Assessment of a brief point-of-care ultrasound training workshop among a large cohort of medical students

Introduction

Point-of-care ultrasound (POCUS) has widely demonstrated its value as a diagnostic tool that enhances patient safety and clinical efficiency (1-6). Its utility also extends into medical education as a tool to improve students’ understanding of anatomy, physiology, and semiology (7-9). For all these reasons, POCUS has generated increasing interest among clinicians and educators and prompted several medical societies to publish guidelines for its integration into medical schools’ curricula (10-12). Despite these recommendations, only a few medical schools offer such training (13), primarily due to organizational challenges and limited access to ultrasound equipment, usually only available during clinical internships. In 2006, the University of South Carolina integrated a comprehensive and ambitious ultrasound curriculum into its 4-year medical school program for 90 students annually (14,15). In 2015, Hoppman et al. presented an overview of this curriculum that included narrated web-based learning modules, short videos, hands-on in an ultrasound laboratory on each other or with an ultrasound simulation manikin or with phantoms for ultrasound-guided procedures under the supervision of a preceptor (16). Additionally, during the third and fourth years, students were issued a pocket ultrasound device for use during clerkships, which allowed them to enhance their scanning and interpretive skills. Students’ evaluations during the course were excellent. They performed very well during objective structured clinical examinations to acquire and analyze ultrasound images. Their feedback was also excellent, with over 90% of students finding that this course enhanced their overall medical education and understanding of the physical examination. Finally, this ultrasound curriculum was one of the determining factors in choosing this medical school for some students.

In 2023, the Université Paris Cité (UPC) launched a POCUS training within its medical school program (17). As the French university with the largest enrollment of medical students, exceeding 900 annually, UPC faces a challenge in implementing such a curriculum. UPC proposed that 180 final-year students participate in a pilot practical workshop before their residency, focused on thoracic and abdominal ultrasound, to address this challenge. This study aimed to assess the feasibility and evaluation of this workshop.

Methods

Students’ selection process and workshop description

UPC included 180 students in the formation as part of the pilot workshop. Given the limited number of available spots, we had to select the students among the 900 students in their final year of medical school. This selection was based on their performance on a 1-hour online exam that included questions on anatomy and diagnostic reasoning, following access to online courses on thoracic and abdominal POCUS. The aim was also to ensure that participants had at least completed the online courses, allowing them to assimilate the theoretical knowledge beforehand so that the workshops could focus entirely on hands-on practice. Of the 576 students who watched the online courses, 417 (72.4%) took the exam, and the top 180 scorers were chosen.

During the workshops, students were received in groups of 30 for one and a half days (accounting for 10 hours) in a large training room equipped with ten ultrasound scanners and 4 to 5 trainers from different specialties. Each group of 3 to 4 students shared one scanner and performed examinations on each other. The training goals focused on basic machine settings (gain, depth, focus, color Doppler), handling different probes, and visualizing normal images. According to the first and second levels of competency for clinical ultrasound in emergency medicine (18,19) and based on the experience and the modalities of postgraduate education in France (20), the ultrasound key targets included the kidneys, hepato-renal and splenorenal spaces, portal trunk, hepatic hilum, gallbladder, urinary bladder, abdominal aorta, inferior vena cava, lungs, and pleurae, essential cardiac views (subcostal, apical 2/3/4 and five chamber views, parasternal long- and short-axis views), neck vessels, thyroid, and compression of the femoral and popliteal veins. Advanced techniques such as transcranial Doppler and ocular ultrasound were only demonstrated by an instructor. This choice was justified by the fact that the practical training had to be completed within three half-days. Therefore, we focused on the thorax and abdomen, prioritizing commonly targeted areas in emergency medicine with a significant impact on diagnostic reasoning. The objective is for students to eventually be able to orient themselves when faced with dyspnea, abdominal or chest pain, or a state of shock. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional ethics committee CERAPHP Centre. All students were informed, but individual written consent was not required for this type of study.

