Table 3.

Ultrasound assessments in medical education.

Form of assessment	Positive aspects	Negative aspects
Self-assessment or surveys regarding satisfaction	• Easy to create and evaluate • No need of a specialist as assessor • Cost effective	• Only subjective elements are measured, no objective view • No direct feedback to the student • No information about actual knowledge or practical skills • Bias possible, depending on the question structure
OSCE	• Assessment of both scanning technique and image interpretation • Combines evaluation of technical skills and knowledge in real time • Direct feedback to the students • Can connect different assessment forms: case based questions e.g., could be incorporated • Widely used, not only for US but for the assessment of multiple practical skills	• Requires different stations and protocols if different organs/situations shall be presented • Requires assessor who is educated in US and assessment • Better even to have different assessors to prevent bias, therefore high cost- and time expenditure
DOPS	• Assessing skills in a workplace setting • Formative and summative, observing knowledge and skills • Direct feedback	• Requires assessor to rate student, better even more than one • Not widely established yet, might need more studies showing efficiency/validity
OSAUS	• Objective measurement tool • Protocol is applicable for different specializations and clinical situations • Not only focused on direct performance at scanning, further checks if the student has the needed knowledge to evaluate if the US examination is necessary and how it could help in the further treatment of the patient • Approach for global rating system –> delphi consensus • Rating system which has been developed for US only	• Since it should be applicaple for different specializations it is more general than e.g., osce protocols since not every special finding for the different organs are named • Experienced assessor needed, not widely established yet
multiple choice and written questions	• Objective • Can be incorporated into another exam (e.g., internal medicine) • No special educated assessor necessary	• If used alone no direct evaluation of scanning technique • Knowing what is shown on an US image or how a disease would show does not mean that the student is capable to obtain the image and detect the pathology • US is a technical skill while MCQ rather checks theoretical knowledge
Pictures and case based questions	• Objective • Has been shown to be a good learning strategy • No assessor necessary • Can be incorporated into another exam	• No information about how the students' competence in an examination would be • No information about students' probe handling/ image acquisition
Skill assessment on simulators	• No accidental findings which could be detected when scanning other students • Good training prior to examine a real patient, especially for rather advanced tasks	• No clinical setting • Better learning effect while scanning real humans • Might know the simulator from training and memorizes locations
Comparison of findings between students and specialists	• Examination of real patients • Clinical setting • Objective • No theoretical approach but students had to obtain images	• No direct feedback • No check on scanning technique, only results are compared
Rating of images	• Direct outcome is evaluated • Practical skills are assessed • Objective	• Examination itself is not evaluated, therefore no direct feedback on scanning technique • Theoretical knowledge is not evaluated and no globally accepted image rating system is existing yet

This overview depicts the various forms of evaluation, as well as the benefits and drawbacks of the various approaches in medical ultrasound teaching.