title: Sonography and hypotension: a change to critical problem solving in undergraduate medical education.
abstract: OBJECTIVE
  Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students' ultrasound education and provide critical problem-solving exercises.
  
  
  METHODS
  This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions.
  
  
  RESULTS
  One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%-89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%-95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00).
  
  
  CONCLUSIONS
  At our institution, we successfully integrated ultrasound and critical problem-solving instruction, as part of a 1-day workshop for undergraduate medical education.
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Amini
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Stolz
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Hernandez
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Gaskin
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Nicola
authors.initials: N
authors.lastname: Baker
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Arthur Barry
authors.initials: AB
authors.lastname: Sanders
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USA.
authors.forename: Srikar
authors.initials: S
authors.lastname: Adhikari
keywords: point-of-care ultrasound; problem-based learning; protocol-driven education; undergraduate medical education
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