Integration of Point of Care Ultrasound (POCUS) in a Human Cadaveric Dissection Based Anatomy Program: Advantages and Challenges

Integration of Point of Care Ultrasound (POCUS) in a Human Cadaveric Dissection Based Anatomy Program: Advantages and Challenges | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integration of Point of Care Ultrasound (POCUS) in a Human Cadaveric Dissection Based Anatomy Program: Advantages and Challenges Payton Wolbert, Austin Basso, Joydeep Chaudhuri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6256830/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Point-of-Care Ultrasound (POCUS) is emerging as a fundamental aspect of undergraduate medical education. Hence medical schools are incorporating POCUS in their preclinical curriculum, while others are contemplating this notion. This study aimed to assess the opinions of medical students regarding the advantages and challenges of incorporation of POCUS within the curriculum. Methods This study reports on the findings of a study carried out on a cohort of medical students during a six-week extra-curricular dissection program between their first and second years. Each student worked with their peers (3-4 members) to dissect a cadaver. Results The results are based on 31 demographically similar students, none of whom had any previous experience of cadaveric dissection or POCUS. Thematic analysis of student responses revealed that POCUS had the ability to highlight anatomical relationships in a hands-on, low stress learning environment, and had a wide breadth of clinical utility. However, the major pedagogical challenges identified were the increased cognitive load of acquiring and interpreting POCUS images and aligning them with spatial relationships. The major academic concern was that the integration of POCUS would overwhelm an already congested curriculum. Further, since POCUS is not an intuitive skill, the major logistical barriers include a need for additional equipment and faculty. Conclusion While exposure to POCUS in medical education is not novel, there is variable evidence regarding its formal integration within the anatomy curriculum. Hence, this study presents relevant information as institutes initiate steps to implement POCUS. POCUS medical education preclinical curriculum cadaveric dissection hands-on learning INTRODUCTION Challenges of learning anatomy Anatomy is a central component of preclinical medical education, and human cadaveric dissection is a key strategy for teaching anatomy (Khalil et al., 2005, Niedermair et al., 2022, Rathbun et al., 2023). It is also universally acknowledged that anatomy is a stressful subject due to its reliance on declarative memory that involves the storage and recall of facts (Hafez, 2002, Van Nuland et al., 2016; Son et al., 2023). Further, students are expected to develop procedural skills and recognize complex anatomical relationships during cadaveric dissection (Küçük et al., 2016, Chytas et al., 2023). This exacting task has become more daunting for students due to the increasing emphasis on self-directed learning (Arroyo-Jimenez Mdel, et al., 2005, Boulger, 2021). Reports suggest that the emphasis on self-directed learning has led to an increase in the cognitive load in students (Van Nuland et al., 2016, Rhodes et al., 2018, Orsini et al. 2021). Cognitive load in anatomy education The overall cognitive load of students is defined as the cumulative effect of intrinsic, extraneous, and germane loads (Lufler et al., 2022; Castellano et al., 2023). The intrinsic load is a direct function of the complexity of the performed task and the expertise of the learner, while the superfluous processes that do not directly contribute to learning constitute the extraneous load (Küçük et al., 2016, Dempsey et al., 2023). The germane load originates from the learning activities that are related to the intrinsic load. The cognitive load theory assumes a limited working memory and an unlimited long-term memory of cognitive schemas (Khalil et al., 2005, Van Nuland et al., 2016, Dempsey et al., 2023). The learning efficiency of students depends on their ability to construct and automate such schemas (Black et al., 2016, Rathbun et al., 2023). This aligns with the principles of authentic learning theory that aims to match the training of students to their professional duties (Eddy et al., 2016, Thammasitboon, Brand, 2022). This allows students to meaningfully construct concepts and relationships that involve real-world situations that are relevant to them (Eddy et al., 2016, Martin et al., 2023). Therefore, any learning activity should focus on the fundamental tenet that knowledge acquisition is affected by structured context and progressively developed by use (Stone-McLean et al., 2017, Haidar et al., 2022; Rathbun et al., 2023) . Advantages and challenges of POCUS It is established that the provision of visual feedback of spatial relationships improves learning efficiency in anatomy (Khalil et al., 2005, Black et al., 2016, Rempell et al., 2016, Stone-McLean et al., 2017). In this context, Point-of-Care Ultrasound (POCUS) offers the opportunity to develop factual (Stone-McLean et al., 2017, Haidar et al., 2022, Martin et al, 2023) and procedural (Varsou 2019, Wang et al., 2021, Lufler et al, 2022) knowledge in anatomy through visualization of internal organs. This learning tool is robustly supported by technological advances that allow students to acquire POCUS images with minimal training (Feilchenfeld et al., 2017, Haidar et al, 2022, Chytas et al., 2023). It also engages students in an interactive manner due to the opportunity for direct connectivity with a phone or tablet (Alexander et al., 2020, Son et al., 2023). This is relevant considering the increasing incorporation of POCUS in all medical disciplines (Hennekes et al., 2021, Mulder et al., 2023). While some educators have extolled the advantages of incorporation of POCUS in a cadaver dissection-based anatomy program, others have identified numerous challenges (Hennekes et al., 2021, Olivares-Perez, et al., 2022, Dempsey et al., 2023). A major concern has been the increased cognitive load imposed on students, due to inefficient instructional designs that exceed the limits of their working memory (Khoury et al., 2019, Haidar et al., 2022, McKinley et al., 2023). In addition, POCUS related curricular innovations are often unable to demonstrate to students the direct relevance of these approaches to their future professional careers (Rempell et al., 2016, Stone-McLean et al., 2017, Rathbun et al., 2023). Medical institutions are incorporating POCUS without considering the challenges and opinions of students Further, based on the premise that POCUS can facilitate anatomy teaching, some institutions have incorporated it in their preclinical curriculum, while others are contemplating this notion (Rempell et al., 2016, Alerhand et al., 2020, Wang et al., 2021; Dempsey et al., 2023). However, this is challenging due to the lack of established guidelines for integration of POCUS into an already saturated preclinical medical education (Varsou, 2019, Lufler et al., 