International consensus conference recommendations on ultrasound education for undergraduate medical students.

OBJECTIVES: The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS: 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS: A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS: The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.

Patient and physician perceptions after software-assisted hospital discharge: cluster randomized trial.

BACKGROUND: Hospital discharge software potentially improves communication and clinical outcomes. OBJECTIVE: To measure patient and physician perceptions after discharge with computerized physician order entry (CPOE) software. DESIGN: Cluster randomized controlled trial. SETTING: Tertiary care, teaching hospital in central Illinois. PATIENTS: A total of 631 inpatients discharged to home with high risk for readmission. INTERVENTION: A total of 70 internal medicine hospital physicians randomly assigned (allocation concealed) to discharge software vs. usual care, handwritten discharge. MEASUREMENTS: Discharge perceptions from patients, outpatient primary care physicians, and hospital physicians. RESULTS: One week after discharge, 92.4% (583/631) of patients answered interviews. For 78.6% (496/631) of patients, their outpatient physicians returned questionnaires 19 days (median) postdischarge. Generalized estimating equations gave intervention variable coefficients with 95% confidence intervals (CIs). When comparing patients assigned to discharge software vs. usual care, patient mean (standard deviation [SD]) scores for discharge preparedness were higher (17.7 [4.1] vs. 17.2 [4.0]; coefficient = 0.147; 95% CI = 0.005-0.289; P = 0.042), patient scores for satisfaction with medication information were unchanged (12.3 [4.8] vs. 12.1 [4.6]; coefficient = -0.212; 95% CI = -0.937-0.513; P = 0.567), and their outpatient physicians scored higher quality discharge (17.2 [3.8] vs. 16.5 [3.9]; coefficient = 0.133; 95% CI = 0.015-0.251; P = 0.027). Hospital physicians found mean effort to use discharge software was more difficult than the usual care (6.5 [1.9] vs. 7.9 [2.1]; P = 0.011). CONCLUSIONS: Discharge software with CPOE caused small improvements in discharge perceptions by patients and their outpatient physicians. These small improvements might balance the difficulty perceived by hospital physicians who used discharge software.

Software design to facilitate information transfer at hospital discharge.

Discharge communication between inpatient and outpatient physicians is often an inefficient and error-prone process. Adverse events result from poor communication at the time of discharge. The objective of this study was to describe development of discharge software to overcome communication barriers. The secondary objective was to assess factors that influence the time to complete tasks with the software. Methods were a performance improvement model and database analysis of 336 discharges. Software design specifications included computerised physician order entry, immediate utility, minimal development and deployment costs, acceptability to physician-users, and satisfaction of primary care physicians, patients and pharmacists. Design features included simple 'just-in-time' prompts and point-of-care prescribing resources. The dependent variable for analysis was physician time to complete discharge prescriptions and instructions while using the software. General linear and mixed-effects regression models adjusted for physician effects and other predictors. Results revealed that physician factors significantly affected the time to complete a discharge while using the software. As the number of accesses (log-ins) and free text typing increased, then time to complete the computerised discharge increased. Patient-related factors that increased physician time were discharge diagnoses, prescriptions and length of stay. In conclusion, discharge software can help inpatient physicians transfer timely, complete and legible information to outpatient physicians, pharmacists and patients. Physician and patient factors influence the time to complete discharges using the software.