Effect of Ultrasonography on Student Learning of Shoulder Anatomy and Landmarks

Kristen D. de Vries, DO; Rebecca Brown, OMS IV; Joseph Mazzie, DO; Min-Kyung Jung, PhD; Sheldon C. Yao, DO; and Michael J. Terzella, DO
Notes and Affiliations
Notes and Affiliations

Received: May 1, 2017

Accepted: June 5, 2017

Published: January 1, 2018

From the Department of Internal Medicine in the Jacobi Medical Center at the Albert Einstein College of Medicine in Bronx, New York (Dr de Vries); the Department of Osteopathic Manipulative Medicine (Drs Yao and Terzella) at the New York Institute of Technology College of Osteopathic Medicine in Old Westbury (Student Doctor Brown and Dr Jung); and the Department of Radiology at NYU Winthrop Hospital in Mineola (Dr Mazzie). This study was presented as a poster at the American Academy of Osteopathy’s Convocations in March 2016 in Orlando, Florida, and in March 2017 in Colorado Springs, Colorado.

J Osteopath Med; 118(1): 34-39

Context: Ultrasonography is becoming more common in clinical use, and it has been shown to have promising results when introduced into medical school curricula.

Objectives: To determine whether the use of ultrasonography as an educational supplement can improve osteopathic medical students’ confidence and ability to locate 4 specific shoulder anatomical landmarks: the coracoid process, the transverse process of T1, the long head of the biceps within the bicipital groove, and the supraspinatus tendon.

Methods: In this randomized controlled study, first-year osteopathic medical students aged 18 years or older were recruited and randomly assigned to a group with exposure (ultrasonography group) or without exposure (control group) to an ultrasonography machine. First, a survey was administered to measure students’ baseline knowledge of shoulder anatomy, confidence in palpation skills, and opinion on anatomical landmark identification teaching methods. Next, students were shown presentations on shoulder anatomy and allowed to practice locating and palpating the specified landmarks. Students in the ultrasonography group were also given instruction on the use of ultrasonography. All students were asked to locate each of the 4 specified anatomical landmarks and then given a follow-up survey. A Mann Whitney U test was used to compare the confidence of the students before and after the intervention. A secondary analysis was performed to compare the degree of deviance from the correct position of the specified anatomical landmark between the ultrasonography and control groups. P values less than .05 were considered statistically significant.

Results: Sixty-four students participated. Compared with the control group, students in the ultrasonography group had a greater increase in confidence after the session in their ability to locate the coracoid process, bicipital tendon, and supraspinatus tendon (P=.022, P=.029, P=.44, respectively). Students in the ultrasonography group were also able to more accurately palpate the landmarks than those in the control group, with a significant difference in accurate palpation of the bicipital tendon (P=.024). The ultrasonography group showed less deviation with palpation of the other 3 landmarks compared with the control group, but these results were not significant (P=.50, P=.82, P=.29, respectively).

Conclusions: Ultrasonography in the preclinical curriculum may improve medical students’ confidence in and accuracy of palpation.

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