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.

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.

Medical student identification of knee effusion by ultrasound.

Twenty-one fourth-year medical students were given a brief lecture on ultrasound of the knee and fifteen minutes of supervised ultrasound scanning of three cadavers which had been injected with saline to give varying degrees of knee effusions. Each student was then individually observed and required to scan both knees of a cadaver different from the practice cadavers and identify the patella, the femur, the quadriceps tendon and if a suprapatellar effusion was present, and which knee had the larger effusion. All twenty-one students correctly identified all anatomical structures, suprapatellar effusions, and which knee had the larger effusion. Identifying a knee effusion can be an important clinical finding in diagnosing and managing a patient with knee complaints. Fourth-year medical students can learn to identify knee effusions with ultrasound following a brief introductory lecture and hands-on scanning practice session.

Evaluation of medical student performance on objective structured clinical exams with standardized patients with and without disabilities.

PURPOSE: To investigate whether medical students' performance on a family medicine clerkship objective structured clinical exam (OSCE) differed when the standardized patient (SP) had a disability versus when the SP did not have a disability. METHOD: SPs with spinal cord injury (SP-SCI), SPs with intellectual disability (SP-ID), and SPs without a disability participated separately in two OSCE scenarios that were administered by the University of South Carolina School of Medicine's Department of Family and Preventive Medicine from 2007 to 2009. OSCE scores were determined based on the number of critical actions completed by the student, and scores were analyzed to determine differences among scenarios. RESULTS: Students scored lower in history, physical exam, lab tests, and interpersonal skills with an SP-SCI, and lower in history, physical exam, and lab tests with an SP-ID than did students interacting with SPs without a disability. The odds ratio for ordering a hemoglobin A1c in one scenario was 4.16 times higher in cases when the SP did not have a disability (95% confidence interval [CI] 1.78-9.17, P = .001). In the second scenario, the odds ratio was 3.08 times higher for ordering a urinalysis (95% CI 1.34-7.08, P = .006) and was 2.15 times higher for providing lifestyle counseling (95% CI 1.04-4.44, P = .038) in students interacting with SPs without a disability. CONCLUSIONS: Students performed better when the SP did not have a disability. This suggests that greater emphasis should be placed on teaching appropriate care of patients with a disability.

Effects of Reiki on anxiety, depression, pain, and physiological factors in community-dwelling older adults.

The purpose of this study was to evaluate the effect of Reiki as an alternative and complementary approach to treating community-dwelling older adults who experience pain, depression, and/or anxiety. Participants (N = 20) were randomly assigned to either an experimental or wait list control group. The pre- and posttest measures included the Hamilton Anxiety Scale, Geriatric Depression Scale-Short Form, Faces Pain Scale, and heart rate and blood pressure. The research design included an experimental component to examine changes in these measures and a descriptive component (semi-structured interview) to elicit information about the experience of having Reiki treatments. Significant differences were observed between the experimental and treatment groups on measures of pain, depression, and anxiety; no changes in heart rate and blood pressure were noted. Content analysis of treatment notes and interviews revealed five broad categories of responses: Relaxation; Improved Physical Symptoms, Mood, and Well-Being; Curiosity and a Desire to Learn More; Enhanced Self-Care; and Sensory and Cognitive Responses to Reiki.

Focus groups to explore the perceptions of older adults on a pedometer-based intervention.

Focus group methodology was used to explore in depth the perceptions of older adults who had participated in a 12-week pedometer-based intervention. Nineteen women and 8 men, ages 55-86 years, volunteered to take part in the focus groups following participation in the intervention. Four focus groups of six to eight participants were scheduled at primary sites in the southern Maine area. Analysis of the data revealed four specific topical areas: (a) factors that led to increases in daily step count, (b) factors that hindered increases in daily step count, (c) benefits of pedometer intervention program, and (d) recommendations on how to improve older adults' physical activity. Overall, focus group participants found this intervention to be beneficial and recommended its expansion to other groups.

Cognitive training for early-stage Alzheimer's disease and dementia.

