Letters to the Editor
References 1 International Centre for Communication in Healthcare. The International Charter for Human Values in Healthcare. http:// charterforhealthcarevalues.org. Accessed May 31, 2013. 2 American Medical Association. Initiative to Transform Medical Education: Recommendations for Change in the System of Medical Education. http://www.ama-assn. org/resources/doc/council-on-med-ed/itmefinal.pdf. Accessed May 31, 2013. 3 Witzburg RA, Sondheimer HM. Holistic review—Shaping the medical profession one applicant at a time. N Engl J Med. 2013;368:1565–1567.
accurate hemodynamic assessments makes us optimistic about integrating basic vascular ultrasound teaching into the regular undergraduate surgical curriculum. Efstratios Georgakarakos, MD Lecturer on vascular surgery, Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Medical School, Alexandroupolis, Greece; [email protected]
George Georgiadis, MD Assistant professor of vascular surgery, Democritus University of Thrace, Medical School, Alexandroupolis, Greece.
Miltos K. Lazarides, MD
Peripheral Vascular Ultrasound Examinations Are Important in Ultrasound Training for Medical Students To the Editor: We read with great interest the excellent article by Bahner and Royall1 reporting the effectiveness of a structured ultrasound training program for fourth-year medical students. Interestingly, a thorough observation of the listed course components reveals a lack of peripheral vascular ultrasound examinations. These could be of great value if integrated in such programs, since a recent study2 shows that both incoming internal medicine interns and physicians share generally limited knowledge regarding peripheral arterial disease. Our medical school’s preliminary experience with pivotal, basic vascular ultrasound training of undergraduate students has shown encouraging results regarding students’ ability to detect the vascular structures in two easily accessible sites of the lower limbs (i.e., the femoral triangle and the popliteal fossa), providing accurate estimations about the presence of venous thrombosis and unimpaired arterial flow. The students’ ability to quickly learn the method and to give
Head, Department of Vascular Surgery, and professor of vascular surgery, Democritus University of Thrace, Medical School, Alexandroupolis, Greece.
References 1 Bahner DP, Royall NA. Advanced ultrasound training for fourth-year medical students: A novel training program at the Ohio State University College of Medicine. Acad Med. 2013;88:206–213. 2 Schwarcz AI, Quijano A, Olin JW, Ostfeld RJ. Internal medicine interns have a poor knowledge of peripheral artery disease. Angiology. 2012;63:597–602.
In Reply to Georgakarakos et al: We appreciate the kind letter from Drs. Georgakarakos, Georgiadis, and Lazarides, whose comments raise the interesting question of what constitutes appropriate undergraduate medical education (UME) ultrasound course content.
in peripheral artery disease and may augment students’ understanding and their ability to diagnose the disease. This is supported by a sentinel study by Wittich1 in 2002, where focused echocardiography performed by medical students was shown to produce improved cardiac physical examination accuracy. This finding was likely related to students’ directly visualizing the anatomy and physiology corresponding to characteristic findings on the physical exam. We agree that active learning to perform focused peripheral vascular ultrasound examinations can augment students’ understanding of cardiovascular pathophysiology. But should skill in such examinations be considered a core competency or an enriched competency? Future medical student ultrasound training should define the topics of both these types of competencies and the training needed to attain them. Despite early programs, such as our own advanced ultrasound program, we feel that a national discussion on which components of ultrasound education are needed in UME is becoming imperative. David P. Bahner, MD, RDMS Associate professor, director of ultrasound in emergency medicine, and director, Emergency Medicine Ultrasound Fellowship, Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, Ohio; [email protected]
Nelson A. Royall, MD
The purpose of medical student training in the United States should be to prepare the future clinician to rapidly and safely evaluate the patient. Clearly, venous and arterial disease produces significant morbidity and mortality. Ultrasound training is thus important in UME, since it has the potential to provide better understanding of the physiology
Resident, Department of Surgery, Orlando Health, and resident instructor, University of Central Florida College of Medicine, Orlando, Florida.
Reference 1 Wittich CM, Montgomery SC, Neben MA, et al. Teaching cardiovascular anatomy to medical students by using a handheld ultrasound device. JAMA. 2002;288: 1062–1063.
Academic Medicine, Vol. 88, No. 9 / September 2013