2022, Rathbun et al., 2023). Hence, many institutional decisions related to POCUS are based more upon the perceptions of the health education planners, with a limited consideration of the opinions of students (Black, et al., 2016, Haidar et al., 2022, Son et al., 2023,). This is potentially harmful as the impact of POCUS training on the performance of first year medical students in anatomy remains disputed (Stone-McLean, 2017, Alerhand et al., 2020, Reisinger and Koratala, 2022). Conclusion In summary, integrating POCUS within the anatomy curriculum provides an opportunity to train students for future clinical practice while simultaneously developing their anatomy knowledge. However, considering the paucity of information it is necessary to evaluate the perceptions of students regarding this proposition. AIM This study aimed to assess the opinions of first year medical students regarding the incorporation of POCUS within the anatomy curriculum, with a particular focus on the perceived challenges. This will provide empirical evidence for the feasibility of a systematic implementation of POCUS training in the preclinical medical curriculum. Material and Methods This cross-sectional mixed-method study was conducted at the College of Medicine, Central Michigan University following approval by the Institutional Review Board of the university (Protocol 2023 − 277). Since the study was anonymous, it was deemed that no harm could arise to the respondents. Informed written consent was obtained from students, and it was explicitly stated that they had the option to withdraw from the study at any time. Study subjects The study was carried out during the Summer Anatomy Dissection course, an extra-curricular program that was offered in the summer (June- July 2023) to students just after completion of the M1 year. This course was chosen for this study since it had previously received high student ratings for having clearly defined learning objectives and emphasizing active student involvement. All the students included in the study had been taught anatomy in their M1 year (August-May) through a systems-based curriculum by means of prosections, textbooks, models, and imaging methods. However, none of the students had any previous experience of human cadaveric dissection or POCUS. The option to participate in this study was offered to all enrolled in the course. Learning environment in the Summer Anatomy Dissection program The Summer Anatomy Dissection course consisted of 120 hours of dissection time and included content in the following sequence: upper extremity, and back, thorax, abdomen, pelvis, lower extremity, head, and neck. The students were provided with learning objectives for each dissection session and were required to dissect by referencing the Grant’s Dissector Manual (17th Edition). Students were also expected to complete reading assignments from Grant's Dissector (Tank, 2012) and Atlas of Human Anatomy (Netter, 2010). Senior medical students, served as teaching assistants and assisted students during dissections. Each student in the course worked with a group of their peers (3–4 members) to dissect an assigned cadaver over the course of six weeks. When dissections were being performed on a small area, students rotated turns to offer every student an opportunity to dissect. Students who were not dissecting were expected to assist their colleagues in identifying all the relevant anatomical structures. Survey design The survey instruments were developed by content experts and did not undergo additional testing before implementation. The initial part of the study collected the demographic data of the participants. The opinions of students regarding the incorporation of POCUS within the premedical curriculum was evaluated at the end of the course through a voluntary anonymous questionnaire. Analysis of qualitative data Since the research team was diverse in terms of gender, disciplinary backgrounds and research experiences, a team reflexivity exercise was performed prior to data analysis. The exercise enabled the research team to understand the roles of individual team members in this study. Following the team reflexivity exercise, the student responses were systematically analyzed. At the familiarization stage, the themes of responses were identified through preliminary analysis of the responses. The preliminary thematic framework of themes and subthemes were then developed through discussions between authors. The resulting thematic framework was then used to code, chart and interpret the data (Lei et al., 2022 ). RESULTS A total of 31 students enrolled in the course and the response rate for the study was 96.77% (n=30). The gender distribution was 17 females and 14 males, there were no significant differences (P = 0.155) in the demographic characteristics of the students in the study. Advantages of POCUS Based on an analysis of the student responses, the general opinion was that POCUS enhanced the appreciation of anatomical relationships and infused clinical relevance into the anatomy content (Table 1). The following themes were identified: i. Enhancement of learning of anatomy : Students identified that incorporation of POCUS enhanced their learning of anatomy by providing real-time imagery alongside anatomical structures. Sample Comment: I think having POCUS will provide further visualization, learning and knowledge of anatomy. Having imagery along with dissection will provide a full circle approach to dissection. ii. Clinical applicability : Students felt that POCUS was transformative by providing early training in an imaging modality, thereby linking preclinical medical education and clinical practice. Sample comment: Ultrasound is huge in diagnosis in hospitals and using POCUS in lab will allow med students to become more proficient in its use and coming up with differential diagnoses. iii. Development of clinical reasoning skills: The conjunction of anatomical spatial relationships with pathological conditions promoted a holistic approach to enhancing clinical reasoning skills. Sample comment: Since medicine is moving more towards imaging, I think learning to conceptualize ultrasound images as we are learning the anatomy would be extremely beneficial for developing clinical reasoning. Challenge with POCUS The student responses indicated the following themes as being challenging for students (Table 1): i. Pedagogical challenges: the major pedagogical challenges identified by students were the increased cognitive load of acquiring and interpreting POCUS images and aligning it with the anatomically accurate spatial relationships. Sample comments: Not everyone has had experience using ultrasound, so taking the time to have instruction for using an ultrasound would be the main challenge. The cadavers aren't very mobile, so may it be difficult to visualize everything. ii. Curricular concerns: the major curricular concern among students was that the integration of POCUS would be overwhelming within an already congested preclinical medical curriculum. Sample comments: There is only a certain amount of time to use the instruments and probably