Outcomes

Before the workshops started, students completed a questionnaire to assess their prior ultrasound experience using a four-level Likert scale and the number of abdominal, cardiac, and pleuro-pulmonary ultrasound examinations they had performed during their studies. We also evaluated their self-confidence in visualizing the designated target level on a scale from 0 to 10 (Appendix 1).

At the end of the workshop, a new questionnaire re-evaluated their self-confidence in achieving these targets post-training and their overall satisfaction on a scale ranging from 0 to 10 (Appendix 1). Additionally, students were asked how much they would be willing to invest in an handheld ultrasound probe. Finally, all students had to perform a timed ultrasound examination (not exceeding 5 minutes) targeting 15 anatomical areas: abdominal aorta, inferior vena cava, hepatic hilum, gallbladder, right and left kidneys with hepato- and splenic-renal spaces, right and left pleural cavities, urinary bladder, heart views from subcostal, apical and parasternal long- and short-axis, right and left pleural sliding. The quality of the 15 ultrasound key targets was validated by an instructor who timed the exam. Before taking the test, trainers showed students exactly what view we expected for it to be considered valid. For example, for a four-chamber view, the septum must be vertical and centered in the image, with both ventricles clearly visible, along with the mitral and tricuspid valves. The atria should not be cropped, and the depth should be adjusted appropriately. If the image was reversed, cropped, or if a key part was missing, the view was not validated.

Statistical analysis

Descriptive statistics were reported as absolute numbers and percentages for categorical variables and medians with interquartile range [first–third quartiles] for continuous variables. The Wilcoxon test was used to compare continuous variables between groups. The threshold for statistical significance was set as a two-tailed P value of less than 0.05. Graphs were plotted, and data was analyzed using R Studio^® (R Core Team, 2013; R: a language and environment for statistical computing; R Foundation for Statistical Computing, Vienna, Austria).

Results

Of the 180 students, 175 (97%) answered the questionnaire, and 164 (91%) performed the post-workshop timed test. Before the workshop, 144 students (82.3%) reported having no or little experience with ultrasound (Table 1) and had performed a small number of abdominal, cardiac, or pulmonary ultrasound examinations (Table 2).

The initial self-confidence level in visualizing the designated targets was 4 [3–6], varying by target type. Post-workshop, self-confidence improved significantly to 8 [7–9], P<0.0001, and exhibited reduced variability among the different targets (Figure 1).

Figure 1 The level of self-confidence depends on the target before and after practice. IVC, inferior vena cava; PLA, parasternal long axis; PSA, parasternal short axis.

Among the responders, 164/175 (96%) found having a handheld ultrasound device helpful for their future practice. They indicated that the maximum price they would be willing to pay for a handheld ultrasound device was €300 [€200–675].

In the final timed test, 123 out of 164 students (75%) achieved all 15 ultrasound targets within 5 minutes, while 32 (19.5%) achieved between 10 and 14 targets. The students who obtained all the targets completed the task in 252 [210–285] seconds. The overall student satisfaction was exceptionally high, rated at 10 [9–10].

Discussion

This study demonstrated that 180 medical students with no or minimal experience in ultrasound were capable of obtaining approximately fifteen key ultrasound images learned during a 10-hour workshop, significantly increasing their self-confidence level uniformly across various types of images, confirming, on a large scale, the study conducted by Safavi et al. (21).

POCUS is a powerful diagnostic and procedural tool and will most likely be part of every medical doctor’s daily equipment. Indeed, it answers the challenges of modern medicine as it offers a rapid, reliable tool that allows for diagnostics, security of procedures, and personalized medicine (1). Nevertheless, integrating POCUS within medical studies can be a real challenge as students need significant human and logistical resources to manipulate probes on real persons. Before implementing it on a large scale of more than 900 students annually, we conducted this pilot study to assess logistical constraints.

