Fully Integrated Musculoskeletal Point of Care Ultrasound Training for Chiropractic Students
General description of the project
There is a rapidly growing body of evidence supporting the impressive accuracy of sonography (diagnostic ultrasound) for diagnosing musculoskeletal soft tissue pathologies, especially those in the upper and lower extremities. The sensitivity, specificity, and diagnostic accuracy of sonography is comparable to MRI for full thickness rotator cuff tears, carpal tunnel syndrome, quadriceps tears, Achilles’ tendinopathies, and many others.
The utilization of focused, limited ultrasound exams performed by healthcare providers at the bedside is known as point-of-care ultrasound (POCUS). A musculoskeletal POCUS training program would give chiropractic students the necessary knowledge and skills to inform appropriate patient selection, to identify normal anatomic structures with diagnostic ultrasound, and to simultaneously distinguish pathological findings in the soft tissues.
The Doctor of Chiropractic Program (DCP) at Universidad Central del Caribe (UCC) is assimilating ~85 hours of fully comprehensive musculoskeletal point of care ultrasound training. The curriculum was specifically selected and tailored by a diagnostic imaging specialist for best uses in chiropractic clinical practice. Laboratory training sessions involve the use of virtual reality simulated patients and sham ultrasound probes with motion sensing capabilities; this allows for the assessment of student technical skill development, which is then transferrable to general clinical practice after graduation.
The DCP program at UCC is the first truly integrative educational experience for chiropractic trainees in North America; chiropractic students share training experiences with professionals and students in the UCC School of Medicine. Of note, it is the first and only chiropractic school in Puerto Rico, and the first and only chiropractic school in Latin America to be fully accredited by the Council on Chiropractic Education- USA (CCE-USA).
In the long term, this additional training and interprofessional exchange may encourage more meaningful collaborations between chiropractors and medical physicians, both in Puerto Rico and beyond. Outcomes like this may ultimately lead to a deeper incorporation of chiropractors into the global healthcare system, and augmentation of their patient outcomes.
Technologies
In recent years, diagnostic ultrasound training has been incorporated into medical education programs across the globe; currently at least 62% of medical schools in the United States have some level of diagnostic ultrasound training in their curricula. Ultrasound instruction for medical students typically includes basic imaging principles and physics of ultrasound, hands-on technical skills training (image acquisition), and the interpretation of ultrasound imaging studies.
This is the first fully integrated ultrasound training program in a chiropractic school, so there is significant opportunity for the collection and dissemination of data on student outcomes in this regard. Training hours are distributed into various courses in the DCP curriculum, including diagnostic imaging, anatomy, histology, clinical diagnosis, sports medicine and fitness, and clinical rotations.
The SonoSim training program, which will be used to deliver a majority of the MSK ultrasound content, has an asynchronous online diagnostic ultrasound course library for several body regions and scan protocols. It includes access to digitized simulated patients with normal and pathological anatomy, which can be evaluated using virtual-reality sham ultrasound probes with motion sensing capabilities; this is designed to aid students in developing the psychomotor skills that are crucial for performing clinical diagnostic ultrasound exams. Presential laboratory sessions are designed for students to demonstrate and observe simulated patient interactions, scanning techniques, and/or imaging interpretations.
Online access to training materials lessens the requirement for ultrasound expertise in the teaching faculty, and the cost of ultrasound devices and live models used in traditional presential training programs; these are commonly reported barriers to the implementation of POCUS training in medical schools.
Explain project results
The student population of the DCP program is entirely comprised of Puerto Rican students. The additional training will provide a unique professional advantage for graduates, who will then be able to provide excellent diagnostic services for their communities. They will also be qualified leaders who can make an impact on the future of the chiropractic profession.
Why it should be considered best practice?
Interprofessional teams in healthcare have potential to augment patient outcomes, due to the various unique perspectives that may be generated and shared. Interprofessional collaborations in the educational setting can effect a cultural change in practicing healthcare professionals, to ultimately encourage more teamwork between providers.
Chiropractors are increasingly being incorporated into interprofessional care teams for their expertise in the diagnosis and management of musculoskeletal conditions. POCUS exams are a valuable addition to the clinical practice skillset of chiropractors, allowing them to promote better, and more accessible global patient care in the long term.
Highlights of your proposed presentation
Students are engaged when technology is integrated into the classroom. Additionally, interprofessional training experiences may cause a positive cultural shift in healthcare practices. When healthcare professionals are willing and able to collaborate, the patient is the ultimate beneficiary.
The Evaluation Committee will evaluate submitted proposals based on the following criteria. Each area will be rated on a scale from 1 to 7 (1= non-satisfactory; 7 =outstanding), for a maximum of 63 points.