Open and Shut Case: Revitalization of a Medical Student Abdominal Ultrasound Teaching Session with an Infusion of Active Learning Through a Case-Based Approach

Objective:
To determine if utilizing active learning through the case-based approach within an abdominal ultrasound learning session improved student perception of learning.

Methods:
Traditional means of teaching medical students involve passive learning, which asks students to memorize and internalize instructor-driven content to apply to relevant situations. This approach to education uses the instructor and assigned textbook as the ultimate source of knowledge. Passive learning methods include lectures, assigned readings, and demonstrations where the learner has minimal interaction with the content, instructor, or peers. A more modern approach to teaching medical students is based on the Constructivist Learning theory, which proposes that students develop their knowledge by connecting new ideas with previous knowledge and experiences to form enhanced understanding. Based on this theory, active learning methods such as case-based learning have been adopted to deepen the learning outcomes. The case-based learning method engages students with an interactive discussion of real-world scenarios specific to their field of study.

The case-based learning approach was applied to a first-year medical student ultrasound session on scanning techniques and pathological review of abdominal ultrasound. The learning session consisted of a 15-minute scanning exercise on a standardized patient to review the session objectives. This exercise was followed by a 30-minute case-based interactive presentation to review the scanning anatomy and pathologic findings of actual patient scenarios, followed by hands-on student scanning. Students completed an online, anonymous, voluntary post-session survey following the session to document their perception of learning. The post-session survey consisted of 7 questions based on a 5-point Likert scale and two open-ended free-text questions. This study aimed to determine if teaching ultrasound using active learning methods, such as case-based learning, increased students’ overall perception of learning specific aspects of abdominal ultrasound.

Results:
The post-session survey was distributed to 184 medical students enrolled in the first-year curriculum through an online evaluation software. The response rate to this anonymous and voluntary survey was 85%. The feedback gained from the post-session survey was overwhelmingly positive. The survey contained seven questions based on a 5-point Likert scale and two open-ended free-text questions to document the students’ perception of learning during the session.

Several questions on the survey asked students their level of agreement on a 5-point Likert scale ranging from 1, indicating strongly disagree, to 5, denoting strongly agree. When asked if using active learning methods such as case-based learning to teach ultrasound should remain part of the curriculum, the students gave an average score of 4.39 on the 5-point Likert agreement scale. Students also reported that the active learning format of the session was beneficial to their education, with a 4.47 out of 5 on the same agreement scale. Additional agreement questions asked students if the case-based interactive format helped them identify essential abdominal anatomical features (4.39 out of 5), whether this format of learning could integrate well with other anatomical areas of the ultrasound curriculum (4.60 out of 5), and if the material in the clinical cases were appropriate for their level of medical training (4.5 out of 5).

The open-ended free-text questions of the survey also revealed the students specifically appreciated the clinical relevance of the cases to enhance their learning of the abdominal ultrasound content. In response to the question concerning the most valuable aspect of learning in the abdominal ultrasound session, students’ responses most frequently included the phrases of “clinical correlations” and “interactive learning.” Other responses to the question of value of the session included themes of student engagement, appropriate content for learner level, and appreciation of clinically focused content.

Conclusions:
The study aimed to determine if adding active learning through case-based learning increased the overall educational perception of first-year medical students participating in a session on abdominal ultrasound. Since the feedback from the medical students was overwhelmingly positive for the case-based learning method, other forms of active learning could be explored and developed to enhance student engagement in the ultrasound curriculum. Additional active learning methods that could be utilized include flipped learning, peer learning, and technology-enhanced learning. Each method is already used across the medical school curriculum and could be easily adapted for the ultrasound content. Flipped learning engages students in learning before the actual class session and allows students additional time for hands-on scanning during the session. Peer learning could be added to initiate students working together outside structured class sessions to gain experience with advanced ultrasound concepts in patient care settings. Adding technology-enhanced learning to the ultrasound curriculum would allow students quick access to expert instruction through online learning modules, publicly available resources, and machine-specific tutorials to enhance and increase knowledge of specific ultrasound content.

Although this session only included first-year medical students, active learning methods could also be used to promote ultrasound education in clerkship sites and remote learning areas across our distributed campus model. Active learning methods such as lecture-related software, learning management systems, social media, and web resources would increase the availability of learning ultrasound even when instructors were not regionally located. Adding the case-based learning approach and other active learning strategies would promote student perception of learning and continue the focus on ultrasound education through the remainder of medical school.