The purpose of this article is to critically review and synthesize the literature on the effects of nonpharmacological cognitive training on dementia symptoms in early-stage Alzheimer's disease (AD) and related dementia. Electronic databases MEDLINE (PubMed), CINAHL, PsycInfo, and the Cochrane Library were searched using the keywords cognition, reality orientation, Alzheimer's disease, psychosocial factors, cognitive therapy, brain plasticity, enriched environments, and memory training. The findings support that cognitive training improves cognition, activities of daily living, and decision making. Interventions are more effective if they are structured and focus on specific known losses related to the AD pathological process and a person's residual ability, or are combined with cognitive-enhancing medications. Nursing implications are also discussed.

Does it stick? Effects of an integrated vertical undergraduate aging curriculum on medical and surgical residents.

Experts acknowledge the unmet need for all physicians to have basic knowledge of aging and competency in geriatric care given the context of population aging. The University of South Carolina (USC) School of Medicine implemented a highly successful program of aging-oriented undergraduate medical training, including a geriatrics vertical curriculum and its senior mentor program-a required, 4-year experience matching students with older community volunteers, referred to herein as the integrated vertical curriculum in geriatrics (IVC). In earlier work, it was established that IVC graduating classes were significantly more likely to report exposure to and coverage of various geriatrics topics than prior USC classes or other U.S. medical graduates. Here the results of a follow-up survey of USC graduating classes before and after exposure to the IVC and contemporaneous Medical University of South Carolina (MUSC) graduates after two to three years of residency (before the initiation of a senior mentor program at MUSC) is reported. Of 403 graduates, 227 returned questionnaires (response rate 56%). Significantly more IVC (2004) than pre-IVC (2003) and 2003 and 2004 MUSC graduates rated themselves fairly or very well prepared by their undergraduate education to treat older adults seen in residency (95% vs 77% and 52%; P<.001). Implications of this and other findings are discussed.

Review of exemplar programs for adults with early-stage Alzheimer's disease.

In response to the need to develop evidence-based best practices interventions and services for individuals in the early stages of Alzheimer's disease (AD), the authors conducted an interdisciplinary literature review of exemplar programs, defined as those including multimodal or unimodal interventions; shown to be appropriate for individuals in the early stages of AD; demonstrating promise to support, maintain, and improve independent functioning; and shown to have positive effects for a variety of outcomes, including quality of life. This article examines evidence from five kinds of programs: (a) multimodal interventions, (b) programs developed by the Southwest Florida Interdisciplinary Center for Positive Aging, (c) sleep enhancement interventions, (d) managed care programs, and (e) technology-based interventions. Evidence from the review suggests that a number of programs can support functioning and improve quality of life for adults living with the early stages of memory loss. The article concludes with recommendations to advance a national research agenda in this area.

Effect of a pedometer-based intervention on daily step counts of community-dwelling older adults.

This study investigated the effect of a 12-week pedometer-based intervention on daily step counts of 147 older adults randomly assigned to an intervention or wait-list control group (M age = 72.9 years, SD = 8.8). The intervention group significantly increased their daily step counts after 12 weeks (M=639, SD=2239) and continued to significantly increase during a 12-week maintenance period (M=680, SD=1721). The control group exhibited no change during the control period (M = -393, SD=2050) but had a significant increase in daily step counts (M=1580, SD=2305) when enrolled in the intervention. The pedometer-based intervention was effective in increasing participants' daily step counts.

The Senior Mentor Program at the University of South Carolina School of Medicine: an innovative geriatric longitudinal curriculum.

This paper describes development, implementation, and evaluation strategies of a longitudinal geriatric curriculum, the Senior Mentor Program (SMP). The rationale for exposing undergraduate medical students to healthy, community-dwelling older adults is to use the relationship and activities as vehicles for improving knowledge of aging and providing students experience with aging as a stage and process. The University of South Carolina School of Medicine's major aim in geriatrics is to prepare students to become skilled physicians in care of older adults. The SMP is embedded into the curriculum. The program introduced medical students to healthy older adults, presented selected health care issues in this population, integrated material early in the curriculum, acquainted students with longitudinal patient care, and introduced students to older adults' living arrangements. The SMP is an effective means of infusing geriatric content into the medical school curriculum and positively affects mentors' and students' attitudes toward each other. This has implications for medical and professional schools, such as nursing, social work, and physical therapy.

