Implementing and evaluating coordinated cross-specialty ultrasound training in undergraduate medical education using a longitudinal spiral-learning approach: A study protocol

Camilla Aakjær Andersen^1,2, Angela Mahdi^1,3, Alexander Hakon Zielinski1⁴, Camilla Lundahl¹, Christian Sander Danstrup^1,5, Ditte Nymark Hansen^1,6, Jacob Gjessing Miehe^1,5, Jens Lykkegaard Olsen^1,2, Julie Jepsen Strøm^1,2, Jonas Kjeldbjerg Hansen^1,7, Louise Jønholt^1,8, Louise Thomsen Schmidt Arenholt^1,9,1, Martin Bach Jensen^1,2, Mikkel Lønborg Friis^1,11, Peter Søgaard^1,12, Salome Kristensen^1,8, Søren Hagstrøm^1,7, Thøger Persson Krogh^1,13, Thor Lind Rasmussen^1,14, Ulla Møller Weinreich^1,14, Jette Kolding Kristensen^1,2

¹ Department of Clinical Medicine, Aalborg University, Denmark
² Center for General Practice at Aalborg University
³ Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Denmark
⁴ Department of Vascular Surgery, Aalborg University Hospital, Denmark
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Aalborg University Hospital, Aalborg, Denmark
⁶ Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
⁷ Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
⁸ Department of Rheumatology, Center of Rheumatic Research Aalborg, Aalborg University Hospital, Aalborg, Denmark
⁹ Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
¹⁰ Department of Obstetrics and Gynecology, North Denmark Regional Hospital, Hjoerring, Denmark
¹¹ NordSim – Centre for Skills Training and Simulation, Aalborg University Hospital, Denmark
¹² Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
¹³ Center for Sports Medicine, Regional Hospital of Northern Denmark, Frederikshavn, Denmark
¹⁴ Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark

Introduction

Ultrasound examinations are increasingly integrated in most clinical specialties [1], performed either as comprehensive examinations by imaging specialists or as point-of-care ultrasound (POCUS) by a clinician at the bedside [2]. Medical students often encounter both during clinical rotations [3] [4] and guidelines recommend incorporating ultrasound training into medical school curricula [5] [6]. However, a shortage of qualified ultrasound teachers has been described across specialties [4] [7] [8].

At Aalborg University in Denmark (AAU), ultrasound training for medical students was initially handled by the specialty of anesthesiology with a focus on using ultrasound in acute situations. Ultrasound training in other specialties was sporadic, depending on individual lecturersʼ interests and qualifications. As interest in ultrasound grew among students and faculty, AAU decided to rethink the undergraduate ultrasound education and involve more clinical specialties in the teaching.

This article outlines the phased implementation of a coordinated cross-specialty ultrasound training program to enhance ultrasound scanning skills and understanding among medical students.

Foundation for the undergraduate ultrasound education

The restructured ultrasound training had to comply with the learning principles of AAU including problem-based learning [9] and principles of building competencies in a spiral learning process [10]. As previous studies on ultrasound education [11] and international guidelines [12] emphasized the need for theoretical knowledge, practical training, and continuous practice over time, short stand-alone hands-on courses were thought to be insufficient.

Although handheld ultrasound devices show promise [13], AAU opted for mid-range and high-end scanners, as their high-resolution images were assumed to make it easier for the students to identify anatomical structures as well as align with the equipment encountered during clinical rotations. Following international guidelines training [14], ultrasound education was integrated both preclinically and clinically (Textbox 1).

The preclinical ultrasound education was meant to enhance studentsʼ understanding of anatomy and pathology [15] [16] by incorporating ultrasound demonstrations and images into lectures and case-based teaching. Through repetition, students would gradually develop a deeper understanding, priming them for its use [17]. Basic theoretical training was thought to be introduced early to create a foundation for learning [16]. For this, a flipped-classroom approach [18] – including self-study of theory prior to practical training – was applied.

The clinical ultrasound education intended to involve a range of relevant clinical specialties and include both ultrasound demonstrations and hands-on training during clinical rotations. A spiral learning process allowed students to first acquire basic scanning skills in a skills lab, then build upon them through repetition and exposure to increasingly complex ultrasound applications and cases.

Implementing the undergraduate ultrasound education in phases

The redesigned ultrasound education at AAU was enrolled in phases ([Fig. 1]). In the beginning, efforts were made to involve and anchor the teaching in many clinical specialties. Nine clinical specialties (rheumatology, sports medicine, pulmonology, cardiology, vascular surgery, gynecology, otorhinolaryngology, family medicine, pediatrics) agreed to get involved and provide extra teaching resources. Radiology, anesthesiology, and emergency medicine agreed to continue their involvement and ultrasound training with some smaller modifications.

Fig. 1 Stepwise implementation of undergraduate ultrasound education in a spiral learning process.