a finite amount, so it would affect efficiency. Time constraints especially in first week when students don't know how to use it and also work with cadavers. iii. Logistical barriers: the students felt that the lack of adequate equipment and faculty to facilitate small group training would be a barrier in their learning. Sample comments: It may be challenging to get high quality US machines along with space constraints and the number of machines available (due to expense). In summary, the overall opinion of students was that incorporation of POCUS during cadaveric dissection represented a paradigm shift from decontextualized preclinical medical education to more clinically applicable learning. However, since POCUS is not an intuitive skill, the students felt that an optimal learning environment should include reduced cognitive load with appropriate curricular changes and logistical support. DISCUSSION The results of the study and previous reports have established that POCUS is an invaluable educational tool in preclinical medical education. Therefore, this novel opportunity should be leveraged to formally integrate POCUS into the anatomy curriculum. However, due to inadequate instructional approaches there are still barriers to its maximal utilization by medial students. Hence, POCUS should include curricular interventions that closely align with the objectives of the anatomy course to demonstrate its value to medical students. Therefore, based on existing opportunities and resources, the following measures are suggested for the effective amalgamation of anatomy and POCUS training. Teaching interventions The creation of flipped classrooms and virtual learning modules are useful teaching approaches in anatomy (Mitchell et al., 2017, Xiao and Adnan, 2022 ). Prior to each POCUS session, students can be instructed to watch brief videos created by ultrasound faculty. These videos would be viewed in sequential order, and students would not require any previous knowledge of POCUS. A dedicated website could also be developed to house all narrated videos, images, and commonly cited ultrasound publications (Feilchenfeld et al., 2017 , Kapoor et al., 2022, Rathbun et al., 2023 ). The lack of experienced instructors is a pedagogical challenge in the implementation of POCUS in the preclinical medical curriculum (Rhodes et al., 2018 , Haidar et al., 2022 , Martin et al., 2023 ). However, since early development of skills in POCUS does not require significant ultrasound expertise, even student tutors and anatomists can be effective instructors (Hennekes et al., 2021 ; Orsini et al. 2021 ; Mulder et al., 2023 ). This will allow for small student-to-instructor ratios without overextending clinical faculty time or hiring additional faculty (Feilchenfeld et al., 2017 , Wang et al., 2021 , Dempsey et al., 2023 ). Further, this small group teaching can be staggered across the curriculum with other non-POCUS activities. This will enable faculty the accommodation of an entire class in small groups over a short course of time (Valaikiene et al., 2022 , Chytas et al., 2023 ; Ludden-Schlatter et al 2023 ). The exposure to POCUS can also be extended beyond the classroom to involve extracurricular activities. Faculty can promote special interest groups hosted by POCUS trained residents to foster enthusiasm. Senior medical students can serve as near-peer teachers in these elective POCUS sessions (Van Nuland et al., 2016, Valaikiene et al., 2022 , Ludden-Schlatter et al 2023 ). Gamification, an approach that involves the incorporation of game elements into the learning environment, can also be included in these sessions (Stone-McLean et al., 2017 , Varsou 2019 , Blans et al., 2020 , Krishnamurthy et al., 2022 ). Students can be invited to compete in games that span the physics of ultrasound and POCUS image acquisition and interpretation (Perumal et al., 2022 , Castellano et al., 2023 ). These activities can be followed by a large-group interactive debriefs, which will enable a smaller number of faculty members to engage with a large group of students (Black et al., 2016 , Küçük et al., 2016 , Reisinger and Koratala, 2022 ). Logistical challenges Handheld POCUS devices are particularly useful in human cadaveric dissection due to their versatility, portability, and accessibility (Rempell et al., 2016 , McCormick et al., 2018 , Chytas et al., 2023 ). Studies have reported that with careful planning, even a limited number of POCUS devices can be used to train many students during cadaveric dissection (Rhodes et al., 2018 , Varsou 2019 , Delacruz et al., 2021 ). In such situations, students can rotate between using POCUS, observing peers, and serving as patient models. The acquired images can be uploaded into a shared cloud space where they can be reviewed by ultrasound faculty for feedback to students (Eddy et al., 2016 , Orsini et al. 2021 , Lei et al., 2022 ). In summary, this study presents information on the perceived advantages and challenges of students of the incorporation of POCUS within such a curriculum. Therefore, preclinical medical education should focus on the controlled and sustained integration of POCUS within the existing curricular structure. It should enable students to identify clinically relevant structures and demonstrate how this knowledge can be meaningfully applied beyond the anatomy laboratory. Concurrently, the objective should also be to address the apprehensions of students in adopting this learning tool and developing the confidence to utilize these tools. LIMITATIONS Despite the strengths of the study, certain limitations need to be considered. Since the sample of students was from a single institution, the external validity of the current findings is limited. Further, the positive perceptions of the course components may be influenced by the fact that students had chosen to participate in the course. Therefore, the generalization of the presented data should be interpreted with caution. CONCLUSION This study underscores the role of POCUS in the integration of clinical training into anatomy education. Since pre-clinical medical students emphasize the early introduction of imaging modalities into their curriculum, POCUS can provide a transformative instructional approach in anatomy teaching. This will provide an opportunity for preclinical students to seamlessly incorporate this tool during their clinical experiences. Declarations Disclosures All authors have declared that no financial support was received from any organization for the submitted work. All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Author Biography: Payton Wolbert, MD/MBA candidate, at Central Michigan University College of Medicine. He was a previous teaching assistant for the summer dissection program, undergraduate anatomy course, and undergraduate genetics course. Austin Basso, MD candidate, at Central Michigan University College of Medicine. He received a Bachelor of Science in Biomedical Sciences from Central Michigan University and was the ultrasound student interest group leader. Joydeep Dutta Chaudhuri, MD, is a Professor of Foundational Sciences at College of Medicine, Central Michigan University, at Mount Pleasant, Michigan. He teaches anatomy to medical students, and his research is focused on methods to enhance learning experiences of healthcare students. References Alerhand S, Choi A, Ostrovsky I, Chen S, Ramdin C, Laboy M, Lamba S. Integrating Basic and Clinical Sciences Using Point-of-Care Renal Ultrasound for Preclerkship Education. MedEdPORTAL. 