The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience.

Interest in ultrasound education in medical schools has increased dramatically in recent years as reflected in a marked increase in publications on the topic and growing attendance at international meetings on ultrasound education. In 2006, the University of South Carolina School of Medicine introduced an integrated ultrasound curriculum (iUSC) across all years of medical school. That curriculum has evolved significantly over the 9 years. A review of the curriculum is presented, including curricular content, methods of delivery of the content, student assessment, and program assessment. Lessons learned in implementing and expanding an integrated ultrasound curriculum are also presented as are thoughts on future directions of undergraduate ultrasound education. Ultrasound has proven to be a valuable active learning tool that can serve as a platform for integrating the medical student curriculum across many disciplines and clinical settings. It is also well-suited for a competency-based model of medical education. Students learn ultrasound well and have embraced it as an important component of their education and future practice of medicine. An international consensus conference on ultrasound education is recommended to help define the essential elements of ultrasound education globally to ensure ultrasound is taught and ultimately practiced to its full potential. Ultrasound has the potential to fundamentally change how we teach and practice medicine to the benefit of learners and patients across the globe.

Factors that influence physicians' and medical students' confidence in counseling patients about physical activity.

Less than half of US adults and two-thirds of US high school students do not meet current US guidelines for physical activity. We examined which factors promoted physicians' and medical students' confidence in counseling patients about physical activity. We established an online exercise survey targeting attending physicians, resident and fellow physicians, and medical students to determine their current level of physical activity and confidence in counseling patients about physical activity. We compared their personal level of physical activity with the 2008 Physical Activity Guidelines of the US Department of Health and Human Services (USDHHS). We administered a survey in 2009 and 2010 that used the short form of the International Physical Activity Questionnaire. A total of 1,949 individuals responded to the survey, of whom 1,751 (i.e., 566 attending physicians, 138 fellow physicians, 806 resident physicians, and 215 medical students) were included in this analysis. After adjusting for their BMI, the odds that physicians and medical students who met USDHHS guidelines for vigorous activity would express confidence in their ability to provide exercise counseling were more than twice that of physicians who did not meet these guidelines. Individuals who were overweight were less likely to be confident than those with normal BMI, after adjusting for whether they met the vigorous exercise guidelines. Physicians with obesity were even less likely to express confidence in regards to exercise counseling. We conclude that physicians and medical students who had a normal BMI and met vigorous USDHHS guidelines were more likely to feel confident about counseling their patients about physical activity. Our findings suggest that graduate medical school education should focus on health promotion in their students, as this will likely lead to improved health behaviors in their students' patient populations.

Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone.

BACKGROUND: Ultrasound is increasingly recognized as a valuable addition to medical school curriculum. PURPOSE: In this study, we tested the ability of rising second year students to learn and conduct an ultrasound examination of vertical liver span at the point of care. METHODS: Six patients from a GI clinic volunteered to have their liver size measured. Ten students were trained to measure vertical liver span with ultrasound. Four physicians were recruited to measure liver span with standard methods. Student and physician measurements were compared to each other and to a reference ultrasound measurement for accuracy and variability. RESULTS: Compared to the reference, students overestimated liver size an average of 1.5 cm. Physicians underestimated liver size an average of 6.7 cm. Variance in student measurements for each patient was 10% to 17% and among physicians 20% to 50%. CONCLUSION: With limited instruction and clinical experience medical students can obtain liver size measurements with ultrasound that are more accurate and have less variability than those by physicians using physical examination. Given the ease with which students can learn to use ultrasound and the teaching and clinical value of ultrasound, ultrasound should be considered as a standard of medical education in the future.

Determining levels of physical activity in attending physicians, resident and fellow physicians and medical students in the USA.

OBJECTIVE: Evidence suggests that the level of physical activity of physicians can be correlated directly with physician counselling patterns about this behaviour. Our objective was to determine if medical students, resident and fellow physicians and attending physicians meet the physical activity guidelines set forth by the US Department of Health and Human Services. METHODS: A representative cross-sectional web-based survey was conducted in June 2009-January 2010 throughout the USA (N=1949). Using the short form of the International Physical Activity Questionnaire, the authors gathered demographical data and information related to physical activity, the level of training, the number of work hours per week, body mass index (BMI), confidence about counselling about physical activity and frequency with which the physical activity is encouraged to his/her patients. RESULTS: Based on the 1949 respondents, attending physicians (84.8%) and medical students (84%) were more likely than resident (73.2%) and fellow physicians (67.9%) to meet physical activity guidelines. CONCLUSION: Physicians and medical students engage in more physical activity and tend to have a lower BMI than the general population. Resident and fellow physicians engage in less physical activity than attending physicians and medical students.

An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience.

A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education.

Adoption and implementation of physical activity and dietary counseling by community health center providers and nurses.

BACKGROUND: Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers. METHODS: Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity. RESULTS: Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered. CONCLUSIONS: A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.

Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women.

BACKGROUND: African American women are at increased risk for CVD morbidity and mortality relative to white women. Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk. Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD, yet few lifestyle counseling interventions have been conducted in this setting. METHODS: The HHER Lifestyle trial is a randomized controlled trial to compare the effects of a standard care intervention (provider counseling, nurse goal setting, and educational materials) to a comprehensive intervention (standard care intervention plus 12 months of telephone counseling and tailored print materials) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months. Secondary outcomes are body mass index, central adiposity, and total cholesterol. Potential mediators of outcome are self-efficacy for overcoming barriers, social support, and decisional balance. RESULTS: African American women (N=266; 130 standard care, 136 comprehensive intervention) 35 years and older from nine clinics within two community health centers were enrolled. Most participants were overweight or obese with existing chronic health conditions. CONCLUSION: The HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers, incorporates a standard care intervention into a routine clinical appointment, and includes a comprehensive process evaluation. The design will permit further research examining the added effect of regular telephone counseling and tailored print materials to a primary care provider and nurse intervention.

Healthy behavior change of adults with mental retardation: attendance in a health promotion program.

Participation in a health promotion program for 192 overweight and obese adults with mental retardation was associated with behavior change resulting in reduction of body mass index-BMI (weight in kg, divided by height in meters, squared) by the end of the program. We analyzed the mediating and intermediate factors contributing to weight reduction and found knowledge and exercise to be the primary contributing factors. The curriculum emphasized exercise, nutritional choices, and stress reduction. Participation in the program was associated with a reduction of 0.8 BMI or approximately 2.3 kg for 26% of the participants. Increased knowledge about healthy diet and exercise was the most significant mediator of program impact on BMI.