Pedagogical Role of Bedside Ultrasound
CCCF ePoster library. Arora S. Oct 27, 2015; 117349; P93
Dr. Samantha Arora
Dr. Samantha Arora
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Topic: Education Science

Pedagogical Role of Bedside Ultrasound

Samantha Arora, J. Ailon, A. Cheung, U. Tarique, A. Agarwal

Critical Care, McMaster University, Hamilton, Canada | Medicine, St. Michael's Hospital, Toronto, Canada | Gastroenterology (Division of Hepatology), Toronto Western Hospital, Toronto, Canada | Medicine, University of Toronto, Toronto, Canada | Medicine, University of Toronto, Toronto, Canada


Bedside ultrasound is being widely used as both a diagnostic and pedagogical tool, sometimes in the hands of very inexperienced users.

Objectives: The objective of this study was to assess the ability of medical students to diagnose hepatomegaly and ascites with bedside ultrasound compared with evidence-based physical examination.


In this prospective randomized controlled trial, 52 medical students (45 first year medical students, 7 fourth year medical students) were randomized to instruction in either bedside ultrasound or the JAMA Rational Clinical Exam for both hepatomegaly and ascites. For both modalities, 30 minutes of instruction was provided to students, in groups of 4 per instructor. Twenty-five students learned ultrasound (US), and 27 students learned physical exam (PEx). For examination purposes, 8 patients were recruited from a hepatology clinic. These patients were scanned and categorized on the same day as the study, by a staff radiologist using ultrasound. Two patients were found to have hepatomegaly, 3 patients had ascites, 1 patient had both, and 2 patients had neither hepatomegaly or ascites. The patients were allocated to tracks so that each track had 4 patients of varied pathology. Medical students were then randomized to examine one of the two tracks of patients, using the exam modality they had been instructed upon. Each medical student recorded their exam findings, including the presence or absence of hepatomegaly (defined as liver span > 14cm in mid-clavicular line) and ascites, and their confidence in their responses on a 10-point scale. Each student also completed a post-study questionnaire.


For the diagnosis of hepatomegaly, students who learned US had fair agreement with radiologist findings = 0.37, p<0.001], whereas there was no statistical agreement between students who learned PEx and radiologist findings [κ = 0.11, p=0.272]. This difference was statistically significant [κdiff = 0.27, CI 95%: 0.01,0.53]. US also had greater sensitivity and specificity for detection of hepatomegaly (sens 68%, spec 70%) than did PEx (sens 45%, spec 66%). For the diagnosis of ascites, students who learned US were in substantial agreement with radiologist findings = 0.62, p<0.001], whereas students who learned PEx were in moderate agreement with radiologist findings [κ = 0.44, p<0.001]. This difference was not statistically significant [κdiff = 0.18, CI 95%: -0.07,0.39]. US was more specific than PEx for detection of ascites (84% vs. 61%), however PEx was slightly more sensitive (78% vs. 83%).

Students’ self-rated confidence in their findings (on a 10-point Likert scale) were similar between US and PEx groups (mean confidence 6.7 US vs. 5.9 PEx). Students found both US and PEx skills easy to learn, useful, and applicable, however those assigned to learn PEx rated it as less useful and applicable compared with those who learned US.


Medical students, the majority in first year medical school, achieved better agreement with radiologist diagnoses of hepatomegaly and ascites when using ultrasound as compared with evidence-based physical exam, after 30 minutes of instruction in either modality. Students found both PEx and US easy to learn, with good utility and applicability. Ultrasound was perceived to be more useful, easy to learn, and applicable. The implications of these findings on curriculum development are discussed.

References: Below are selected references only.

Mouratev, G., Howe, D., Hoppmann, R., Poston, M. B., Reid, R., Varnadoe, J., . . . DeMarco, P. (2013). Teaching medical students ultrasound to measure liver size: Comparison with experienced clinicians using physical examination alone.
Teaching and Learning in Medicine, 25(1), 84-88.

Hoppmann R et al. Ultrasound in medical education: A vertical curriculum at the University of South Carolina School of Medicine. Journal of the South Carolina Medical Association, v.102, p.330, 2006.

Butter J et al. Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?. Medical Education, v.41, p.843, 2007.

Borchert D et al. Comparison of panorama ultrasonography, conventional B-Mode ultrasonography, and computed tomography for measuring liver size. Ultrasound in Medicine, v.31, p.31, 2010.

Naylor CD. Physical examination of the liver. Journal of the American Medical Association, v.271, p.1859, 1994.

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