Comments on “Twelve tips for teaching with ultrasound in the undergraduate curriculum”

Dear Sir

Please find our response regarding the following article, ‘Twelve tips for teaching with ultrasound in the undergraduate curriculum’ by Griksaitis et al. (2014).

We found this article on the application of ultrasound to assist undergraduate medical students to learn anatomy provides valuable guidance. The article highlights a novel use of ultrasound. However, tip 10 of the article, advocates providing hands on scanning time with supervision where time permits and we would like to both deconstruct this concept and highlight the potential consequences of using this tip.

We currently have a paper in press which highlights that the foundational skills to manipulate and move a transducer (or psychomotor skills) are complex and multidimensional (Nicholls et al. 2013). Opportunistic and “trial and error” scanning we suggest does not develop the motor neural maps and skills to move a transducer effectively. We report that the probe movements to move a transducer maybe single or sequenced. Both require extensive practice in order to attain basic skill level. We identify practice of these skills is facilitated by having a visual example of what the skills should look like. That is, how to move the transducer and what a normal structure looks like ultrasonically. Dedicated skill practice we believe is required to both learn and acquire the skill, and permit recall at a later date.

In our paper, we identify that there are two key psychomotor skills used in medical ultrasound imaging; visuo-spatial and visuo-motor skills (Nicholls et al. 2013). We report visuo-spatial skills assist in creating a three-dimensional mental picture or topographical representation of two-dimensional anatomies displayed on the ultrasound monitor. The generation of a three-dimensional mental image of anatomical structures required developed scanning skills. We argue this is essential in order to move the transducer in multiple planes. The multi-planar movement allows the operator to create a mind map of the orientation, angle, rotation and relational anatomy of the structure being scanned. The skills to move a transducer are not related to the simplicity or complexity of the anatomical structures being examined. In other words, simple anatomical structures require the same psychomotor skills to move a transducer as a complex structure. We are concerned that a medical student who is learning foundational skills with limited opportunity to practise their scanning skills under guidance maybe given an unrealistic impression. This being an impression that as they can perform limited planar scanning on simple anatomical structures, that this will translate to a conceptual ability to generate a three-dimensional image of that structure. Likewise, we are concerned with the suggestion that a limited window of exposure to medical ultrasound imaging whilst a student may somehow have tangible outcomes for skill recall and execution later in their career. We look forward to continued discussion on these important educational matters.

Declaration of interest: The authors report no conflicts of interest.