2020 Dec 9;16:11037. doi: 10.15766/mep_2374-8265.11037. PMID: 33324747; PMCID: PMC7732135. 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Rempell JS, Saldana F, DiSalvo D, Kumar N, Stone MB, Chan W, Luz J, Noble VE, Liteplo A, Kimberly H, Kohler MJ. Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience. West J Emerg Med. 2016 Nov;17(6):734-740. doi: 10.5811/westjem.2016.8.31387. Epub 2016 Sep 12. PMID: 27833681; PMCID: PMC5102600. Rhodes D, Fogg QA, Lazarus MD. Dissecting the role of sessional anatomy teachers: A systematic literature review. Anat Sci Educ. 2018 Jul;11(4):410-426. doi: 10.1002/ase.1753. Epub 2017 Dec 4. PMID: 29205901. Son MJ, Thomas A, Jackson G, Banh D, Terlizzese T, Oh J, Burrows J, Vedantam R, Quach S, Gibson J. Screening unfixed cadavers with handheld ultrasound as a new teaching modality. Rural Remote Health. 2023 Jan;23(1):8144. doi: 10.22605/RRH8144. Epub 2023 Jan 10. PMID: 36802705. Stone-McLean J, Metcalfe B, Sheppard G, Murphy J, Black H, McCarthy H, Dubrowski A. Developing an Undergraduate Ultrasound Curriculum: A Needs Assessment. Cureus. 2017 Sep 28;9(9):e1720. doi: 10.7759/cureus.1720. PMID: 29188164; PMCID: PMC5705172. Thammasitboon S, Brand PLP. The physiology of learning: strategies clinical teachers can adopt to facilitate learning. Eur J Pediatr. 2022 Feb;181(2):429-433. doi: 10.1007/s00431-021-04054-7. Epub 2021 Mar 29. PMID: 33782760; PMCID: PMC8821380. Valaikiene J, Schlachetzki F, Azevedo E, Kaps M, Lochner P, Katsanos AH, Walter U, Baracchini C, Bartels E, Školoudík D. Point-of-Care Ultrasound in Neurology - Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group. Ultraschall Med. 2022 Aug;43(4):354-366. English. doi: 10.1055/a-1816-8548. Epub 2022 May 5. PMID: 35512836. Van Nuland SE, Rogers KA. E-learning, dual-task, and cognitive load: The anatomy of a failed experiment. Anat Sci Educ. 2016 Mar-Apr;9(2):186-96. doi: 10.1002/ase.1576. Epub 2015 Oct 19. PMID: 26480302. Varsou O. The Use of Ultrasound in Educational Settings: What Should We Consider When Implementing this Technique for Visualisation of Anatomical Structures? Adv Exp Med Biol. 2019;1156:1-11. doi: 10.1007/978-3-030-19385-0_1. PMID: 31338774. Wang TC, Chen WT, Kang YN, Lin CW, Cheng CY, Suk FM, Chen HY, Hsu CW, Fong TH, Huang WC. Why do pre-clinical medical students learn ultrasound? Exploring learning motivation through ERG theory. BMC Med Educ. 2021 Aug 19;21(1):438. doi: 10.1186/s12909-021-02869-4. PMID: 34412610; PMCID: PMC8375120. Xiao J, Adnan S. Flipped anatomy classroom integrating multimodal digital resources shows positive influence upon students' experience and learning performance. Anat Sci Educ. 2022 Nov;15(6):1086-1102. doi: 10.1002/ase.2207. Epub 2022 Jul 21. PMID: 35751579; PMCID: PMC9796349. Table Table 1: Advantages and Challenges of POCUS Identified by Anatomy Students Advantages Challenges 1. Enhancement of Learning of Anatomy 1. Pedagogical Challenges Students identified that POCUS enhanced their learning of anatomy by providing real-time imagery alongside anatomical structures. The major pedagogical challenges identified by students were the increased cognitive load of acquiring and interpreting POCUS images and aligning it with the anatomically accurate spatial relationships. 2. Clinical Applicability 2. Curricular Concerns Students felt that POCUS was transformative by providing early training in an imaging modality, thereby linking preclinical medical education and clinical practice. The major curricular concern among students was that the integration of POCUS would be overwhelming within an already congested preclinical medical curriculum. 3. Development of Clinical reasoning Skills 3. Logistical Barriers The conjunction of anatomical spatial relationships with pathological conditions promoted a holistic approach to enhancing clinical reasoning skills. The students felt that the lack of adequate equipment and faculty to facilitate small group training would be a barrier in their learning. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6256830","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":430746796,"identity":"08756369-fc97-4e26-884a-d09cf28ce5da","order_by":0,"name":"Payton Wolbert","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYFAC5jYGBgMGBn4g8wBjA4gkqIURqKWAgUGygTQtH4AWgVQSpcXgeGPbgw8Gd+SNj59OPPBzB4Mc340EAlrOHGw3nGHwzHDbmdwNB3vPMBhLEtJidiOxTZrH4DDjthu8Gw4DHZm4gSgtfwwO22+eAdFST5wWBoPDiRskIFoSDAhpsQf5pcfgWfIMsF/aJAxnnnmAX4tke/OxBz/+3LHtbz+7+cPPNht5vuMEbIGCAzCGBFHKUbSMglEwCkbBKMAEAFKaU9eq8uwGAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-1102-1408","institution":"Central Michigan University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Payton","middleName":"","lastName":"Wolbert","suffix":""},{"id":430746797,"identity":"d78174cd-19c8-443e-8f8c-ddc65e7f6e8d","order_by":1,"name":"Austin Basso","email":"","orcid":"","institution":"Central Michigan University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Austin","middleName":"","lastName":"Basso","suffix":""},{"id":430746798,"identity":"e3f579ca-dbe3-4f65-b6ae-ed825df0850f","order_by":2,"name":"Joydeep Chaudhuri","email":"","orcid":"","institution":"Central Michigan University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Joydeep","middleName":"","lastName":"Chaudhuri","suffix":""}],"badges":[],"createdAt":"2025-03-19 01:08:58","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6256830/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6256830/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78872002,"identity":"3a28fe33-24b8-4ebc-92c8-2d49f78823bf","added_by":"auto","created_at":"2025-03-20 06:11:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":574482,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6256830/v1/199f1f8c-f598-4aaf-9f5e-4012451dc8ee.