Introducing point-of-care ultrasound (PoCUS) to first-year graduate-entry medical students: a mixed methods feasibility study

Introducing point-of-care ultrasound (PoCUS) to first-year graduate-entry medical students: a mixed methods feasibility study | 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 Introducing point-of-care ultrasound (PoCUS) to first-year graduate-entry medical students: a mixed methods feasibility study Rory Crean, Andrea Doyle, Izabella Orban, Sneha Singh, Fiona Boland, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7448244/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background : Point-of-Care Ultrasound (PoCUS) is increasingly recognised as an essential clinical tool, yet there is limited formal exposure in medical school. This study introduced first-year Graduate Entry Medicine (GEM) students to PoCUS through structured teaching, simulation-based workshops, and guided practice, evaluating changes in knowledge, confidence, and attitudes toward curriculum integration, with emphasis on appropriate application and stewardship. Methods : This was a mixed-methods, single-arm pre-post study. GEM Year 1 students (n = 36) were provided a teaching intervention, preparatory online learning, a didactic introduction to PoCUS governance, and a two-hour hands-on workshop across four stations: knobology, ultrasound-guided vascular access, FAST scanning, and simulator-based pathology recognition. Pre- and post PoCUS knowledge were assessed using a 25-item multiple-choice questionnaire (MCQ) covering physics, anatomy, pathology and governance. Practical skills in probe handling, knobology, normal anatomy and pathology recognition were assessed. Attitudes toward PoCUS integration were evaluated, along with a post-session User Experience Questionnaire (UEQ), survey and focus group. Medium term retention was assessed with a repeat MCQ and OSCE 6-weeks post intervention. Results : MCQ scores improved by 37.8% (mean change: 4.2, p<0.001), and all subdomains demonstrated statistically significant gains (p<0.001). The median practical skill score (max 15) was 13 (range, 8 –15). Students rated the experience highly on the UEQ in terms of novelty, efficiency and attractiveness. Thematic analysis of feedback highlighted enthusiasm for hands-on learning, the multimodal teaching format, and relevance to clinical practice. Students expressed a desire for more practice time and the majority (64%, n = 23) supported early integration of PoCUS into the curriculum. There was no significant decline in knowledge or practical scores at 6 weeks, indicating satisfactory medium term retention. Conclusion : This feasibility study demonstrates that structured PoCUS teaching for early medical students is practical, well received, and educationally beneficial. Significant knowledge and skills gains were achieved with retention at six weeks. Importantly, governance emerged as a key educational theme, underscoring the need to teach when not to use PoCUS alongside technical competence. With modest resource requirements, early integration of PoCUS into undergraduate curricula is achievable and may promote responsible adoption in clinical practice. Point-of-Care Ultrasound Simulation Curriculum Development Graduate Entry Medicine OSCE Ultrasound Teaching Focused Assessment with Sonography for Trauma Figures Figure 1 Figure 2 Introduction Point-of-Care Ultrasound (PoCUS) has become an increasingly prevalent tool in modern clinical practice across a variety of medical disciplines, in both the hospital and primary care settings 1,2 . Its utility in enhancing diagnostic accuracy, procedural safety and clinical decision making has led to it being referred to as a “need skill” 1 . Commonly cited barriers included insufficient training, competency assurance and credentialing pathways 2 . The increasing ubiquity of PoCUS in multiple departments and wards of the hospital has led to the moniker of “the new stethoscope” 3 or the “fifth pillar” to physical examination after inspection, palpation, percussion and auscultation 4 . Given this expansion in the use of PoCUS, medical educators have responded by incorporating imaging-based learning into medical curricula to improve both knowledge of disease processes and diagnoses 5 , as well as competence in interpreting and performing PoCUS 6 . The United States leads the way in terms of integration, but the degree to which this is integrated, and at what stage, is variable 7 . In the UK, a recent national survey of anatomy departments found 55% of medical schools reported using ultrasound (US) in their teaching, though only 26% of these had teaching monthly or more frequently 8 . A systematic review of the UK landscape found evidence of formal integration in only 8 medical schools 9 . Of the 15 eligible studies in that review, most targeted clinical-year students, and the majority included hands-on sessions. Teaching staff