors and different aspects of diastolic filling assessed by each method. This study indicated that ABD was a feasible and reproducible method compared with Doppler echocardiography for serial evaluation of LV diastolic function among neonates.