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Can Transfontanellar Ultrasound Be Adequately Taught To Undergraduate Students?

Marcus Bastos, Jose Pazeli Jr, Júlia Ferreira, Eleusa Dias, Bianca Oliveira, Gabriela Cumani, Gustavo Camilo

INTRODUCTION

Transfontanellar ultrasonography (UTNF) is an imaging method of great importance in the evaluation of newborns and provides additional information regarding the physical examination.

OBJECTIVE

To evaluate if the UTNF can be taught to undergraduate students without previous ultrasonographic knowledge.

METHODS

Fifteen medical students underwent a multiple choice test before and after receiving four hours of theoretical and practical sessions on adjustment of the ultrasound machine and on UTNF.

The hands-on sessions were carried out in human models (five healthy newborns with previous authorization of their responsible), aiming at the recognition of the main brain structures of newborns.

The UTNF was performed in the anterior fontanelle with the individuals in dorsal decubitus, through images obtained in the coronal and longitudinal planes.

Finally, three clinical cases were presented about hydrocephalus, peri-ventricular hemorrhage and a normal case, for the students to establish the diagnosis.

RESULTS

The cognitive evaluation of the theoretical subjects (total of 10 points) increased from 3.9 ± 1.3 (before) to 8.8 ± 1.01 points after the training (p <0.05).

An excellent result was observed in the OSCE evaluation (9 theoretical-practical questions) with performance superior to 90% in 7 of the 9 questions.

The students were able to choose the correct transducer, determine the correct side that they were evaluating and adjust the appropriate parameters of the device, having obtained integral performance in these questions.

The determination of anatomical structures (corpus callosum, brainstem and cerebellum) did not generate incorrect answers.

The score 5 on Likert Scale (“totally agree”) was obtained in 97% for the sentence

“The use of ultrasonography as well as the transfontanella study should be included in undergraduate medical education” ”; in 96.7% for the sentence

“After the course on transfontanella ultrasonography the student added knowledge and believes he has more capacity to evaluate the cerebral part of a newborn”; in 86.6% for the sentence

“Practical theoretical training using ultrasound allows the identification of cerebral structures”; and 80.0% for the sentence

“The course on transfontanella ultrasonographic meets the student’s pre-course expectations”. The ability to identify the completely normal exam was the situation that raised the highest index of doubtful answers (60%).

CONCLUSION

These results demonstrate that medical students after performing a short course acquire the ability to adjust the ultrasound and correctly to determine the main anatomical structures of the brain.

However, they have had some difficulties to identify normal UTNF when exposed to images that also included pathologies. Student satisfaction with the short theoretical-practical courses was evident.

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