Ultrasound in undergraduate medical education: A systematic and critical review

Introduction: Point-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications.

Methods: This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA.

Results: We identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students’ understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent,and rests on minimal evidence. With POCUS, students’ diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate.

Discussion: Our analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

Balancing Rights in Religious Education through Collaboration and Dialogue

While the right of parents to educate their children in their religious or philosophical conviction is recognised in Human Rights instruments (e.g. CoE 1952, protocol 1), educators must also attend to the right of a child to autonomy (UN 1989, Article 12.1) and the right of liberal democratic states to reproduce values of equity and freedom. This paper argues that certain forms of inter-religious dialogue and/or inter-religious collaborative learning can assist educators in balancing these rights where religion has significant influence and power over the management of schools and/or the curriculum. It is argued that in addition to the learning benefits which may result, the use of collaboration and dialogue goes some way in addressing three philosophical criticisms of religious education: first that religiously separate and religiously based education pays insufficient attention to the rights of children and, secondly, is likely to contribute to social fragmentation; and third, pupils will lack the skills to overcome prejudice or intolerance where they have no experience of others as a result of separate schooling or from a religiously narrow curriculum, and the latter may in fact support intolerant views. A rationale is developed that asserts the value of collaboration or dialogue as a pedagogical strategy that can, to some degree, mitigate potential negative outcomes from religious education. This argument is further supported with reference to a range of empirical studies.