INTRODUCTION
Ultrasound (US) has become an important tool in clinical practice. Due to its real-time imaging capability, non-invasiveness, absence of radiation exposure, and relatively low cost, the applications of the US are continuously expanding in medical practice.
1,2
As the use of US in medical specialties has grown, the demand for education has also increased.
3 Several studies have shown that undergraduate education helps improve the understanding of anatomy and physiology across a range of organs and the capabilities of acquisition and interpretation of US images.
1,3-5 Therefore, efforts have been made in the United States to develop and implement an educational curriculum for medical students. By contrast, in Korea, US training is mainly offered as one-time workshops for specialists and residents, with little structured education available for medical students. Educational opportunities in neurology are limited. While US education curricula often complement traditional organ system-based blocks such as hepatobiliary, cardiac, and head-and-neck modules, there is no neurology-focused US component in preclinical education.
6 One study reported that medical students who voluntarily attended a neurological US workshop followed by pre-and post-tests on neuroanatomy and neurophysiology showed improved results.
6 However, the sample size was limited, and the assessment primarily relied on test scores.
This study aimed to determine the effects of neurological US education on all medical students, and not just on voluntary participants, to provide insights that can support the development of future curricula and structured educational programs.
SUBJECTS AND METHODS
This was a single-center, prospective educational trial from 2022 to 2023 with a total of 231 participants. All first-year medical students from the Chungnam National University College of Medicine will be enrolled in 2022 and 2023. Each year, the students were divided into two groups (groups A and B). Approximately 50 students were included in each group because of the capacity limitations of the lecture rooms and equipment. The education session on Transcranial Doppler and carotid Doppler included a 30 minutes lecture and a 30 minutes demonstration, both led by a neurology specialist. For those interested, an additional 30–60 minutes were allocated for hands-on practice. The education session focused primarily on neuroanatomy and physiology, with US techniques as a supplementary component. Immediately after each session, a written survey was administered to gather feedback. The post-session survey included questions on students’ willingness to receive US education, their preferences and expectations, understanding of the material, feedback on the session, and suggestions for improvement (
Supplementary Material 1).
For the Likert-scale survey questions, responses were dichotomized into positive (combining 'Strongly agree' and 'Somewhat agree') and negative responses (combining 'Somewhat disagree' and 'Disagree'), while neutral responses ('Don't know' or 'Not sure') were excluded from the analysis. Comparisons between the 2022 and 2023 responses were conducted using the chi-square test or Fisher's exact test when the expected cell count was less than five. Statistical significance was set at p<0.05. All statistical analyses were performed using IBM SPSS Statistics for Windows (version 27.0; IBM Corp., Armonk, NY, USA).
RESULTS
Of the 122 students, 103 (83%) will respond to the post-session survey in 2022, and 105 out of 107 (98%) will respond in 2023. The results of the post-session survey are shown in
Table 1.
For statistical comparisons between years, Likert scale responses were analyzed after dichotomization into positive and negative responses. More than half of the students were aware of the use of US in medical practice (Q2 positive responses: 99.0% in 2022 vs. 61.0% in 2023, p<0.001). Interest in US education significantly increased from 2022 to 2023 (Q4:80.5% vs. 92.4%, p=0.013). Over 80% of the students reported increased interest in the US after the session, with a significant improvement in 2023 compared with 2022 (Q14:81.6% vs. 94.3%, p=0.004). Overall, satisfaction with the anatomical ultrasound class was significantly higher in 2023 (Q16:82.5% vs. 96.2%, p<0.001).
The most preferred format was special lectures or workshops offered as additional programs within the university (Q6: Additional programs within the university, 45.6% in 2022 and 41.0% in 2023; Q9: Additional programs within the university, 41.7% in 2022 and 40.0% in 2023). The next preferred formats were, in order, selective courses, mandatory courses, and external programs (Q6: Selective 26.2% in 2022, 28.6% in 2023, mandatory 12.6% in 2022, 22.9% in 2023, external programs outside the university 10.7% in 2022, 7.6% in 2023; Q9: Selective 27.2% in 2022, 33.3% in 2023, mandatory 22.3% in 2022, 16.2% in 2023, external programs outside the university 8.7% in 2022, and 10.5% in 2023).
After the session, over 80% of the students found it helpful for understanding anatomy, physiology, and their overall learning, with no significant differences between the years (Q7 positive responses: 84.4% in 2022 vs. 89.5% in 2023, p=0.695; Q8:81.6% vs. 91.4%, p=0.136). Most students responded that they would extensively use US in their future medical practice, with no significant change between the years (Q13:84.5% vs. 88.6%, p=0.463).
Students showed a clear preference for specialists or residents as instructors (Q10: Resident or specialist, 89.3% in 2022 and 92.4% in 2023), and the most suitable academic year for education was the second year (Q11: second year, 39.8% in 2022 and 55.2% in 2023). The proportion of students supporting the mandatory inclusion of US education in the curriculum showed an increasing trend but was not statistically significant (Q12 positive responses: 42.7% vs. 57.1%,
p=0.340). Similarly, the demand for expanded US education increased, although this change was not statistically significant (Q18:68.0% vs. 78.1%,
p=0.578).
Fig. 1 illustrates a comparison of positive and negative responses between 2022 and 2023, showing an overall trend toward increased positive responses in 2023 for most survey questions.
