Adeline Yang, a first-year medical student, could see the tendons running through the carpal tunnel in Rachel Blankenship’s wrist as the second-year resident in physical medicine and rehabilitation sat connected to a portable ultrasound machine.
Five of Yang’s classmates gathered around to see an internal view of the wrist and take turns applying the transducer and studying the ultrasound images under instruction of Blankenship, a doctor of osteopathic medicine. Teams of other first-year medical students repeated the exercise throughout the day.
The hands-on laboratory experience will be replicated in other classes as the College of Medicine moves to integrate the use of ultrasound into its curriculum. All medical students may be required to use ultrasound as early as the fall semester of 2015.
"I like the hands-on experience with ultrasound,” says Yang. "It’s good to actually see what’s normal and what should be happening in the body. If a patient were to come in and move a joint, we could see it. If there is shoulder pain or problems with the carpel tunnel, we can see their movements with ultrasound. We can see it in real time.”
David Pettigrew, PhD, associate professor of medical education, says UC, like other medical schools for the past decade, has been moving in the direction of trying to integrate clinical training with basic science knowledge for students from day one.
"What we are trying to accomplish is to expose medical students to hands-on clinical experience as early as possible,” says Pettigrew.
During the spring semester of their first year, medical students participate in a longitudinal primary care clerkship, which consists of students spending time in primary care clinics, says Pettigrew.
"They get their first introduction to the clinical environment, direct patient care in the first year, and that was introduced three or four years ago,” Pettigrew says. "Previously, it was reserved for the third year of medical school.”
The use of ultrasound is continuing this trend in medical schools. Ultrasound is becoming less expensive and more portable than ever. Some say it may eventually replace the stethoscope in medical practice.
"Why would you only listen to something when you could see it?” says Pettigrew. "Given how portable they are we are looking to expand the ultrasound in the curriculum.”
Lester Duplechan, MD, division director of Physical Medicine and Rehabilitation in the UC Department of Neurology and Rehabilitation Medicine, says first-year medical students are taught a great deal about the body with the use of cadavers, but that in real practice students have living patients.
Ultrasound may help bridge that gap.
Duplechan utilizes musculoskeletal ultrasound as an adjunct in his medical practice, both in diagnostic evaluation and as an imaging guide for procedures. "It’s much better to be able to visualize in real time on patients without having to use radiation,” says Duplechan.
"The patient is able to describe where the problem is and pinpoint the location of their symptoms,” says Duplechan. "We are able to use the transducer over the area of concern and perform dynamic movements to examine their impairment and be able to find out what’s going on.
"It’s a newer technology so it is more portable. When I finished residency, we didn’t have any access, but now that ultrasounds are portable like laptop computers and iPads, they are more readily available so you can carry them from location to location.
"Ultrasound is often used to find vascular access in a patient,” says Duplechan. "We are really bringing the technology to the patient.”
Duplechan says students learned about carpal tunnel syndrome, which occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.
"They have had lectures about it, but we were able to show them the median nerve through the carpal tunnel and in a few of the students we found that they had some pathology,” says Duplechan. "One student had a cyst on the back of his wrist and we were able to classify it.
"It is one thing to learn things in didactic lecture, but it’s another thing to actually see it at work, wiggle the tendon, wiggle the fingers and be able to see how that nerve moves under the ligament, whether there is swelling around the nerve and whether the diameter is too large,” says Duplechan. "It provides more information to be able to treat the patient better and takes away the guesswork.
"I wish this had been available 20 years ago when I was a resident and a medical student. What we are finding is students are learning important physical examination skills much sooner and are able to treat the patient more precisely early in the course.”