The two winners of the poster competition were:
Lead author: Peter Kondrashov
Additional authors: Kondrashova T., Johnson J.C., Boehm K., Rice D.
Institution: A.T. Still University/Kirksville College of Osteopathic Medicine
Title: Impact of the Clinical Ultrasound Elective course on retention of anatomical knowledge by second-year osteopathic medical students in preparation for board exams
PURPOSE. Ultrasound has been integrated into Gross Anatomy and Osteopathic Manipulative Medicine (OMM) courses during the first year of osteopathic medical education (OME) at the A.T. Still University-Kirksville College of Osteopathic Medicine (KCOM) since 2011. Ultrasound labs and web-based learning modules allowed students to acquire images and interpret findings to visualize “living anatomy” through correlations with cadaveric dissection. During OMM labs, students used ultrasound to validate and ultimately enhance their palpatory diagnostic skills. A Clinical Ultrasound Elective course was developed to continue ultrasound training during the second year of OME. The goal of this study was to identify the impact of the ultrasound elective on the understanding of normal anatomy by second-year students as they prepared for board exams.
METHODS. Throughout the elective course, students participated in ultrasound labs, which involved different regions of the body. A multiple-choice 50-question anatomy exam was compiled by two second-year students who were not participating in course design and were not aware of the exercises planned for the elective. Before the start of the elective and after its conclusion, the exam was administered to students who enrolled in the elective and students who didn’t. Wilcoxon signed ranks tests were used to determine whether exam scores changed from pre- to post-test. Nonparametric analysis of covariance was used to compare students who took the elective to those that didn’t on the post-test exam score, covarying on the pre-test exam score.
RESULTS. The majority of students in this study (93/100) took the elective. Students who took the elective showed statistically significant improvement in the overall anatomy exam score between the pre- and post-tests (8.9 [2.4] vs 12.3 [5.3], p<0.001). For those students who did not take the elective, there was no statistically significant improvement (6.1 [2.4] vs 9.9 [4.9], p=0.19). There was no significant difference between the groups on the post-test score after accounting for differences in pre-test scores (p=0.47). Scores for exam questions pertaining to the upper extremity, lower extremity, chest, and abdomen regions were significantly improved for students who took the elective (p≤0.001) but not the head and neck (p=0.12) region.
CONCLUSIONS. Ultrasound elective course offered during the second year of OME at KCOM provided students with an important review of key anatomical concepts preparing them better for board exams. Musculoskeletal, abdominal, and heart ultrasound proved to be most important for retaining relevant anatomical information. More emphasis should be placed on head and neck ultrasound to improve student performance in this area.
Lead author: Kurtis O. Webster
Additional authors: Eric Matthew Vinceslio, Brion Benninger, MD
Institution: Western University of Health Sciences, COMP-NW
Title: Investigation of the sliding lung sign on embalmed cadaveric tissue: A teaching method for healthcare students.
INTRODUCTION: The sliding lung sign (SLS) is used to confirm proper endotracheal tube (ETT) placement after intubation, and to rule out a pneumothorax (PTX) in a critically injured patient. This sign is visualized as an ultrasound (US) transducer is placed classically on the second intercostal space of the mid-clavicular line of the anterior thoracic wall to observe the “sliding” of parietal and visceral pleura during respiration. Rantanen presented this method in 1986 while assessing equine pneumothoraces, then Werneck in 1987 described the US appearance of the pleura on humans, and Lichtenstein coined the term “sliding lung” in his 1995 study. The objective of this study was to investigate if the SLS could be revealed on embalmed cadaveric tissue for use of ETT placement training.
METHODS: A literature search was conducted on contemporary anatomical and ultrasound texts and journals, regarding the SLS on embalmed cadaveric tissue. Intubation was found by experimentation to be most successful using a size 4 miller blade. An ambu bag was used to inflate the lungs, and a Sonosite M-Turbo US machine using an HFL50X transducer was placed at the second, fourth, and sixth intercostal spaces of the anterior wall to visualize the SLS.
RESULTS: Literature research revealed no known articles regarding SLS using embalmed human cadaveric tissue. However, a large number of articles existed on the SLS in human and animal models that were not embalmed. Following intubation, the SLS was visualized using both 2D and M-Mode views. This indicates proper ETT placement and ruled out a PTX in the area.
DISCUSSION: Airway management by properly intubating with an ETT, and correctly assessing for a PTX are both critical skills. Providing students outside of an emergency setting without risking the life of a patient will be incredibly beneficial to their future career. Occasionally, the SLS was not seen at the second intercostal space, but the sixth intercostal space at the anterior axillary line was an ideal location.
CONCLUSION: This pilot study demonstrates that it is possible to visualize the SLS on embalmed cadaveric tissue. Visualization of the SLS confirms proper ETT placement after intubation and the absence of a PTX in that area. Practicing these procedures on a embalmed cadaver enables the healthcare student to learn life saving skills early on in their education.