By: Dr Allan Whitehead
I have been interested in introducing POCUS teaching to the medical schools in Victoria for at least
the last half dozen years. Having the opportunity to speak with David Bahner from Ohio State
University and Chris Fox from University of California Irvine and witnessing the enthusiasm of their
medical students who have been given the opportunity to learn POCUS within their medical school
curriculum, just impressed on me on where we need to be with POCUS in our medical schools.
The article published by Nicholas et al shows the rapid uptake of POCUS within the curriculum in
medical schools in the USA such that it had reached 73% of the 84% of schools who responded in
2019 and this rate had been steadily increasing over the decade so could be expected to have
increased even further by late 2021/early 2022. 79% of medical schools had their own machines for
the purpose of teaching ultrasound. Some medical schools have been given many hand-held POCUS
devices by ultrasound companies as per the photo in the link below (provided courtesy of Ashes
Mukherjee).
Personal contacts, local experience and anecdotal reports indicate to me that easily less than half of
medical schools in Australasia currently have POCUS teaching within their curriculum and a smaller
number again have dedicated machines. Those that do incorporate POCUS – either into basic
sciences or basic clinical skills or in clinical rotations – are yet to offer integrated POCUS across a 4
year medical school curriculum as the medical schools leading with POCUS are doing in the USA.
I have also attached a powerpoint presentation that was used during a talk I gave recently for the
ASUM Virtual 2021 Conference which includes very insightful survey responses from 146 medical
students mostly from 1 Victorian University who attended one of a series of extra-curricular POCUS
workshops I helped coordinate over a 2 year period prior to COVID appearing. Kind thanks to Chloe
Cheng who was instrumental in making these workshops happen and who constructed, collated and
analysed the post-workshop survey and provided the results which appears in the presentation.
The key take home messages from our local survey were that they overwhelmingly agreed that basic
POCUS skills should be taught in the medical school curriculum as they were relevant to their current
education and future clinical practice. 64% supported teaching POCUS in one of the clinical years,
while 23% preferred teaching in the pre-clinical years. Our extra-curricular free POCUS workshops
were oversubscribed with waiting lists for each workshop. Additionally, since I started to hold the
series of workshops described above with features in the ASUM presentation, I have been
approached by medical students from the other 2 medical schools in Victoria to assist with running
extra-curricular workshops so there is clearly unmet demand from medical students in our state. A
goal for us at EMUGs is to promote POCUS by harnessing student feedback and support as means of
lobbying medical school deans and faculty to recognise the value of making space for POCUS within
their curriculum. A generic integrated curriculum in the Australasian context which is based on a
number of examples from leading institutions in the USA could look like:
Year 1: Basic US physics, knobology, Ultrasound inserted into Anatomy topics with practical
scanning on cadavers, student models in lab sessions and when teaching surface anatomy.
Ultrasound workshops for Physiology – cardiac, vascular, GIT
Year 2: US for pathology of different systems, basic focused US protocols, needle guidance using
ultrasound. During physical examination teaching, US can be added as a complimentary diagnostic
tool.
Year 3: Integrated specialty-based hands-on ultrasound experience during clinical rotations on ward
rounds and during weekly teaching sessions, logging POCUS examinations and presenting cases,
running workshops etc Further develop procedural US skills during clinical rotations and with
dedicated workshop/s
Year 4: ED rotation building skills in POCUS indications/acquisition of images/interpretation of
images/medical decision making resulting from performance of POCUS. Learn & utilise core EM
focused scanning protocols. In other clinical rotations, further integrated specialty-based hands-on
US experience during ward rounds, weekly teaching sessions, logging and presenting POCUS cases
and running workshops.
Also in Year 4 an elective in Focused Ultrasound/Point of Care Ultrasound can be offered – typically
based in a critical care department of a hospital such as ED, ICU or CCU, but could also be in General
Medicine or Family Medicine/General Practiced depending on the skills of the supervisor/teaching
faculty.
If you are interested in joining this interest group within EMUGs on Slack, or you have insights or
useful recent information about what is happening in this space within Australasian medical schools
then please contact me via my email: snowydoogie@ozemail.com.au
Best wishes on your POCUS journey,
Allan Whitehead FACEM CCPU(Otago) CCPU(ASUM)
Emergency Physician, Wonthaggi Hospital, Bass Coast Health, Vic
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