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.

'Dancing the Downward Slide: Spaces of Affective Adjacency in Rian and Bird with Boy'

This chapter examines how the choreography of affect in two dance theatre works creates a space of affective adjacency—a space in which the building of an alternative structure of feeling and an alternative economy of the body can be experienced. Focusing on the choreographic use of repetition in Junk Ensemble’s Bird With Boy (2011) and Fabulous Beast Dance Theatre’s Rian (2011), it shows how the work required to build an alternative affective space can become visible. Although affect is most often viewed as a preconscious, ephemeral phenomenon (a passage of intensities), that can have little or no lasting impact on socio-political action, theorists such as Megan Watkins have argued for a consideration of the ‘cumulative aspects of affect’. Highlighting Spinoza’s distinction between affectus (the capacity for a body to affect and be affected), and affectio (the impact the affecting body leaves on the affected), Watkins points out that affectio can ‘leave a residue’ allowing for the ‘capacity of affect to be retained, to accumulate, to form dispositions and thus shape subjectivities’. The choreography of repetition in Bird With Boy and Rian presents sites for an examination of this accumulation of affect and its capacity not only to form and shape dispositions, but also, as Lauren Berlant suggests, ‘to move along and make worlds, situations, and environments’.