included clinicians in 11 of the studies, academic staff in 4 and near-peer facilitators in 1. Assessment of the utility of PoCUS education varied depending on the scope of each paper, where 4 studies were purely qualitative in their assessment. Of the remaining 11, a mixed-methods approach was employed using MCQs, practical assessments and student questionnaires, with most of these studies showing either improvement of practical skills or achievement of minimum competency requirement along with near unanimous support from students for the teaching’s relevance and utility. Less than half of the included studies focused on PoCUS or US-guided procedures specifically, with most of the remaining studies integrating US into anatomy teaching. In contrast, undergraduate PoCUS instruction in Ireland remains limited. The Royal College of Surgeons in Ireland (RCSI) integrated PoCUS into the pre-clinical undergraduate curriculum in 2021, with vertical integration into clinical modules including obstetrics and gynaecology, clinical medicine and anaesthetics 10 , as has University College Dublin (UCD) more recently. This stands in contrast to students across multiple Irish medical schools participating in ultrasound training in an extra-curricular context as evidenced by their participation in the intercollegiate SonoGames. It is presently neither part of the Irish Intern curriculum 11 , or the UK’s General Medical Council’s curriculum 12 despite its proven ability to improve a required curriculum element, intravenous (IV) cannulation 13,14 . To ensure that future clinicians adopt PoCUS responsibly and effectively, we feel that formal exposure during undergraduate training will be necessary. Introducing students to the modality early may improve foundational knowledge, foster appropriate clinical reasoning and highlight both the strengths and limitations of PoCUS. This mixed-methods feasibility study addresses the limited formal adoption of PoCUS in medical curricula by piloting a small-scale, structured intervention aimed at pre-clinical students. It aims to assess the intervention’s acceptability, educational impact and student perceptions, and seeks to inform broader curricular integration of PoCUS in medical education, with particular emphasis on appropriate governance and use. Methodology Ethics Ethical approval was obtained from the RCSI’s Research Ethics Committee (REC202411008). Participation was voluntary, and informed consent was obtained from all participants. Questionnaire data was collected online using MS Forms anonymously. All test data were pseudonymised by the gatekeeper prior to analysis. Context This was a mixed-methods, single-arm, pre-post feasibility study. An invitation to participate in this study was extended by a gatekeeper to students in the 1 st year of the Graduate Entry Medicine (GEM) programme in RCSI. Students have limited formal exposure to ultrasound during the pre-clinical phase of training, despite increasing reliance on PoCUS in contemporary clinical practice. The intervention was designed to address this gap by providing structured introductory training in PoCUS during the elective week of the curriculum. The intervention was embedded within two elective modules (Emergency Medicine and Introduction to Radiology) but was also offered to students not enrolled in these streams. Intervention The PoCUS teaching module consisted of three core components, designed to address the learning outcomes for the intervention. The learning outcomes were: a) Demonstrate an understanding of the basics of POCUS knobology b) Identify and select the appropriate ultrasound probes for different clinical scenarios c) List the indications for using POCUS in emergency medicine d) Understand the limitations and potential pitfalls of POCUS e) Demonstrate the different ultrasound probe movements using appropriate terminology (sliding, rocking, fanning, rotation, compression) f) List the key areas to scan during a FAST exam g) Perform a basic POCUS assessment (e.g., FAST scan, cardiac, or abdominal). h) Demonstrate ultrasound-guided IV access. Pre-session online learning (self-directed): covering the physics of ultrasound, probe selection, basic knobology, and the clinical application of FAST (Focused Assessment with Sonography for Trauma) and RUSH (Rapid Ultrasound for Shock and Hypotension) exams. Online teaching materials were provided ahead of the session using free open access medical education (FOAM) resources, combining video demonstrations and long-form text (see Related Files for full list of resources). Students were guided towards “essential” and additional resources to review, where the essential resources (usually videos) would take 1 hour to review. In-person didactic session : a group lecture delivered at the start of the hands-on component, covering appropriate indications and principles of governance for PoCUS use. The session was led