Comment on Letter by Nicholls et al. – Ultrasound: A hands-on and kinaesthetic approach to anatomy education

Dear Sir

We thank Nicholls et al for their comments on our article (Griksaitis et al 2014). We agree with their comments that the psychomotor skills required to perform ultrasound are multidimensional and complex and this should not be underestimated when initiating ultrasound training programmes within undergraduate curricula.

Our article offers advice on using ultrasound as an adjunct to teach anatomy and physiology but does not advocate using these sessions to teach students how to perform ultrasound as a diagnostic tool (Griksaitis et al 2014), a point emphasised to students during teaching sessions.

Two of the authors of our paper (Griksaitis et al 2014) use ultrasound regularly in their clinical roles, and fully appreciate the need for detailed training to be able to perform ultrasound. However, it is possible to train clinical staff to perform focussed scans after intensive short courses. Such courses teach very basic ultrasonography to obtain images of key organs and body cavities that have a standardised view. For instance, a four chamber apical view for echocardiography will display a great deal of anatomy and physiology for the students and does not require a great deal of probe manipulation.

Hands-on sessions provide basic orientation with generic ultrasound images and some simple physics. Hands-on sessions don’t teach specific views to each organ; time is spent with a trained demonstrator displaying the images to the student. In our experience the hands on time in fact re-enforces to the student how difficult ultrasound can be and does help clarify orientation to the image, and in conjunction with a plastic model or prosection of the organ in question can build on their anatomical knowledge (Griksaitis et al 2014).

Nicholls et al are concerned 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 demonstrate anatomy via imaging and surface anatomy, as this is how anatomy will be encountered in clinical practice. Ultrasound provides a context for students to learn anatomy, but not a skill-set. Contextualised learning has been demonstrated in other areas of anatomy education, and we suggest the same could be applied to ultrasound anatomy education.

Work is ongoing covering a variety of ultrasound-related research questions, and we hope others will continue to look in to this ever-developing area of research.