Overall Learning Objectives for the undergraduate ultrasound education

The aim of scaffolding a longitudinal ultrasound education in the undergraduate medical education is to provide students with a solid foundational understanding of ultrasound. By the end of their medical education, students are expected to: (1) have knowledge of basic ultrasound physics, including the interaction between ultrasound and various anatomical structures, artifacts, and virtual imaging, (2) be familiar with different types of ultrasound equipment, image optimization, and transducer types, and know how to use them, (3) understand the integration of ultrasound as part of the objective clinical examination of patients across different clinical specialties, (4) be able to perform selected POCUS scans under supervision. This will prepare students for their internship year and residency training, where scanning skills will be further developed through practice, enabling them to perform POCUS scans independently [16].

Conclusion

The redesign of the undergraduate ultrasound education began 3 years ago and is now fully implemented, providing students with at least 18 hours of scheduled hands-on training. Students are highly motivated and particularly value the hands-on workshops and multidisciplinary appetizer course, reporting improved learning outcomes. Feedback from the various medical specialties have also been very positive and the clinical lecturers have taken ownership of the teaching being both enthusiastic and engaged. Initially, only a few senior faculty members were involved, but now participation rotates among faculty, easing session planning and fostering knowledge transfer across departments.

This approach may inspire other medical schools to integrate ultrasound into their curricula, demonstrating the benefits of shared responsibility, improved collaboration, and interdisciplinary understanding.

• References

• 1 Bhagra A, Tierney DM, Sekiguchi H. et al. Point-of-care ultrasonography for primary care physicians and general internists. Mayo Clin Proc 2016; 91 (12) 1811-1827
• 2 Weile J, Brix J, Moellekaer AB. Is point-of-care ultrasound disruptive innovation? Formulating why POCUS is different from conventional comprehensive ultrasound. Crit Ultrasound J 2018; 10 (01) 25
• 3 Baltarowich OH, Di Salvo DN, Scoutt LM. et al. National ultrasound curriculum for medical students. Ultrasound Q 2014; 30 (01) 13-19
• 4 Prosch H, Radzina M, Dietrich CF. et al. Ultrasound Curricula of Student Education in Europe: Summary of the Experience. Ultrasound Int Open 2020; 6 (01) E25-E33
• 5 Cantisani V, Dietrich CF, Badea R. et al. EFSUMB Statement on Medical Student Education in Ultrasound [long version]. Ultrasound Int Open 2016; 2 (01) E2-E7
• 6 Haidar DA, Kessler R, Khanna NK. et al. Association of a longitudinal, preclinical ultrasound curriculum with medical student performance. BMC Med Educ 2022; 22 (01) 50
• 7 Russell FM, Zakeri B, Herbert A. et al. The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey. Acad Med 2022; 97 (05) 723-727
• 8 Eisen LA, Leung S, Gallagher AE. et al. Barriers to ultrasound training in critical care medicine fellowships: a survey of program directors. Crit Care Med 2010; 38 (10) 1978-1983
• 9 Wood D. ABC of learning and teaching in medicine: Problem based learning. BMJ 2003; 326 (08) 328-330
• 10 Harden RM. What is a spiral curriculum?. Medical Teacher 1999; 21 (02) 141-143
• 11 Andersen CA, Hedegård HS, Løkkegaard T. et al. Education of general practitioners in the use of point-of-care ultrasonography: a systematic review. Fam Pract 2020; cmaa140
• 12 The European Federation for Ultrasound in Medicine and Biology (EFUMB). Minimum training recommendations for the practice of medical ultrasound. Ultraschall in Med 2006; 27 (01) 79-105
• 13 Haji-Hassan M, Capraș RD, Bolboacă SD. Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis. Diagnostics (Basel) 2023; 13 (24) 3665
• 14 Dietrich CF, Goudie A, Chiorean L. et al. Point of care ultrasound: A WFUMB position paper. Ultrasound Med Biol 2016; 43 (01) 49-58
• 15 Kenny EJG, Makwana HN, Thankachan M. et al. The Use of Ultrasound in Undergraduate Medical Anatomy Education: a Systematic Review with Narrative Synthesis. Med Sci Educ 2022; 32 (05) 1195-1208
• 16 Pless A, Hari R, Harris M. Why are medical students so motivated to learn ultrasound skills? A qualitative study. BMC Med Educ 2024; 24
• 17 Höhne E, Schäfer VS, Petzinna SM. et al. First insights of integrating the Bonn Internship Curriculum for Point-of-Care Ultrasound (BI-POCUS): progress and educational aspects. . BMC Med Educ  2024; 24
• 18 Phillips J, Wiesbauer F. The flipped classroom in medical education: A new standard in teaching. Trends Anaesth Crit Care 2022; 42: 4-8

Publication History

Article published online:
02 April 2025