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eIntegration of Point of Care Ultrasound (POCUS) in a Human Cadaveric Dissection Based Anatomy Program: Advantages and Challenges\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e\u003cstrong\u003eChallenges of learning anatomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnatomy is a central component of preclinical medical education,\u0026nbsp;and human cadaveric dissection is a key strategy for teaching anatomy (Khalil et al., 2005, Niedermair et al., 2022, Rathbun et al., 2023). It is also universally acknowledged that anatomy is a stressful subject due to its reliance on declarative memory that involves the storage and recall of facts (Hafez, 2002, Van Nuland et al., 2016; Son et al., 2023). Further, students are expected to develop procedural skills and recognize complex anatomical relationships during cadaveric dissection (Küçük et al., 2016, Chytas et al., 2023). This exacting task has become more daunting for students due to the increasing emphasis on self-directed learning (Arroyo-Jimenez Mdel, et al., 2005, Boulger, 2021). \u0026nbsp;Reports suggest that the emphasis on self-directed learning has led to an increase in the cognitive load in students (Van Nuland et al., 2016, Rhodes et al., 2018, Orsini et al. 2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCognitive load in anatomy education\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall cognitive load of students is defined as the cumulative effect of intrinsic, extraneous, and germane loads (Lufler et al., 2022; Castellano et al., 2023). \u0026nbsp; The intrinsic load is a direct function of the complexity of the performed task and the expertise of the learner, while the superfluous processes that do not directly contribute to learning constitute the extraneous load (Küçük et al., 2016, Dempsey et al., 2023). The germane load originates from the learning activities that are related to the intrinsic load. The cognitive load theory assumes a limited working memory and an unlimited long-term memory of cognitive schemas (Khalil et al., 2005, Van Nuland et al., 2016, Dempsey et al., 2023). The learning efficiency of students depends on their ability to construct and automate such schemas (Black et al., 2016, Rathbun et al., 2023). \u0026nbsp;This aligns with the principles of authentic learning theory that aims to match the training of students to their professional duties (Eddy et al., 2016, Thammasitboon, Brand, 2022). This allows students to meaningfully construct concepts and relationships that involve real-world situations that are relevant to them (Eddy et al., 2016, Martin et al., 2023). Therefore, any learning activity should focus on the fundamental tenet that knowledge acquisition is affected by structured context and progressively developed by use (Stone-McLean et al., 2017, Haidar et al., 2022; Rathbun et al., 2023)\u003c/p\u003e\n\u003cp\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdvantages and challenges of POCUS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is established that the provision of visual feedback of spatial relationships improves learning efficiency in anatomy (Khalil et al., 2005, Black et al., 2016, Rempell et al., 2016, Stone-McLean et al., 2017). In this context, Point-of-Care Ultrasound (POCUS) offers the opportunity to develop factual (Stone-McLean et al., 2017, Haidar et al., 2022, Martin et al, 2023) and procedural (Varsou 2019, Wang et al., 2021, Lufler et al, 2022) knowledge in anatomy through visualization of internal organs. This learning tool is robustly supported by technological advances that allow students to acquire POCUS images with minimal training (Feilchenfeld et al., 2017, Haidar et al, 2022, Chytas et al., 2023). It also engages students in an interactive manner due to the opportunity for direct connectivity with a phone or tablet (Alexander et al., 2020, Son et al., 2023). This is relevant considering the increasing incorporation of POCUS in all medical disciplines (Hennekes et al., 2021, Mulder et al., 2023). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile some educators have extolled the advantages of incorporation of POCUS in a cadaver dissection-based anatomy program, others have identified numerous challenges (Hennekes et al., 2021, Olivares-Perez, et al., 2022, Dempsey et al., 2023). A major concern has been the increased cognitive load imposed on students, due to inefficient instructional designs that exceed the limits of their working memory (Khoury et al., 2019, Haidar et al., 2022, McKinley et al., 2023). In addition, POCUS related curricular innovations are often unable to demonstrate to students the direct relevance of these approaches to their future professional careers (Rempell et al., 2016, Stone-McLean et al., 2017, Rathbun et al., 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedical institutions are incorporating POCUS without considering the challenges and opinions of students\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurther, based on the premise that POCUS can facilitate anatomy teaching, some institutions have incorporated it in their preclinical curriculum, while others are contemplating this notion (Rempell et al., 2016, Alerhand et al., 2020, Wang et al., 2021; Dempsey et al., 2023). However, this is challenging due to the lack of established guidelines for integration of POCUS into an already saturated preclinical medical education (Varsou, 2019, Lufler et al., 2022, Rathbun et al., 2023). Hence, many institutional decisions related to POCUS are based more upon the perceptions of the health education planners, with a limited consideration of the opinions of students (Black, et al., 2016, Haidar et al., 2022, Son et al., 2023,). \u0026nbsp;This is potentially harmful as the impact of POCUS training on the performance of first year medical students in anatomy remains disputed (Stone-McLean, 2017, Alerhand et al., 2020, Reisinger and Koratala, 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn summary, integrating POCUS within the anatomy curriculum provides an opportunity to train students for future clinical practice while simultaneously developing their anatomy knowledge. \u0026nbsp;However, considering the paucity of information it is necessary to evaluate the perceptions of students regarding this proposition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAIM\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to assess the opinions of first year medical students regarding the incorporation of POCUS within the anatomy curriculum, with a particular focus on the perceived challenges. This will provide empirical evidence for the feasibility of a systematic implementation of POCUS training in the preclinical medical curriculum. \u0026nbsp;\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e This cross-sectional mixed-method study was conducted at the College of Medicine, Central Michigan University following approval by the Institutional Review Board of the university (Protocol 2023\u0026thinsp;\u0026minus;\u0026thinsp;277). Since the study was anonymous, it was deemed that no harm could arise to the respondents. Informed written consent was obtained from students, and it was explicitly stated that they had the option to withdraw from the study at any time.\u003c/p\u003e\n\u003ch3\u003eStudy subjects\u003c/h3\u003e\n\u003cp\u003eThe study was carried out during the Summer Anatomy Dissection course, an extra-curricular program that was offered in the summer (June- July 2023) to students just after completion of the M1 year. This course was chosen for this study since it had previously received high student ratings for having clearly defined learning objectives and emphasizing active student involvement.\u003c/p\u003e \u003cp\u003eAll the students included in the study had been taught anatomy in their M1 year (August-May) through a systems-based curriculum by means of prosections, textbooks, models, and imaging methods. However, none of the students had any previous experience of human cadaveric dissection or POCUS. The option to participate in this study was offered to all enrolled in the course.