Short workshop: preparation and set-up

Before integrating POCUS in medical studies in a large cohort of medical students, we set up a short workshop intended to assess the different choices made by the authors. First, as most students were naive to ultrasound, we proposed theoretical training before the workshop. This online training focused on the physical basics of ultrasonography, artifacts, various normal and pathological cuts, and the integration of the ultrasound exam in the diagnostic approach during everyday clinical situations. Second, we chose to train students with standard ultrasound machines on themselves. Despite the growing use of ultrasound simulators (22), we believed students would be more willing to participate in this workshop by handling probes on real people—after obtaining their written consent (23). The choice of a standard ultrasound machine was motivated by the possibility of explaining in detail the concepts of gain, depth, and other “basic” parameters not always available on ultraportable machines. Finally, we had to limit the key target views to keep the allotted time. These key targets were chosen based on the international consensus conference recommendations on ultrasound education for undergraduate medical students by Hoppman et al. (9). They were considered “introductory views” and relatively easy to learn for those new to ultrasound, allowing students to prepare well for postgraduate training.

With these choices, we allowed students to conduct as many exams as possible in small groups of three or four, with one ultrasound scanner per group and many instructors to guide the students. Interestingly, this organization made it possible to train a large volume of students naive to ultrasound in a very short time, with most students having achieved the set objectives. The timed final exam showed that the majority of students were able to acquire the taught ultrasound loops within a very short time frame, despite most of them having no prior experience in ultrasound practice. Beyond assessing their progress, this exam also allowed us to revisit points that some students had not fully understood, and to guide those who struggled to obtain certain views before the end of the workshop, so they would not leave with a sense of failure. It also demonstrated that, in the end, nearly all of them were able to acquire the vast majority of the required views, and often quite quickly (even those who initially couldn’t do so in under 5 minutes managed it relatively fast).

Handheld ultrasound device acquisition

Post-training practice is essential for skill retention and competency validation (24). Yet, this is often hindered by the limited access to ultrasound equipment during internships and the variable expertise of supervising physicians. To address these challenges, deploying handheld ultrasound probes and leveraging the use of artificial intelligence for remote loop monitoring and image interpretation could be transformative. However, the financial barrier is significant; the study reveals that the cost of these probes (exceeding €1,000) is prohibitive for most students, who indicated a willingness to pay a median of €300, with the upper quartile of reported maximum willingness to pay being €675.

Limitations

Our study presents several limitations. First, the students who participated in the workshop were selected based on their performance on an exam. This selection criterion might bias the sample toward those already academically inclined or with better prior knowledge, which may not represent the average student’s capability. Second, as noted, students practiced primarily on each other, mainly encountering normal anatomy. This limitation could impact their ability to diagnose conditions in a real clinical environment with varied pathologies. Simulation mannequins during such a workshop could allow students to encounter pathological images. Third, instructors were all experts in POCUS and standardized the information and techniques taught, which may not be possible in a larger setting. This is where artificial intelligence and remote evaluation of students’ loops could become interesting. Fourth, while the study measures immediate improvements in self-confidence and the ability to capture images quickly, it does not assess deeper diagnostic competencies or decision-making skills. Therefore, self-confidence scores should be interpreted with caution. Fifth, we did not have a control group to measure the difference in performance between students who participated in the workshops and those who did not. Finally, because the study focuses on a single medical school and a self-selecting group of students, the findings might not be readily generalizable to other settings or populations with different educational backgrounds or resources.

Conclusions

Short, focused workshops can efficiently equip students with fundamental ultrasound skills and significantly enhance their self-confidence. They could be a first step into integrating POCUS into large cohorts of medical students.

Acknowledgments

The authors would like to thank the Université Paris Cité for enabling the implementation of the POCUS curriculum during the medical school program, Thomas Goddé for his help in logistics, the instructors Hiba Boussaha, Sami Ellouze, Thibault Jacquet, Clément Montabord, Ralitsa Stoeva, Clara Tescher, Louise Wang, Sophie-Hélène Zaimi, for their active participation during the 9-day workshops, and the 180 highly motivated students who participated in these workshops.

Footnote

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-2025-934/coif). O.P. has received honoraria for talks on behalf of BMS and Qiagen, expertise for Sanofi, and was sponsored by Shionogi for the congress. M.G. received honoraria for delivering a lecture on behalf of Mindray on ultrasound echocardiography at the EUSEM 2025 congress in Vienna. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional ethics committee CERAPHP Centre. All students were informed, but individual written consent was not required for this type of study.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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