An introductory ultrasound session includes: 

• basic instrumentation and knobology.
• image orientation.
• hands-on scanning of wrist structures.

Students learn scan technique and relevant ultrasound anatomy on standardized patients and ultrasound simulators.

Formal Ultrasound Labs

1. Cardiac
   • Parasternal long axis (PLAX) view of heart
2. Right Upper Quadrant
   • Liver, gallbladder, & hepatorenal recess
3. Kidney and Urinary Bladder
   • Right kidney, left kidney, & urinary bladder
4. Musculoskeletal
   • Shoulder & knee
5. Neck
   • Carotid arteries, internal jugular vein, thyroid gland, airway, & muscles

Open Labs

Students practice scan techniques covered in the formal ultrasound labs.

Ultrasound Objective Structured Clinical Exam (OSCE)

Students scan and identify selected anatomy from the five formal lab sessions. They are also assessed on their interaction with the standardized patient.

Students learn ultrasound scans that highlight cardiovascular physiology principles.

Formal Ultrasound Labs

1. Introduction to Vascular Ultrasound
   • Color Flow and Spectral Doppler are used to illustrate blood flow dynamics.
2. Cardiac cycle and Heart Sounds
   • Apical 4 chamber view with Color Doppler to show intracardiac flow patterns throughout the cardiac cycle.
   • PLAX view with simultaneous auscultation to correlate valve closure with the heart sounds.
3. Ultrasound in Shock
   • Students learn how cardiogenic and obstructive shock can manifest on cardiac ultrasound.
   • Specific views: PLAX, parasternal short axis (PSAX), apical 4-chamber, & subcostal

Students use ultrasound as a tool to augment learning the physical exam.

Ultrasound Assisted Physical Diagnosis Lab

• Students scan standardized patients to correlate physical exam findings with ultrasound findings.
  • Diaphragmatic excursion, liver span, sonographic Murphy’s sign, heart sounds

Students learn additional ultrasound scans that relate to content within some of the M2 systems blocks.

Formal Ultrasound Labs

1. Echocardiography
   • Within cardiovascular block
   • This lab covers the standard cardiac views: PLAX, PSAX, apical 4/5 chamber, and subcostal.
   • Students learn to recognize reduced left ventricular systolic function and the ultrasound appearance of a pericardial effusion.
2. Abdominal Aorta and Inferior Vena Cava (IVC)
   • Within cardiovascular block
   • Abdominal aorta: Students learn the proper technique for measuring the abdominal aorta and how to recognize an abdominal aortic aneurysm (AAA).
   • IVC: Students learn to measure the IVC, determine its collapsibility, and use those data points in the assessment of intravascular volume status.
3. Rapid Ultrasound in Shock/Hypotension (RUSH)
   • Within cardiovascular block
   • Students learn the various views to evaluate the “pump, tank, and pipes.”
   • They learn to recognize pneumothorax, pleural effusion, intraperitoneal fluid, and B-lines.
4. Lower Extremity Venous Ultrasound
   • Within hematology block
   • Students learn to perform a two-zone compression test for deep venous thrombosis (DVT) including the femoral vein at the saphenofemoral junction and the popliteal vein.

Open Labs

Students practice scan techniques covered in the formal ultrasound labs.

Ultrasound OSCE

Students are assessed on proper probe selection, scan technique, distinguishing normal from abnormal ultrasound findings, and interpreting abnormal findings. They perform selected scans from the labs done in the cardiovascular block.  

Ultrasound images are incorporated into lectures and small group clinicopathologic sessions to demonstrate pathologic and ultrasound correlates and enhance the transfer of pathology knowledge to the clinical diagnostic arena.

Students learn additional ultrasound scans that relate to content within some of the M2 systems blocks.

Formal Ultrasound Labs

1. Ultrasound Guided Procedures
   • Within gastrointestinal block
   • Students practice ultrasound guided procedures using phantoms.
   • Procedures: central venous access, thoracentesis, paracentesis, & arthrocentesis.
2. Female Pelvic Ultrasound & Scrotal Ultrasound
   • Within endocrine/reproductive system block
   • Female pelvic ultrasound: Students perform transabdominal pelvic scans on standardized patients and a phantom.  They perform transvaginal scans on an ultrasound simulator. They learn to recognize normal structures and some pathologies. 
   • Scrotal ultrasound: Students perform scans on a scrotal ultrasound phantom.  They learn to recognize normal anatomy and some key abnormalities.

Open Lab

Students practice scan techniques coverd in the formal ultrasound labs.

Ultrasound OSCE

Students are assessed on proper probe selection, scan technique, distinguishing normal from abnormal ultrasound findings, and interpreting abnormal findings.  For the procedures they are assessed on knowledge of correct techniques and adjustments.

Ultrasound images are incorporated into lectures and small group clinicopathologic sessions to demonstrate pathologic and ultrasound correlates and enhance the transfer of pathology knowledge to the clinical diagnostic arena.

• Clerkship-Specific Ultrasound Instruction 
• Internal Medicine, Family Medicine, Pediatrics, Surgery, & Obstetrics/ Gynecology.
• Available Instructional Methods:
• Image review sessions
• Bedside ultrasound rounds
• Independent and supervised patient scanning
• Simulation Center ultrasound sessions
• Ultrasound Institute scanning sessions
• Specialty and subspecialty ultrasound observation
• Equipment
• Hand-held devices are available in Internal Medicine, Family Medicine, & Pediatrics.
• Cart-based units are also available in various inpatient & outpatient settings.
• Objective Structured Clinical Examination (OSCE)
• Ultrasound is incorporated into some of the end-of-clerkship OSCEs like Internal Medicine.

In the M3 year, students get to take two one-week electives of their choosing.  Some of them provide opportunities to perform ultrasound scans.

• Emergency Medicine
  • Includes supervised instruction and scanning of important emergency medicine ultrasound protocols, image review sessions, and online emergency medicine ultrasound learning modules.
• Critical Care Medicine
  • Includes supervised instruction and scanning in the intensive care unit for assessment of volume status, heart function, pneumothorax, and other important critical care scans.

In the M4 year, students typically take four electives that are each four weeks long.  Some of them focus on or incorporate ultrasound instruction. 

• Ultrasound Independent Study Month
  • Learning activities include self-regulated learning modules, ultrasound simulation, peer instruction during student ultrasound labs, and self-directed learning presentation. Students are provided with a hand-held ultrasound unit to practice scanning during the elective.
• Emergency Medicine Ultrasound
  • Includes online emergency medicine ultrasound modules, supervised instruction and scanning of emergency medicine patients, and image reviews.
• Radiology Elective
  • Includes an ultrasound learning module and image reviews.  Students can assist with peer instruction during student ultrasound labs.

Some acting internships offer ultrasound learning activities like those available in the M3 Clerkships.  On those, students can strengthen their point of care ultrasound skills and decision making in settings where they are expected to take on greater degrees of responsibility in patient care.

Students can practice their point of care ultrasound skills within critical care settings including the various intensive care unit rotations, the emergency medicine rotation, and the anesthesia rotation.  This includes supervised instruction and scanning.