\u003c/p\u003e\n\u003ch3\u003eLearning environment in the Summer Anatomy Dissection program\u003c/h3\u003e\n\u003cp\u003eThe Summer Anatomy Dissection course consisted of 120 hours of dissection time and included content in the following sequence: upper extremity, and back, thorax, abdomen, pelvis, lower extremity, head, and neck. The students were provided with learning objectives for each dissection session and were required to dissect by referencing the Grant\u0026rsquo;s Dissector Manual (17th Edition). Students were also expected to complete reading assignments from Grant's Dissector (Tank, 2012) and Atlas of Human Anatomy (Netter, 2010). Senior medical students, served as teaching assistants and assisted students during dissections.\u003c/p\u003e \u003cp\u003eEach student in the course worked with a group of their peers (3\u0026ndash;4 members) to dissect an assigned cadaver over the course of six weeks. When dissections were being performed on a small area, students rotated turns to offer every student an opportunity to dissect. Students who were not dissecting were expected to assist their colleagues in identifying all the relevant anatomical structures.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSurvey design\u003c/h2\u003e \u003cp\u003eThe survey instruments were developed by content experts and did not undergo additional testing before implementation. The initial part of the study collected the demographic data of the participants. The opinions of students regarding the incorporation of POCUS within the premedical curriculum was evaluated at the end of the course through a voluntary anonymous questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of qualitative data\u003c/h2\u003e \u003cp\u003eSince the research team was diverse in terms of gender, disciplinary backgrounds and research experiences, a team reflexivity exercise was performed prior to data analysis. The exercise enabled the research team to understand the roles of individual team members in this study.\u003c/p\u003e \u003cp\u003eFollowing the team reflexivity exercise, the student responses were systematically analyzed. At the familiarization stage, the themes of responses were identified through preliminary analysis of the responses. The preliminary thematic framework of themes and subthemes were then developed through discussions between authors. The resulting thematic framework was then used to code, chart and interpret the data (Lei et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 31 students enrolled in the course and the response rate for the study was 96.77% (n=30). The gender distribution was 17 females and 14 males, there were no significant differences (P = 0.155) in the demographic characteristics of the students in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdvantages of POCUS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on an analysis of the student responses, the general opinion was that POCUS enhanced the appreciation of anatomical relationships and infused clinical relevance into the anatomy content (Table 1). The following themes were identified:\u003c/p\u003e\n\u003cp\u003ei. \u003cu\u003eEnhancement of learning of anatomy\u003c/u\u003e: Students identified that incorporation of POCUS enhanced their learning of anatomy by providing real-time imagery alongside anatomical structures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample Comment: I think having POCUS will provide further visualization, learning and knowledge of anatomy. Having imagery along with dissection will provide a full circle approach to dissection.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eii. \u003cu\u003eClinical applicability\u003c/u\u003e: Students felt that POCUS was transformative by providing early training in an imaging modality, thereby linking preclinical medical education and clinical practice. \u003cem\u003eSample comment: Ultrasound is huge in diagnosis in hospitals and using POCUS in lab will allow med students to become more proficient in its use and coming up with differential diagnoses.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eiii.\u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003cu\u003eDevelopment of clinical reasoning skills:\u0026nbsp;\u003c/u\u003e The conjunction of anatomical spatial relationships with pathological conditions promoted a holistic approach to enhancing clinical reasoning skills.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample comment: Since medicine is moving more towards imaging, I think learning to conceptualize ultrasound images as we are learning the anatomy would be extremely beneficial for developing clinical reasoning.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChallenge with POCUS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe student responses indicated the following themes as being challenging for students (Table 1):\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ei. \u003cu\u003ePedagogical challenges:\u003c/u\u003e the major pedagogical challenges identified by students were the increased cognitive load of acquiring and interpreting POCUS images and aligning it with the anatomically accurate spatial relationships.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample comments:\u003c/em\u003e \u003cem\u003eNot everyone has had experience using ultrasound, so taking the time to have instruction for using an ultrasound would be the main challenge. The cadavers aren't very mobile, so may it be difficult to visualize everything.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eii. \u003cu\u003eCurricular concerns:\u003c/u\u003e the major curricular concern among students was that the integration of POCUS would be overwhelming within an already congested preclinical medical curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample comments:\u003c/em\u003e \u003cem\u003eThere is only a certain amount of time to use the instruments and probably a finite amount, so it would affect efficiency. Time constraints especially in first week when students don't know how to use it and also work with cadavers.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eiii. \u003cu\u003eLogistical barriers:\u003c/u\u003e the students felt that the lack of adequate equipment and faculty to facilitate small group training would be a barrier in their learning.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample comments:\u003c/em\u003e \u003cem\u003eIt may be challenging to get high quality US machines along with space constraints and the number of machines available (due to expense).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn summary, the overall opinion of students was that incorporation of POCUS during cadaveric dissection represented a paradigm shift from decontextualized preclinical medical education to more clinically applicable learning. However, since POCUS is not an intuitive skill, the students felt that an optimal learning environment should include reduced cognitive load with appropriate curricular changes and logistical support.