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School of Medicine

  • Student using ultrasound simulator

Integrated Ultrasound

This technology gives you the skills you need to make an impact in many setting, from the prominant technologically-advanced hospital to the rural primary care facility, and everywhere in between. 

In 2006, we became the first university in the country to integrate ultrasound technology into our medical curriculum. Since then, we've worked with our partners to create curriculum, test new technologies and encourage medical providers around the world to use ultrasound technology in ways that improve the quality of patient care. We believe ultrasound should be a core competency because there are practical applications in almost all medical disciplines. 


Back to the Bedside

The best place to teach the art, science and humanity of medicine is at the bedside. With all of the technology we have at our fingertips, it's rare to get this experience as a medical student. One of the benefits of ultrasound is that it requires you to visit patients, to learn to talk to them and use the images as a teaching tool to help them understand their health. 


What You'll Learn

You'll be exposed to ultrasound technology applications as a part of every core medical course you take. During each course, you'll focus on mastering a specific application. 


First Year Curriculum

 Small group introductory ultrasound sessions include: 

  • basic instrumentation and knobology.
  • image orientation.
  • hands-on scanning of neck vessels.

All education material are available to students online throughout all four years: learning modules, videos, laboratory handouts and notes.

  1. Introduction to cardiac ultrasound (laboratory session)
    • Parasternal long axis view (PLAX) - B-mode only; identification of heart chambers, valves, review screen orientation and image orientation marker location, knobology, depth, focus, frequency, gain adjustments
  2. Neck ultrasound ( laboratory session)
    • Carotid artery – B-mode and color flow mode – trace from common carotid to bifurcation, transverse  and longitudinal views, basic principles of color flow Doppler
    • Internal jugular vein – B-mode and color flow mode; anatomic differences of internal jugular vein  and carotid artery, shape, vessel wall, collapsibility, perform valsalva
    • Thyroid gland – B-mode; thyroid (both lobes and isthmus); echotexture, nodules, cysts, measurements, label structures, thyroid lobe volume estimation
  3. Kidney and bladder ultrasound (laboratory session)
    • Urinary bladder – B-mode; identify bladder, measure bladder volume, note artifacts like posterior acoustic enhancement
    • Ureteric jets – Color flow mode; test of total ureteric obstruction
  4. Right and left upper quadrants (laboratory session)
    • Liver, gall bladder, right/left kidney, Morison’s pouch, diaphragm and right costophrenic angle  – B-mode
  5. Introduction to musculoskeletal ultrasound – the knee (laboratory session) – B-mode
    • Anterior longitudinal suprapatellar view – patella, quadriceps tendon, femur, suprapatellar bursa
    • Suprapatellar tranverse flexed knee view - quadriceps tendon, femoral condyles, articular cartilage
    • Infrapatellar longitudinal view – patellar ligament, fat pad, tibia
    • Anisotropy artifact   
  6.  Ultrasound OSCE – proper transducer selection,  preset selection, probe orientation,  scan and identify right kidney/liver/Morison’s pouch, left kidney/spleen, PLAX of the heart, carotid/internal jugular; student is also evaluated on their interaction with the standardized patient
  1. Introduction to vascular ultrasound vascularhemodynamics (laboratory)
    • Common carotid artery analysis
      • B-mode – transverse and longitudinal views
      • Color flow – direction of flow
      • Spectral Doppler/Pulse wave – measure velocity, Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV), arterial and venous pulse wave forms
  2. Heart ultrasound – hemodynamics (laboratory)
    • Apical 4 chamber view (B-mode and color flow mode) – wall motion, valve motion, cardiac cycle with color flow
  3. Heart sounds and ECHO  (laboratory)
    • Students work in pairs – one captures PLAX  view showing both the aortic valve and mitral valve while other student listens with stethoscope and notes relationship of heart sounds and valve closure. Students then reverse roles.
  4. Cardiogenic shock   cardiac views: PLAX, apical 4-chamber, subcostal (laboratory session)
    • Cardiomypoathy – assess wall motion and shape of the left ventricle (LV) during cardiac cycle
    • Cardiac tamponade – assess for pericardial effusion, the right ventricle (RV) size and compression with cardiac cycle
    • Pulmonary embolism – assess for RV strain: size and compression with cardiac cycle; assess RV and right atrium (RA) for thrombosis  
Brain and Cranial Nerves (presentation and demonstration)   
  • Ultrasound measurement of optic nerve sheath diameter for assessment of increased intracranial pressure
  • Ultrasound assessment of direct and consensual pupillary light reflex
  • Ultrasound assessment of ocular movement for patients with marked orbital swelling
Problem based learning  (small group discussion) :
  • Ultrasound-relevant case, such as the 20-year-old student who collapses during a basketball game
  • Discussion of family history of sudden death
  • Physical examination reveals a murmur
  • Evaluation includes ECG, chest x-ray and ECHO show hypertrophic cardiomyopathy.