Preparing medical students to care for older adults: the impact of a Senior Mentor Program.

PURPOSE: To provide alternative training experiences for medical students to improve the competencies needed to provide care for older adults. METHOD: Part of a comprehensive approach to integrating geriatric content at the University of South Carolina (USC) School of Medicine, the Senior Mentor Program (SMP) was launched in 2000. The SMP links pairs of students with older community volunteers in the spring of the first year. Students visit their mentors throughout medical school, and execute assignments that complement materials covered in the traditional curriculum. To evaluate the feasibility and efficacy of the SMP, the authors describe the program's operation and outputs, the extent to which undergraduate medical education at USC and the SMP meet the core competencies for care of older adults promulgated by the American Geriatrics Society (AGS), and analyze the coverage of geriatrics content from 2000 to 2005 at USC, as indicated by responses to the Medical School Graduation Questionnaire. RESULTS: From 2000 to 2005, 379 students enrolled in the SMP; 133 graduates of the classes of 2004 and 2005 have completed the SMP. Students and mentors indicated high acceptance and enthusiasm. The program has been maintained with minimal administrative burden. USC covered only half of AGS competencies before the SMP, but now covers 100%, with nearly a third met specifically through the SMP. USC graduates reporting inclusion of geriatrics throughout their four years of training rose from 66% in 2002 to 96% in 2004-05. CONCLUSIONS: The SMP has had a substantial impact on students' preparation for dealing with an aging patient population.

Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia.

The effects of a therapeutic recreation intervention using animal-assisted therapy (AAT) on the agitated behaviors and social interactions of older adults with dementia were examined using the Cohen-Mansfield Agitation Inventory and the Animal-Assisted Therapy Flow Sheet. In a pilot study, 15 nursing home residents with dementia participated in a daily AAT intervention for three weeks. Results showed statistically significant decreases in agitated behaviors and a statistically significant increase in social interaction pretest to post-test.

Senior mentor program: a geriatrics focused curriculum.

OBJECTIVE: To introduce medical students to a healthy elderly population and present the health care challenges in this population. DESCRIPTION: As medical education has begun to focus more on our aging population and their future health needs, the University of South Carolina School of Medicine has developed a senior mentor program. This program provides a longitudinal experience for undergraduate students with local elders. The program, currently in its second year, will provide multiple opportunities for students to follow their same senior mentors over a four-year period both in the home and in the clinical setting. In partnership with the division of geriatrics, healthy patients over 65 were recruited to serve as senior mentors. Students, mostly in pairs, were assigned either one senior mentor or a couple, whom they met for the first time at the beginning of the second semester of their first year. Using a multidisciplinary approach, modules have been developed so students can learn how their senior mentors function on a daily basis, thus assessing the whole person, their health, their medical needs, their life-styles, and their social and physical environments. During the first year, students meet with their senior mentors four times and complete modules that address the physiology of aging, medical history taking, mental status examination, and psychological issues involving growing old. The modules were designed to coordinate with other areas of the curriculum where these concepts are being taught so that the students have an opportunity to put them into practice. Students check their senior mentors' blood pressures and write up their findings and thoughts about aging during each visit. In the second year the students meet with their senior mentors six times. Modules include assessing the senior mentors' diets; developing a behavioral modification plan in the first semester; and performing an environmental safety check, physical examination, and medication evaluation. The modules are coordinated with the curriculum and involve student consultation with our nutritionist and pharmacists. As the students enter their third and fourth years they will be expected to continue to meet with their senior mentors, to discuss issues concerning death and dying and advance directives, and to accompany their mentors to a physician visit. DISCUSSION: The responses from students, senior mentors, and faculty have been overwhelmingly positive. Students have enjoyed the early clinical experience, senior mentors have enjoyed meeting and talking to the students, and the faculty are pleased with the ability to integrate classroom material into a clinical setting early in the curriculum. Difficulties have arisen as some of our senior mentors have become ill and in the coordination of schedules between senior mentors and students. The plan is to continue the program as a permanent part of the curriculum. The hope is that it will be seen as a model for increasing the focus on geriatrics and early clinical experiences in the curriculum.