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe results of the study and previous reports have established that POCUS is an invaluable educational tool in preclinical medical education. Therefore, this novel opportunity should be leveraged to formally integrate POCUS into the anatomy curriculum. However, due to inadequate instructional approaches there are still barriers to its maximal utilization by medial students. Hence, POCUS should include curricular interventions that closely align with the objectives of the anatomy course to demonstrate its value to medical students. Therefore, based on existing opportunities and resources, the following measures are suggested for the effective amalgamation of anatomy and POCUS training.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTeaching interventions\u003c/h2\u003e \u003cp\u003eThe creation of flipped classrooms and virtual learning modules are useful teaching approaches in anatomy (Mitchell et al., 2017, Xiao and Adnan, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Prior to each POCUS session, students can be instructed to watch brief videos created by ultrasound faculty. These videos would be viewed in sequential order, and students would not require any previous knowledge of POCUS. A dedicated website could also be developed to house all narrated videos, images, and commonly cited ultrasound publications (Feilchenfeld et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Kapoor et al., 2022, Rathbun et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe lack of experienced instructors is a pedagogical challenge in the implementation of POCUS in the preclinical medical curriculum (Rhodes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Haidar et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Martin et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, since early development of skills in POCUS does not require significant ultrasound expertise, even student tutors and anatomists can be effective instructors (Hennekes et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Orsini et al. \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mulder et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This will allow for small student-to-instructor ratios without overextending clinical faculty time or hiring additional faculty (Feilchenfeld et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Wang et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Dempsey et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Further, this small group teaching can be staggered across the curriculum with other non-POCUS activities. This will enable faculty the accommodation of an entire class in small groups over a short course of time (Valaikiene et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Chytas et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ludden-Schlatter et al \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe exposure to POCUS can also be extended beyond the classroom to involve extracurricular activities. Faculty can promote special interest groups hosted by POCUS trained residents to foster enthusiasm. Senior medical students can serve as near-peer teachers in these elective POCUS sessions (Van Nuland et al., 2016, Valaikiene et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Ludden-Schlatter et al \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Gamification, an approach that involves the incorporation of game elements into the learning environment, can also be included in these sessions (Stone-McLean et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, Varsou \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Blans et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Krishnamurthy et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Students can be invited to compete in games that span the physics of ultrasound and POCUS image acquisition and interpretation (Perumal et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Castellano et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These activities can be followed by a large-group interactive debriefs, which will enable a smaller number of faculty members to engage with a large group of students (Black et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e, K\u0026uuml;\u0026ccedil;\u0026uuml;k et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2016\u003c/span\u003e, Reisinger and Koratala, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLogistical challenges\u003c/h2\u003e \u003cp\u003eHandheld POCUS devices are particularly useful in human cadaveric dissection due to their versatility, portability, and accessibility (Rempell et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2016\u003c/span\u003e, McCormick et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Chytas et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Studies have reported that with careful planning, even a limited number of POCUS devices can be used to train many students during cadaveric dissection (Rhodes et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Varsou \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, Delacruz et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In such situations, students can rotate between using POCUS, observing peers, and serving as patient models. The acquired images can be uploaded into a shared cloud space where they can be reviewed by ultrasound faculty for feedback to students (Eddy et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e, Orsini et al. \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Lei et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn summary, this study presents information on the perceived advantages and challenges of students of the incorporation of POCUS within such a curriculum. Therefore, preclinical medical education should focus on the controlled and sustained integration of POCUS within the existing curricular structure. It should enable students to identify clinically relevant structures and demonstrate how this knowledge can be meaningfully applied beyond the anatomy laboratory. Concurrently, the objective should also be to address the apprehensions of students in adopting this learning tool and developing the confidence to utilize these tools.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS\u003c/h2\u003e \u003cp\u003eDespite the strengths of the study, certain limitations need to be considered. Since the sample of students was from a single institution, the external validity of the current findings is limited. Further, the positive perceptions of the course components may be influenced by the fact that students had chosen to participate in the course. Therefore, the generalization of the presented data should be interpreted with caution.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study underscores the role of POCUS in the integration of clinical training into anatomy education. Since pre-clinical medical students emphasize the early introduction of imaging modalities into their curriculum, POCUS can provide a transformative instructional approach in anatomy teaching. This will provide an opportunity for preclinical students to seamlessly incorporate this tool during their clinical experiences.