Second Year Curriculum 

  1. Cardiac ultrasound  standard cardiac views  (laboratory session)
    • Parasternal long and short axis views, apical 4 and 5 chamber, subcostal; assess chambers, valves, wall thickness and motion
  2. General abdomen (laboratory session)
    • Liver, gall bladder, kidneys, spleen, urinary bladder; identify structures and measure organ size
  3. Abdominal Aorta and Inferior VenaCava (IVC) assessment (laboratory session)
    • AAA screening; transverse and longitudinal, B mode, color flow and pulse wave, three measurements, characteristics that differentiate aorta from IVC
    • IVC – B mode and M Mode, measurement and IVC collapsibility index
  4. Lower extremity venous ultrasound (laboratory session)
    • Rule out deep venous thrombosis (DVT) in femoral, saphenofemoral  junction and popliteal vein –  2 point/level compression test, color flow Doppler, normal phasic venous flow, non-phasic venous flow, venous flow augmentation

Ultrasound images are incorporated into lectures and small group clinicopathologic sessions to demonstrate pathologic and ultrasound correlates and enhance the transfer of pathology knowledge to the clinical diagnostic arena.

Small group physical diagnosis hands-on sessions

Seventeen ultrasound components are used to improve physical examination skills and enhance the accuracy of the physical examination.

Systems included:

  • Cardiovascular
  • Pulmonary
  • Abdomen
  • Nervous system
  • Ocular
  • Musculoskeletal
  1.  Female pelvic ultrasound – transabdominal (laboratory session)
    • Uterus, ovaries, pouch of Douglas, endometrium
  2. Abdomen review and pancreas ultrasound - (laboratory session)
    • Upper abdominal vascular structures and transverse view of the pancreas – B mode – identify anatomical segments of the pancreas and normal echotexture
  3. Ultrasound guided procedures (laboratory session with ultrasound phantoms)
    • Central venous access (Internal jugular vein)
    • Pleural effusion detection and pleurocentesis
    • Ascitic fluid/free fluid in peritoneal cavity - detection and paracentesis 
  4. Assessment of patient with undifferentiated shock (laboratory session)
    • RUSH protocol: Rapid Ultrasound for Shock/Hypotension – assess LV function, rule out pericardial effusion/tamponade, assess for RV strain from pulmonary embolus (PE), volume status from IVC size and dynamics, scan abdomen and pelvis for free fluid, assess lungs for pneumothorax and pulmonary edema, assess aorta for rupture, assess femoral vein for DVT
  5. Ultrasound OSCE – As part of an end-of-year comprehensive clinical skills OSCE, each student conducts a focused history and physical examination on a standardized patients with one of three possible clinical scenarios then performs two corresponding ultrasound examinations: urinary bladder and abdominal aorta, renal/diaphragm and thyroid, cardiac and femoral vein. 

Ultrasound images are incorporated into lectures and small group clinicopathologic sessions to demonstrate pathologic and ultrasound correlates and enhance the transfer of pathology knowledge to the clinical diagnostic arena.

Problem Based Learning  (small group discussion) 

Ultrasound relevant cases are discussed, such as pregnancy with heart failure due to rheumatic heart disease

We explore:

  • ECHO with mitral stenosis.
  • chamber enlargement and “hockey- stick” mitral valve leaflet.
  • lung ultrasound with B lines.
  • fetal ultrasound.