by the primary author, a clinical lecturer and incoming radiology trainee, alongside an emergency medicine physician. Hands-on workshop : a 2-hour session structured around four rotating stations: o Station 1: Introduction to knobology (basic machine controls and probe handling) o Station 2: IV access using ultrasound-guided phantoms o Station 3: FAST scanning on surface models o Station 4: Ultrasound simulator (CAE VIMEDIX ™) with side-by-side ultrasound and 3D anatomical visualisation. Stations were facilitated by a mix of faculty members and students including emergency medicine clinicians, radiology trainees, and near peer facilitators. Near peers were senior medical students involved in facilitating stations and were active members of the university’s Radiology and Emergency Medicine societies who had previously participated in national ultrasound competitions, providing them with substantial PoCUS training and experience prior to the event. Required equipment included Mindray TE9 ultrasounds equipped with a curvilinear probe (1–5.7 MHz) and linear probes (3.5-16 MHz) (Shenzhen Mindray Bio-Medical Electronics Co., China), VIMEDIX TM Ultrasound Simulator (CAE Healthcare, United States) and ultrasound phantoms (for vascular access and thoracoabdominal anatomy). Each group of students (4-5) rotated through all four stations in equal time blocks (30 minutes per station). The module concluded with a single-station OSCE-style assessment designed to reinforce and assess applied clinical skills in ultrasound. Quantitative data collection Knowledge acquisition was assessed using a 25-item multiple-choice questionnaire (MCQ) administered immediately before and after the intervention. The MCQ was developed by the research team and aligned with the intended learning outcomes of the session (see Related Files). Questions were categorised into four thematic domains: ultrasound physics and knobology (6 questions), anatomical identification (8 questions), pathology recognition (6 questions), and principles of PoCUS governance (5 questions). Each completed MCQ was scored by the main author using a standardised, pre-made marksheet reviewed by the senior author, a Consultant Radiologist and Professor of Radiology. Participants received one point for every correct answer for a maximum possible score of 25. Additionally, the number of correct responses in each domain were totalled to generate domain-specific scores. The same pool of questions was used in both pre- and post-workshop tests. Practical performance was evaluated via a single-station Objective Structured Clinical Examination (OSCE) conducted under exam conditions at the conclusion of the hands-on session. Students were provided with a brief clinical vignette. Then, using a Mindray TE9 ultrasound system (Mindray Medical International Limited, Shenzhen, China) were asked to conduct a scan on a mannequin phantom where their probe selection, handling and image optimisation were assessed. They were then asked to identify a pathology using the VIMEDIX TM simulator and identify anatomical structures on display in the region of interest. The OSCE was scored out of 15 points: 6 for probe technique and image optimisation, 4 for anatomical and pathological identification, and 5 for a global performance rating. The OSCE was examined by the same examiner who was not involved in the teaching component of the module using a pro forma rubric. The OSCE marksheet is shown in the Supplementary Information section. Student attitudes were assessed using a 5-item Likert-style questionnaire, developed to explore views on the integration of PoCUS into the medical curriculum. Students rated their agreement with statements regarding the timing, relevance, and perceived value of PoCUS instruction. The MCQ and OSCE were repeated 6 weeks after the session to assess medium term retention. Qualitative data collection Likert scale and free-text responses were collected through the post-session survey. Students were prompted to comment on what worked well, what could be improved, their perceived utility of the module and attitudes towards curricular integration. These questions aimed to elicit feedback on the online preparatory materials, didactic teaching, practical stations, and OSCE. Likert responses were dichotomised for descriptive analysis. Additionally, a validated User Experience Questionnaire (UEQ) 15 was used to evaluate student satisfaction, usability of the teaching format, and perceived educational value of the session. This was administered at the conclusion of the hands-on workshop A voluntary focus group was held after the final OSCE. This took the form of a semi-structured, in-person debrief session designed to allow richer exploration of student reflection beyond the confines of survey tools. The session was facilitated by a member of the research team not directly involved in teaching. With participant consent, the session was audio-recorded and transcribed verbatim for thematic analysis 16 . Data analysis Quantitative data were analysed using Stata v18. 