Table 1.
Considerations (pros/cons) are listed for four essential questions when creating an ultrasound curriculum.
| (1) HOW WILL ULTRASOUND BE USED IN THE PROGRAM? | |
|---|---|
| AS A PHYSICAL EXAM TECHNIQUE* | AS A “LIMITED ULTRASOUND” STUDY |
| Frequent (daily) reinforcement of a single exam. | Memorization and use of multiple imaging protocols. |
| Findings correlate with familiar physical techniques. | Specialty specific skills. |
| Subjective interpretation. | Documentation and archived images. |
| Incidental findings minimized. | More comprehensive interpretation. |
| Individual user-specific accuracy and utility. | Competency well defined by standards. |
| No reimbursement. | Significant reimbursement for time spent. |
| Requires a single exam formed by consensus opinion. | Difficulty with hospital staff privileging. |
| (2) HOW WILL THE CURRICULUM BE STRUCTURED? | |
| VERTICAL STRUCTURE* | HORIZONTAL STRUCTURE |
| Development of basic skill set. | Memorization of multiple, unrelated techniques and indications. |
| Repetition of a single, basic exam. | Published exams with known accuracies. |
| Longer lasting memory via repetition. | Multiple exams increase potential revenue. |
| Skills added based upon mastery of prior skills. | Requires reaching competency in each separate exam. |
| Suitable for general use by all residents during all rotations. | Better for motivated self-learners in an elective rotation. |
| Nonparticipating faculty become familiar with exam. | Faculty with subspecialty imaging expertise. |
| Metrics can improve overall program. | Difficult to identify deficiencies in curriculum due to heterogeneity. |
| (3) WHAT RESOURCES ARE AVAILABLE? | |
| MANDATORY PARTICIPATION* | ELECTIVE PARTICIPATION |
| Much larger volume of participants of varying motivation. | Fewer, motivated participants limit costs and improve success. |
| Teaching added in to general curriculum. | Imaging during existing subspecialty or elective rotations. |
| Use existing resources in echo and radiology labs. | Perform and bill limited studies with attending during training. |
| Resident-to-resident teaching. | Hire/recruit expert faculty in point-of-care ultrasound. |
| Faculty development within program. | Use subspecialists familiar with ultrasound. |
| Additional financial support often needed. | Fund new devices from program earnings. |
| Larger participant failure or dropout rate. | Higher competency rate due to selection bias. |
| (4) WHAT LEARNING CONSIDERATIONS ARE SPECIFIC TO ULTRASOUND? | |
| PHYSICAL SKILL* | DIDACTIC KNOWLEDGE |
| Teaching requires frequent repetition. | Lecture and/or study time required. |
| Requires more faculty/sonographer time. | Materials easily made for on-line, self-study. |
| Participants need frequent opportunities to practice and access to equipment for autonomous imaging. | Didactic material easily forgotten, if not reinforced. |
| Standardize exam, grip, approach and orientation. | Imaging skills are likely independent of knowledge. |
| Success more dependent upon teacher. | Success depends on learner and material presented. |
| Proficiency evaluation requires direct observation. | Retention of material easily tested. |
Note:
*
The pathway chosen by our program.