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have declared that no financial support was received from any organization for the submitted work. All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Biography:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePayton Wolbert, MD/MBA candidate, at Central Michigan University College of Medicine. He was a previous teaching assistant for the summer dissection program, undergraduate anatomy course, and undergraduate genetics course.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAustin Basso, MD candidate, at Central Michigan University College of Medicine. He received a Bachelor of Science in Biomedical Sciences from Central Michigan University and was the ultrasound student interest group leader.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJoydeep Dutta Chaudhuri, MD, is a Professor of Foundational Sciences at College of Medicine, Central Michigan University, at Mount Pleasant, Michigan. \u0026nbsp;He teaches anatomy to medical students, and his research is focused on methods to enhance learning experiences of healthcare students.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlerhand S, Choi A, Ostrovsky I, Chen S, Ramdin C, Laboy M, Lamba S. Integrating Basic and Clinical Sciences Using Point-of-Care Renal Ultrasound for Preclerkship Education. 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PMID: 31338774.\u003c/li\u003e\n\u003cli\u003eWang TC, Chen WT, Kang YN, Lin CW, Cheng CY, Suk FM, Chen HY, Hsu CW, Fong TH, Huang WC. Why do pre-clinical medical students learn ultrasound? Exploring learning motivation through ERG theory. BMC Med Educ. 2021 Aug 19;21(1):438. doi: 10.1186/s12909-021-02869-4. PMID: 34412610; PMCID: PMC8375120.\u003c/li\u003e\n\u003cli\u003eXiao J, Adnan S. Flipped anatomy classroom integrating multimodal digital resources shows positive influence upon students\u0026apos; experience and learning performance. Anat Sci Educ. 2022 Nov;15(6):1086-1102. doi: 10.1002/ase.2207. Epub 2022 Jul 21. PMID: 35751579; PMCID: PMC9796349.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 1: Advantages and Challenges of POCUS Identified by Anatomy Students\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvantages\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChallenges \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003e1. Enhancement of Learning of Anatomy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003e1. Pedagogical Challenges\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003eStudents identified that POCUS enhanced their learning of anatomy by providing real-time imagery alongside anatomical structures.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003eThe major pedagogical challenges identified by students were the increased cognitive load of acquiring and interpreting POCUS images and aligning it with the anatomically accurate spatial relationships.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003e2. Clinical Applicability\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003e2. Curricular Concerns\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003eStudents felt that POCUS was transformative by providing early training in an imaging modality, thereby linking preclinical medical education and clinical practice.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003eThe major curricular concern among students was that the integration of POCUS would be overwhelming within an already congested preclinical medical curriculum.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003e3. Development of Clinical reasoning Skills\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003e3. Logistical Barriers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51.5625%;\"\u003e\n \u003cp\u003eThe conjunction of anatomical spatial relationships with pathological conditions promoted a holistic approach to enhancing clinical reasoning skills.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48.4375%;\"\u003e\n \u003cp\u003eThe students felt that the lack of adequate equipment and faculty to facilitate small group training would be a barrier in their learning.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Central Michigan University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"POCUS, medical education, preclinical curriculum, cadaveric dissection, hands-on learning","lastPublishedDoi":"10.21203/rs.3.rs-6256830/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6256830/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePoint-of-Care Ultrasound (POCUS) is emerging as a fundamental aspect of undergraduate medical education. Hence medical schools are incorporating POCUS in their preclinical curriculum, while others are contemplating this notion. This study aimed to assess the opinions of medical students regarding the advantages and challenges of incorporation of POCUS within the curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study reports on the findings of a study carried out on a cohort of medical students during a six-week extra-curricular dissection program between their first and second years. Each student worked with their peers (3-4 members) to dissect a cadaver.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results are based on 31 demographically similar students, none of whom had any previous experience of cadaveric dissection or POCUS. Thematic analysis of student responses revealed that POCUS had the ability to highlight anatomical relationships in a hands-on, low stress learning environment, and had a wide breadth of clinical utility. However, the major pedagogical challenges identified were the increased cognitive load of acquiring and interpreting POCUS images and aligning them with spatial relationships. The major academic concern was that the integration of POCUS would overwhelm an already congested curriculum. Further, since POCUS is not an intuitive skill, the major logistical barriers include a need for additional equipment and faculty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile exposure to POCUS in medical education is not novel, there is variable evidence regarding its formal integration within the anatomy curriculum. Hence, this study presents relevant information as institutes initiate steps to implement POCUS.\u003c/p\u003e","manuscriptTitle":"Integration of Point of Care Ultrasound (POCUS) in a Human Cadaveric Dissection Based Anatomy Program: Advantages and Challenges","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-20 06:03:32","doi":"10.21203/rs.3.rs-6256830/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"90b610d7-6d81-4a76-9073-52b5caa8c764","owner":[],"postedDate":"March 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-20T06:03:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-20 06:03:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6256830","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6256830","identity":"rs-6256830","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}