Osteopathic Manipulative Medicine, Kansas City University - Joplin Campus, Joplin, MO, USA.
Director of Scholarly Activity and Faculty Development, Associate Professor, College of Medicine, Kansas City University, Kansas City, MO, USA.
J Osteopath Med. 2023 Jul 28;123(11):531-535. doi: 10.1515/jom-2023-2002. eCollection 2023 Oct 2.
Medical students with no previous experience may find it difficult to identify and palpate bony landmarks while learning physical examination skills. In a study of 168 medical schools, 72.6 % have indicated that they are utilizing ultrasound in their curriculum. Although the integration of ultrasound curriculum has become more widespread, the depth of instruction is inconsistent. Ultrasound is not commonly taught in conjunction with palpation of bony landmarks in osteopathic structural examination.
The objective of this analysis was to identify whether utilizing ultrasound assistance in teaching palpation of specific thoracic vertebral bony landmarks would improve palpation accuracy in first-year medical students with no previous palpatory experience.
First-year medical students were given video instructions to palpate and identify a thoracic vertebral transverse process and to mark it with invisible ink. The participants were then taught and instructed to utilize ultrasound to identify the same landmark and mark it with a different color. The accuracy of palpation was measured with digital calipers.
A test of the overall hypothesis that participants will show improved accuracy utilizing ultrasound compared with hand palpation was not significant (F=0.76, p>0.05). When separating students into groups according to patient body mass index (BMI), however, there was a trend toward significance (F=2.90, p=0.071) for an interaction effect between patient BMI and the repeated measures variable of palpation/ultrasound. When looking specifically at only those participants working with a normal BMI patient, there was a significant improvement in their accuracy with the use of ultrasound (F=7.92, p=0.017).
The analysis found increased accuracy in bony landmark identification in untrained palpators utilizing ultrasound vs. palpation alone in a normal BMI model, but not in obese or overweight BMI models. This study shows promise to the value that ultrasound may have in medical education, especially with respect to early palpation training and landmark identification.
没有先前经验的医学生在学习体检技能时可能难以识别和触诊骨骼标志。在对 168 所医学院校的研究中，72.6%的学校表示他们在课程中使用了超声。尽管超声课程的整合已经变得更加广泛，但教学的深度却不一致。在骨科学结构检查中，超声通常不与骨骼标志的触诊结合教授。
本分析的目的是确定在没有先前触诊经验的一年级医学生中，利用超声辅助教授特定胸椎骨性标志的触诊是否会提高触诊准确性。
首先，一年级医学生观看视频，学习触诊和识别胸椎横突，并使用不可见墨水标记。然后，他们接受教导并指示使用超声识别相同的标志，并使用不同的颜色标记。使用数字卡尺测量触诊的准确性。
总体假设参与者使用超声比手动触诊会提高准确性的测试不显著（F=0.76，p>0.05）。然而，当根据患者体重指数（BMI）将学生分成组时，在触诊/超声的重复测量变量与患者 BMI 之间存在交互作用的趋势（F=2.90，p=0.071）。当专门观察仅与正常 BMI 患者一起工作的参与者时，他们使用超声的准确性有显著提高（F=7.92，p=0.017）。
在正常 BMI 模型中，与单独触诊相比，未经训练的触诊者使用超声在识别骨性标志方面的准确性有所提高，但在肥胖或超重 BMI 模型中则没有。这项研究表明，超声在医学教育中可能具有价值，特别是在早期触诊培训和标志识别方面。
