Point-of-Care-ultrasound in undergraduate medical education: a scoping review of assessment methods.

BACKGROUND: Point-of-Care-Ultrasound (POCUS) curricula have rapidly expanded in undergraduate medical education (UME). However, the assessments used in UME remain variable without national standards. This scoping review characterizes and categorizes current assessment methods using Miller's pyramid for skills, performance, and competence of POCUS in UME. A structured protocol was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A literature search of MEDLINE was performed from January 1, 2010, to June 15, 2021. Two independent reviewers screened all titles and abstracts for articles that met inclusion criteria. The authors included all POCUS UME publications in which POCUS-related knowledge, skills, or competence were taught and objectively assessed. Articles were excluded if there were no assessment methods used, if they exclusively used self-assessment of learned skills, were duplicate articles, or were summaries of other literature. Full text analysis and data extraction of included articles were performed by two independent reviewers. A consensus-based approach was used to categorize data and a thematic analysis was performed. RESULTS: A total of 643 articles were retrieved and 157 articles met inclusion criteria for full review. Most articles (n = 132; 84%) used technical skill assessments including objective structured clinical examinations (n = 27; 17%), and/or other technical skill-based formats including image acquisition (n = 107; 68%). Retention was assessed in n = 98 (62%) studies. One or more levels of Miller's pyramid were included in 72 (46%) articles. A total of four articles (2.5%) assessed for students' integration of the skill into medical decision making and daily practice. CONCLUSIONS: Our findings demonstrate a lack of clinical assessment in UME POCUS that focus on integration of skills in daily clinical practice of medical students corresponding to the highest level of Miller's Pyramid. There exists opportunities to develop and integrate assessment that evaluate higher level competencies of POCUS skills of medical students. A mixture of assessment methods that correspond to multiple levels of Miller's pyramid should be used to best assess POCUS competence in UME.

A virtual rural medicine self-learning module for preclerkship students.

Implication Statement All Ontario medical schools have a mandatory preclerkship rural placement. Despite these mandatory placements, there is a lack of Canadian rural medicine pre-departure training for students. We describe a virtual self-learning module (SLM) aimed to enhance medical students' abilities to provide compassionate care during their rural medicine placements. This SLM improves students' knowledge about rural health issues while also encouraging exploration of rural career options. Better preparation for a rural medicine placement may lead to an improved experience and eventually an increase in the number of students pursuing rural medicine careers.

Énoncé des implications de la rechercheLe stage de pré-externat en milieu rural est obligatoire dans toutes les facultés de médecine de l'Ontario. En dépit de ces stages obligatoires, la formation que les étudiants reçoivent pour les y préparer avant leur départ est insuffisante. Nous décrivons un module virtuel d'auto-apprentissage visant à améliorer l'aptitude des étudiants à offrir des soins avec compassion dans le cadre de leurs stages en médecine rurale. Ce module enrichit leurs connaissances sur les enjeux de la santé en milieu rural au Canada tout en les encourageant à explorer les possibilités de carrière dans ce milieu. Une meilleure préparation peut améliorer la qualité de l'expérience de stage et entraîner à terme une augmentation du nombre d'étudiants qui choisiront de poursuivre une carrière en médecine rurale.

An unusual case of pediatric embryonal rhabdomyosarcoma with subsequent diagnosis of neurofibromatosis type 1.

A 10-month-old girl presented with a 4-month history of a rapidly growing lesion on the lower lip. Initial assessment and Doppler ultrasound supported a diagnosis of pyogenic granuloma. However, emergent biopsy revealed an embryonal rhabdomyosarcoma, a highly malignant tumor commonly associated with cancer-susceptible syndromes including neurofibromatosis type 1 (NF1). Despite having no apparent clinical features of NF1 at initial presentation, she was later found to have multiple café-au-lait spots and a subsequent diagnosis of NF1 was made.

A case of classic adult pityriasis rubra pilaris successfully treated with a combination of acitretin and ustekinumab: A case report.

Classic adult pityriasis rubra pilaris is a severe papulosquamous disease that tends to resolve in 3-5 years but can have a devastating impact on patients while active. It shares features with psoriasis, but treatment remains largely empiric, based on case reports and series. The condition is often refractory to treatment, especially initially, with topical corticosteroids and oral acitretin the more commonly employed agents. Relatively high doses of acitretin are needed for adequate response, and adverse events often limit adherence. Given the similarity to psoriasis, biologic agents approved for psoriasis have been used with good effect in classic adult pityriasis rubra pilaris and show better tolerance than other agents. In this report, we describe the successful use of a combination of acitretin and ustekinumab in a case of classic adult pityriasis rubra pilaris.

Hypergammaglobulinemic purpura of Waldenström-Unusual and impressive case in a patient with myeloma: A case report.

Background: Hypergammaglobulinemic purpura of Waldenström is an uncommon disease, which presents mostly in women on the lower extremities. It is sometimes associated with underlying immune dysregulation. Sjögren syndrome is the most common association; however, rare occurrences of the self-resolving syndrome with lymphoma or myeloma have been reported. Case Summary: We describe an unusual and impressive presentation of hypergammaglobulinemic purpura of Waldenström in an elderly female patient with myeloma. Notably, the patient did not have any concurrent connective tissue diseases. Despite her florid presentation, her hypergammaglobulinemic purpura of Waldenström spontaneously resolved within a few days. Conclusion: Hypergammaglobulinemic purpura of Waldenström is a self-resolving but recurrent syndrome, which may be associated with autoimmune disorders or rarely myeloma. Early diagnosis of the syndrome may avoid unnecessary treatment interventions and should prompt screening for underlying diseases.