8th-graders perform, teach clinically useful POCUS

Point-of-care ultrasound (POCUS) is so user-friendly that middle-school students can perform scans of acceptable clinical quality and then pass along their skills to classmates.

So found the authors of a study published online Feb. 7 in the World Journal of Emergency Medicine.

John Fox, MD, and Shadi Lahham, MD, both of the University of California, Irvine, together with Alexander Kwon, a student at Sage Hill School in nearby Newport Beach, launched their study after noting that POCUS is increasingly conducted by nonprofessionals in underdeveloped areas of the world.

The team divided into two groups 20 students enrolled in the eighth grade at a small middle school. They supplied one group with expert sonographer training on POCUS for four structures—the liver, spleen, kidneys and heart—using the FAST (Focused Assessment with Sonography for Trauma) protocol. 

The other group was parallel-trained in the same protocol by a fellow 8th-grader who had already received the professional instruction.

Adult volunteers served as the patients. A blinded ultrasound expert evaluated all images (n = 80) and labeled each as either adequate or inadequate for clinical use.

Analyzing the results, the authors found an overall image adequacy rate of 74 percent. This broke down as 78 percent adequacy for the sonographer-trained group and 70 percent for the student-trained group.

The researchers deemed the difference not significant.

“Our data indicates that an 8th grade student can obtain clinically adequate FAST images in all but the subxiphoid view [of the heart] after minimal training,” the authors wrote. “Additionally, there was no difference found between the student-trained group and the instructor-trained group. This data is promising; however, larger studies must be performed to determine the optimal amount of training for proficiency in novice or non-traditional ultrasound users.”

Fox and colleagues acknowledged several limitations in their study design, including small sample and use of a single school, making generalizability questionable. Also, the groups were split by gender—boys vs. girls—which may have produced a selection bias.

Training non-physicians “may be the only way to sustain ultrasound use” in developing countries and resource-limited settings, the authors pointed out. “Peer teaching and ‘training the trainer’ education programs may be another way to expand and maintain ultrasound skills.”

The journal has posted the study in full for free.