title: Ultrasound in undergraduate medical education: a systematic and critical review.
abstract: BACKGROUND
  The use of point-of-care ultrasound (POCUS) 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.
  
  
  OBJECTIVE
  We conducted a critical and systematic review framed by the rationales enumerated in academic publications by advocates of ultrasound in UME.
  
  
  METHODS
  This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified from an archive of 403 academic publications using techniques from Foucauldian critical discourse analysis (CDA). We then sought empirical evidence in support of these rationales, using a critical synthesis methodology also adapted from CDA.
  
  
  RESULTS
  We identified four dominant discursive rationales with different levels of evidentiary support. The use of 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 the quality of patient care was difficult to evaluate.
  
  
  CONCLUSIONS
  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 legitimises them and may preclude further primary research. As 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.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zac
authors.initials: Z
authors.lastname: Feilchenfeld
authors.affiliation: Centre for Medical Education, Queen's University Belfast, Belfast, UK.|School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Dornan
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.|The Wilson Centre, Toronto, Ontario, Canada.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Whitehead
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|The Wilson Centre, Toronto, Ontario, Canada.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Kuper
mesh_terms: D002983:Clinical Competence; D003479:Curriculum / Q000639:trends; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000639:trends; D006801:Humans; D019095:Point-of-Care Systems; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching; D014463:Ultrasonography / Q000379:methods*