The most common level of class comprehension was 61–80%, followed by 41–60% (Q15: 61–80: 56.3%, 41–60: 25.2% in 2022, 61–80: 44.8%, 41–60: 32.4% in 2023). The satisfaction scores most commonly fell within the 81–100% range, followed by the 61–80% range (Q17: 81–100:39.8% in 2022, 68.6% in 2023, 61–80: 39.8% in 2022, and 24.8% in 2023). Among the individual opinions, it was suggested that, due to limitations in equipment and time, more in-depth theoretical education and personalized practical guidance should be provided to students with a strong interest.
DISCUSSION
This study included all first-year medical students over two years, ensuring a comprehensive sample of 231 students with a sample size of 208 respondents, as opposed to relying solely on voluntary participants. The results demonstrated a positive response from the students toward the US education session. Although there was interest in US education, it appeared that students had not been given sufficient educational opportunities prior to these sessions. The results suggest that the sessions were perceived as beneficial for enhancing students’ understanding of anatomy and physiology, as well as their overall knowledge. The lecture fostered the students’ interest in the US and encouraged them to use it in future medical practice.
The results also highlight the increasing demand for a more comprehensive US education at the undergraduate level. From a curriculum development perspective, students prefer optional programs with voluntary participation to mandatory courses. They also indicated that the second or third year of medical school would be the most appropriate time for these sessions, suggesting that US education might be more effective once students have acquired foundational knowledge of anatomy.
Previous studies have demonstrated the effectiveness of near-peer teaching in medical education and its benefits for peer-led learning7. However, in this study, the students expressed a clear preference for instruction by specialists or residents, presumably because of the technical complexity of US techniques, which require advanced expertise. This preference may have been influenced by the study population, which comprised first-year students who felt more comfortable learning from experienced instructors. Given the complexity of US techniques and the skills required for effective insonation, it is understandable that students would favor expert-led instruction.
Compared to 2022, the 2023 results indicate significantly increased student interest and willingness to participate in US education. Overall satisfaction with the sessions and students’ interests after the sessions also showed significant improvement. This improvement may be attributed to refinements in teaching methods as the program matured over two years. Additionally, the growing prominence of the US in medical practice may have increased students’ interest, motivating them to engage more actively in the sessions.
It should be noted that it remains challenging to generalize these findings because of the differences in the educational environments at each institution. Therefore, it is difficult to broadly standardize the integration of US education. However, this study suggests that the expansion of US educational integration should be considered along with discussions on the necessary equipment and appropriate educational approaches.
This study did not analyze the relationship between students’ pre-existing knowledge or academic performance and their understanding of the US. The understanding of US can vary depending on the students’ anatomical knowledge, which forms the basis of US education. Therefore, these findings should be considered as an overall impression of the US education system. While this study suggests that US education has positive aspects, it does not reflect the extent to which it aids students based on their level of understanding. Future studies should consider more objective assessment metrics.
A recent systematic review demonstrated the efficacy of remote education in US training, even for learners with minimal or no prior experience.
8 Given the inherent temporal and spatial constraints of large-scale US education programs, the integration of remote learning technologies presents a viable alternative to traditional in-person training. Evidence suggests comparable improvements in knowledge and practical skills through telehealth-based instruction.
9 Our survey findings also indicate an increasing student demand for US education and a clear preference for expert-led instruction, suggesting that remote education modalities can substantially expand educational opportunities. While various digital technologies can support educational programs, US provides unique advantages by offering real-time visualization of anatomical structures while simultaneously demonstrating its clinical applications in patient care. Therefore, efforts to optimize the educational advantages in the US should receive significant attention.
The US is a valuable educational tool that enables lower-year students to apply their theoretical anatomical knowledge from cadaver dissection and textbooks to practical clinical understanding through real-time bedside visualization of structures. It is important to analyze how this tool can be effectively used, how educational environments can be adapted, and how US education can be integrated into other subjects in the curriculum.
Future research should address several key methodological considerations to strengthen the evidence base for US education in medical curricula. Structured pre- and post-assessments can provide quantitative measures of knowledge gain and skill development. These assessments should include standardized theoretical knowledge tests covering neuroanatomy, US principles, and practical skill evaluations using standardized checklists designed for US competencies. Additionally, long-term retention assessments conducted 6–12 months after the initial training would provide valuable insights into the durability of the learned skills and knowledge. Future curriculum development may benefit from emerging technologies. Hybrid approaches combining traditional and remote education can incorporate synchronous demonstrations by specialists, artificial intelligence-assisted learning tools for immediate feedback, and virtual reality simulations for anatomical correlations and scanning practices. These technological integrations should be evaluated for their educational effectiveness while addressing the current limitations in equipment availability and instructor time.
This study has several limitations that should be considered. The lack of pre- and post-assessment designs and the absence of structured knowledge evaluations limit the ability to objectively measure the educational impact of the sessions. Although a previous study reported improved Observed Simulated Clinical Encounters scores among students who received US education compared to those who did not8, another study reported no significant differences in anatomy and written exam scores between students who participated in a neurological US workshop and those who did not.
10 This highlights the need for further research that incorporates objective assessments. Future studies should develop methods for evaluating students’ practical US skills. Additionally, the large group format, constrained by limited equipment and time, may have affected the quality of hands-on learning. Some students also suggested that more comprehensive theoretical instruction and personalized practical guidance would enhance their educational experiences, especially those with a strong interest in the US.
In conclusion, this study demonstrated that neurological US education provides a positive learning experience for medical students, fostering their willingness to apply US in future practice and pursue further training. By conducting surveys after neuroanatomy and US classes, the study also identified students’ preferences and areas for improvement in the curriculum. Unlike previous studies on general US education, this study specifically focused on neurological US, offering insights that can support the development of specialized curricula in this field. Further research is needed to assess the improvements in objective performance outcomes and the long-term educational impact of incorporating neurological US into medical curricula.