Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

EVALUATING THE FEASIBILITY AND EFFICACY OF USING MODULE BASED LEARNING IN ULTRASOUND-NAIVE MEDICAL STUDENTS TO OPTIMIZE HEALTH OUTCOMES IN THE SETTING OF INTERNATIONAL MEDICAL OUTREACH Julia Wolf OMS-II, Olivia Anderson OMS-II, Erica Kropp OMS-II, Emma Thompson OMS-II, Dr. Tommy Lindsey DO, FACOS, CHSE Edward Via College of Osteopathic Medicine- Carolinas Campus, Spartanburg, SC Introduction Results Conclusions

Discussion. In a mission trip environment where medical resources were lacking, the Butterfly ultrasound provided a method for a more comprehensive evaluation of patients. OMS-II students were able to utilize the Butterfly ultrasound platform for self-education on proper techniques of ultrasound to deliver optimal care to patients in the Dominican Republic. The Butterfly ultrasound provided a portable screening tool to improve health outcomes (85.9%), minimize unnecessary follow-up visits, and identify or rule out certain diagnoses, which is essential in populations that have inadequate access to healthcare resources. Future Directions. The original list of modules used for education provided a platform of experience that can now be expanded upon in the future to improve patient care and further evaluate the role the Butterfly ultrasound has on patient outcomes. With the success of the utilization of Butterfly ultrasounds in the Dominican Republic, other VCOM medical outreach trips are including Butterfly ultrasounds as necessary tools for expanding and improving care provided. This process can be continued to be reproduced to increase the overall amount of knowledge of POCUS in medical students. POCUS Images Figure 3: Ultrasound findings. Images below show unique ultrasound findings with the following diagnoses: a) Polycystic Kidney Disease, b) Uterine mass, c) Crown-Rump length measurement, d) Doppler image of Mitral valve prolapse A B C D

Background. Ultrasound technology has been utilized in diagnostic criteria since the 1950s. 1 It is a first line diagnostic tool for many specialties due to its minimal risk of complication, ease of use, and clear visualization of anatomy. Barriers to ultrasound in the past have included both lack of access and trained providers. 2 These barriers can be overcome by the Butterfly Ultrasound, which is a hand-held, portable, user-friendly device that comes with asynchronous educational modules. 3 While studies have shown a relationship between POCUS usage and improvement in international health outcomes amongst trained physicians 4 , there is little research available for point of care ultrasounds ( POCUS) as a supplement for clinical decision making amongst preclinical medical students. Objectives. This study investigated whether OMS-II students could utilize self guided education modules to learn proper ultrasound techniques, with the goal of translating these skills in the clinical context of an international mission trip. The primary goal of this project was to determine if utility and availability of on-site ultrasound technology could improve health outcomes and clinical decision making within an international setting. It also investigated whether ultrasound could be used to reduce the burden associated with diagnosing advanced disease states by providing a baseline scan to rule in or out conditions. Overview. Four OMS-II students enrolled at VCOM-CC that were planning to attend a week-long medical outreach trip in the Dominican Republic were provided a Butterfly ultrasound device and assigned online educational modules to complete independently. Students had no experience handling ultrasound devices prior to this project and relied solely on these educational modules. The list of modules that were compiled were chosen by the assumed population prevalence of disease states. During the international mission trip, students performed ultrasounds on patients within the clinics and villages when clinically indicated. Physicians were chaperones on site, but only the students performed the ultrasound assessment. All ultrasound assessments were reviewed with a Physician to confirm their validity and outcome. Outcomes assessed. Primary outcome measures included the number of patients scanned, the type of ultrasound performed, and if improved health outcome were observed. Improved health outcomes associated with ultrasound use were based on whether the ultrasound: 1. Diagnosed or had suspicion for a condition that may have required further follow-up at a secondary location 2. Was utilized as a general wellness visit for prenatal care to determine gestational age and/or sex that would have otherwise required a hospital referral 3. Ruled out a diagnosis and provided evidential findings that warranted additional follow-up 4. Health outcomes were not considered changed if the patient was treated or referred for follow-up regardless of ultrasound results, or those that did not need an ultrasound but were scanned for the sake of education. Statistical approach. Data analysis utilized a descriptive statistical approach. Methods

Figure 1: Ultrasound usage. Students performed ultrasounds on renal, cardiac, gallbladder, OB/GYN, spleen, appendix, lungs, and soft tissue systems. Of the ultrasounds performed, 64.1% were used for OB/GYN purposes with the rest being relatively equivalent. Study Results. 585 patients were seen in the rural villages and local free clinics. 74 ultrasound scans were performed on patients with clinical indications to aid in their diagnosis and plan of care, which was 12.6% of the total patients that were seen.

Figure 2: Outcomes due to ultrasound usage. Of the patients that received ultrasounds, 85.9% had associated improved health outcomes, while 14.1% had no relative change in health outcomes. The improved health outcomes included ruling out conditions with suspicious findings, diagnosing conditions with suspicious findings, and reassurance to mothers at prenatal wellness visits.

References

1. Nadrljanski M, Murphy A, Bell D, et al. History of ultrasound in medicine. Reference article, Radiopaedia.org . 2010. https://doi.org/10.53347/rID-8660 2. Wong J, Montague S, Wallace P, et al. Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. Ultrasound J . 2020;12(19). https://doi.org/10.1186/s13089-020-00167-6 3. Baribeau Y, Sharkey A, et al. Handheld point-of-care ultrasound probes: the new generation of POCUS. J Cardiothorac Vasc Anesth . 2020;34(11):3139-3145. https://doi.org/10.1053/j.jvca.2020.07.004 4. Rominger AH, Gomez GAA & Elliott P. The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico. Crit Ultrasound J . 2018;10(19). https://doi.org/10.1186/s13089-018-0101-8

Thank you to the VCOM campuses for organizing this mission trip, as well as the VCOM- Carolinas Simulation Center for providing us with the Butterfly Ultrasound equipment.

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2024 Research Recognition Day