During the first two years (M1 and M2), open laboratory sessions are held weekly during a time when no other classes are scheduled. Students are encouraged to come in pairs or small groups and practice their ultrasound skills on each other. At least one ultrasound faculty member is available to help with scanning and answer questions.


Third Year Curriculum

Clinical Rotations include clerkship-specific ultrasound instruction – internal medicine, family medicine, pediatrics, surgery, obstetrics and gynecology.

Instructional methods include:

  • image review sessions.
  • bedside ultrasound rounds.
  • independent and supervised patient scanning.
  • simulation center ultrasound sessions.
  • Ultrasound Institute scanning sessions.
  • specialty and subspecialty ultrasound observation.

Objective Structured Clinical Examinations (OSCE) are administered at the end of the clerkship.


Some of the OSCEs that have been used over the nine years:
  • Thyroid ultrasound (patient with a “lump in the neck”)

    After the focused history and physical exam, each student must properly scan the thyroid and identify and measure a thyroid cyst.
  • Septic patient who needs central line placement for intravenous access.
  • Abdominal Aortic Aneurysm (AAA) screen - elderly patient with risk factors for AAA, student must discuss the procedure with the patient, perform the ultrasound examination, discuss results and educate the patient about AAA
  • Musculoskeletal ultrasound in a patient with joint pain
  • Two OSCE stations with previously captured images of findings that were covered with students during the rotation in observational and hands-on ultrasound learning sessions.
  • OB ultrasound exam – patient is 27 weeks pregnant with a history of vaginal bleeding, student must perform an obstetrical ultrasound and determine fetal number, heart rate, placental location and fetal position
  • Assess soccer player who has “passed out twice during practice” – PLAX view with appropriate measurements for assessment of hypertrophic cardiomyopathy
  • Assess volume status / dehydration – 9 year old with history of nausea/vomiting and poor oral intake, student must assess volume status using the aorta/inferior vena cava ratio
  • Interpretation of lung ultrasounds of a case of bacterial pneumonia with air bronchograms and pleural effusion

Assess a trauma patient using the FAST exam (Focused Abdominal Sonography for Trauma) 

  • Scan a patient for trauma and demonstrate Morison’s pouch, spleen/kidney interface, urinary bladder, sub-xiphoid view of the heart
  • Emergency Medicine – supervised instruction and scanning of important emergency medicine ultrasound protocols, image review sessions, online emergency medicine ultrasound learning modules
  • Critical Care Medicine  supervised instruction and scanning in the intensive care unit for assessment of volume status, heart function, pneumothorax and other important critical care scans

Pocket ultrasound devices in primary care clerkships

  • capture images from the heart, abdomen and pelvis for submission and review at the end of the rotation.
  • All students at the end of the M3 year are required to complete a Gate OSCE that assessing a student’s readiness to progress to the M4 year. An ultrasound station is included.
  • Assessment includes capturing a PLAX view of the heart and a longitudinal view of the inferior vena cava with a pocket ultrasound device to assess for heart function and volume status
  • Students must evaluate cardiac and IVC ultrasound loops on a laptop computer for overall heart function, pericardial effusion and volume status


Fourth Year Curriculum

Four week emergency medicine ultrasound elective – online emergency medicine ultrasound learning modules, supervised instruction and scanning of emergency medicine patients and image review, a minimum of 10 eFAST examinations is required.

Traditional radiology elective with and ultrasound component that includes ultrasound learning modules, image review and “hands-on” ultrasound sessions focused primarily on guided procedure skill development.

Work with ultrasound faculty and fellows to expand knowledge and skill in ultrasound. Includes  scanning and ultrasound simulation, assisting with M1 and M2 ultrasound labs  participating in original research, and preparation of  a 30 minute presentation on a ultrasound topic of  their choosing.

Offered at the end of the 4th year – stresses ultrasound skills most important for students as they prepare for internship (ultrasound guided procedures, FAST exam, RUSH exam, lung ultrasound and soft tissue ultrasound to differentiate abscess and cellulitis).

Students on acting internships have been offered pocket ultrasound devices when available.

Challenge the conventional. Create the exceptional. No Limits.