[Vscan Air] Medical Students Get to Grips With Point-of-care Ultrasound
HKUMed has become the first medical school in Hong Kong to introduce hands-on teaching for point-of-care ultrasound (POCUS) as it seeks to equip students with the skills required for modern healthcare settings.
POCUS refers to the practice of using ultrasound wherever the patient is being cared for to facilitate immediate assessment and therapy. Despite POCUS becoming an increasingly common diagnostic tool in hospitals, training in handheld ultrasound is yet to be widely taught in the top global medical schools.
To address this need, the technology has been incorporated into the teaching for orthopaedics, surgery and medicine rotations for final-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students.
The introduction of ultrasonography teaching has been made possible by the generous donation of 450 handheld ultrasound devices by the Tam Shiu Charitable Trust to support the Faculty’s innovative teaching curriculum.
The technology is designed to act as an extension of stethoscopes, which have been used in medicine for 200 years. It also serves to augment the traditional “four pillars” of physical examination — inspection, palpation, percussion and auscultation.
POCUS devices range from wireless probes that pair with a smartphone or tablet to larger, wired probes and portable ultrasound scanners wheeled to the bedside.
In late May, students currently completing their specialty clerkship in medicine received their first taste of performing handheld ultrasonography at a POCUS boot camp.
Dr Pauline Yeung, Clinical Assistant Professor in Practice, Division of Respiratory and Critical Care Medicine, Department of Medicine, who led the boot camp, said it is important for students to gain an appreciation of these tools as part of routine clinical care.
A unique role of POCUS in undergraduate teaching is that it empowers medical students to formulate diagnoses at the bedside during clerking, without needing to wait for formal tests to be ordered and returned, Dr Yeung said. She added that it can also help boost a student’s confidence.
Drawing on a recent example from the wards, Dr Yeung said students came across a patient with polycystic liver and kidney disease, but could not determine whether one or both of the enlarged organs should have been palpable.
“They put the ultrasound probe on the abdomen and realized both were so massively enlarged that it was practically difficult to tell them apart,” she said. “Their confidence levels were boosted after they realised it was not due to a limitation of their skills in physical examination.”
The May workshop combined didactic lectures and hands-on training to provide the students with a foundation in the different grips and angles to use depending on the target organ or desired view.
After reviewing the identifying shapes of the structures of the heart and the anatomy of the thorax and abdomen, the students practised on one another to capture images and finesse their technique.
Students said they found the devices, which pair with an app that allows you to select the correct preset for the corresponding part of the body, easy to use.
“You need to have a good knowledge of anatomy, so if your base is not very good, it wouldn’t be that simple,” said Nicole Ngai, MBBS year 6. “But as we’re in our final year, maybe it would be a difficulty of four or five out of 10.”
Mok Chiu Hang, MBBS year 6, said he welcomed the introduction of hand-held ultrasounds, describing the devices as “21st-century technology to teach 21st-century students”.
“This ultrasound [device] is very useful because when using the stethoscope to detect valvular heart disease we are always uncertain whether it’s a systolic murmur or a diastolic murmur,” he said. “But with this ultrasound scan we can see anatomically whether it is a regurgitation or a stenosis.”
The handheld devices were also introduced to students who worked at government Community Isolation Facilities during Hong Kong’s fifth wave of COVID-19 infections in spring 2022. With limited facilities at the CIFs, the handheld ultrasounds acted as a vital tool for diagnosis.
June Yau, MBBS year 6, who had joined a CIF during the spring, described how when presented with a patient with acute retention of urine, a doctor at the facility used POCUS to visualise the full bladder.
Yau added that after the scan, the patient was catheterised and transferred to hospital for further treatment.
