Impact of gross anatomy review on ultrasound learning in first-year medical students: A pilot study




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Introduction: Ultrasound (US) integration in undergraduate medical education (UME) has been a popular topic for the past decade. Current literature indicates ultrasound inclusion in UME is commonly integrated in gross anatomy instruction or clinical skills courses. US inclusion in gross anatomy focuses on overall anatomy understanding, whereas US in clinical skills courses focuses on the diagnostic application of medical imaging. Although there is plenty of literature demonstrating the benefits of US inclusion in gross anatomy, there is little research looking at the use of gross anatomy reviews prior to learning clinical ultrasound. Further, there is little research investigating how transferable gross anatomy identification is to ultrasound anatomy identification. Therefore, this study's purpose is to assess the effects of gross anatomy review prior to learning clinical ultrasound.

Methods: 22 first year medical students interested in joining the ultrasound interest group (USIG), an extracurricular student group, participated in the study in the spring semester of 2023. There were four ultrasound imaging modules taught during the semester: cardiopulmonary, liver/biliary, E-fast, and musculoskeletal. Students were divided into two groups where they were required to participate in a pre-module quiz, attend the ultrasound instruction, then complete a post-module quiz and survey after the ultrasound instruction. The EXP group had to participate in an additional anatomy review prior to the ultrasound instruction session. Pre- and post-module quizzes contained gross anatomy structures of the relevant anatomy for the module, along with paired ultrasound images of that anatomical structure. The quizzes for each module were identical to each other allowing repeated measures. This allows for tracking students ability to transfer knowledge from gross anatomy identification to ultrasound anatomy identification. Groups switched treatments for each module, allowing equal exposure to both treatments. Quiz scores were compared within and between groups, setting significance level at p<0.05.

Results: Both CON and EXP groups significantly improved in their performance from pre-quiz to post-quiz in all four sub-scores for Module 1 (p<.001 for overall; d=1.3, US; d=1.16 and transfer; d=1.34, p<.05 for anatomy; d=.51) and Module 4 (p<.001 for overall; d=1.1,and transfer; d=.74, p<.01 for anatomy; d=.67, and US; d=1.47). Significant increases were seen in three sub-scores for module 2 (p<.01 for overall; d=.77, and US; d=.65, p<.05 for transfer; d=.46). There were no significant increases in performance from pre-quiz to post-quiz in module 3. Looking at self-improvement between groups, the EXP group did show higher mean gains than the CON group and mild to moderate effect sizes, although these comparisons were not significant. The EXP group showed higher mean scores on post-quiz assessments for most sub-scores, including mild to moderate effect sizes, although none of these were significant.

Conclusion: Ultrasound is a valuable tool in all areas of medicine, especially in anatomy learning. This study shows that a gross anatomy review does have a positive impact on student performance when learning US. Medical students learning US may receive benefit from a gross anatomy review to reintroduce previously learned material and further reinforce US instruction.