17 Appropriate descriptive analysis were used to describe participants and summarise Likert responses. A repeated measures analysis was conducted initially using data from participants who completed all three time points (pre-intervention, post-intervention, and 6-week follow-up) to compare total MCQ (for each domain and overall). Paired t-tests and Wilcoxon signed rank tests were then used to compare total MCQ (for each domain and overall) and OSCE scores at the relevant time points using all available data. Both paired t-tests and Wilcoxon signed-rank tests were conducted, with the latter included to ensure robustness of findings in cases of potential violations of normality assumptions. Responses to the UEQ were entered into the official UEQ data analysis Excel tool (version 12) which calculates means, standard deviations, and confidence intervals for each of the six UEQ scales: Attractiveness, Perspicuity, Efficiency, Dependability, Stimulation, and Novelty. The tool also generates benchmark comparisons using a validated reference dataset, benchmarked against 468 other products using responses from 21175 persons. Free-text responses and focus group transcripts were analysed thematically following the Braun and Clarke framework 16,18 . Two researchers independently reviewed and coded the data, developing recurring themes related to student experience, perceived value, and suggested improvements. Results Participant demographics Of the 82 students enrolled in the 1st year of the GEM programme, 40 students consented to participate in the study and completed the baseline MCQ. 36 students went on to attend the hands-on session, with 22 of these attending for the follow-up assessment. The mean age of participants was 25.6 (SD: 4.7), Range: 21–46, with 61% female (22 participants), 36.1% male (13 participants) and 2.8% non-binary (1 participant). Of the 36 participants, the majority (83%) self-reported minimal or no familiarity with US (38% no familiarity, 44.4% minimal familiarity, 8.3% moderate familiarity and 8.3% good familiarity). Quantitative findings Knowledge acquisition In the hands-on session, a mean increase in total MCQ score of 37.8% (4.2, p < 0.001) was observed, pre to post module, which was reflected across all sub-domains (Table 1 ). Knobology scores increased by 84%, anatomy by 19%, pathology by 44.7% and governance by 21.3%, all of which were statistically significant. Table 1 Post-module knowledge check scores increased after completion of the PoCUS module. Domain Pre-module Mean Post-module Mean Mean Difference [95% CI] Paired t-test p-value Total MCQ 11.11 ± 3.82 15.31 ± 2.51 4.2 [3.11, 5.28] < 0.001 Knobology 2.25 ± 1.59 4.14 ± 1.38 1.89 [1.30, 2.48] < 0.001 Anatomy 3.69 ± 1.56 4.39 ± 1.27 0.70 [0.23, 1.16] 0.004 Pathology 2.17 ± 1.50 3.14 ± 1.07 0.97 [0.46, 1.48] < 0.001 Governance 3.00 ± 1.10 3.64 ± 1.13 0.64 [0.16, 1.12] 0.011 Pre-module vs post-module MCQ raw scores are presented (n = 36). The maximum score for the test was 25. Mean difference (post – pre scores) is also shown. Error is presented as standard deviation and statistics was performed using paired Student’s t-test. These gains in knowledge were largely retained by the 22 returning participants when comparing the post-workshop MCQ scores with the 6-week follow-up MCQ results (Table 2 ), with no significant differences observed between the post-workshop scores and 6-week follow-up scores. Table 2 Knowledge gains were maintained after 6 weeks. Domain Post-module Mean 6-week follow-up Mean Mean Difference [95% CI] Paired t-test p-value Total MCQ 15.50 ± 2.79 14.55 ± 3.29 0.95 [0.26, 2.17] 0.12 Knobology 4.00 ± 1.45 3.50 ± 1.41 0.50 [0.32, 1.32] 0.22 Anatomy 4.55 ± 1.26 4.86 ± 1.52 0.32 [0.44, 1.07] 0.39 Pathology 3.23 ± 1.07 2.77 ± 1.31 0.45 [0.15, 1.07] 0.13 Governance 3.73 ± 0.83 3.41 ± 1.01 0.32 [0.14, 0.78] 0.17 Post-module knowledge check MCQ raw scores are presented with scores 6 weeks after the workshops (n = 22). The maximum score for the test was 25. Mean difference (post – pre scores) is also shown. Error is presented as standard deviation and statistics was performed using a paired Student’s t-test. Repeated measures ANOVA was conducted to assess changes in MCQ scores across three time points (pre-intervention, post-intervention, and 6-week follow-up) using data from participants who completed all three time points (n = 22). There was a significant effect of time on total MCQ scores (F(2,42) = 22.26, p < 0.01), indicating a change over time. When examined by domain, knobology scores showed a significant improvement across time points (F(2, 42) = 14.60, p < 0.01), as did anatomy (F(2, 42) = 3.98, p = 0.03), pathology (F(2, 42) = 8.53, p < 0.01) and governance (F(2, 42) = 2.29, p = 0.01). Practical skill : Of the 36 students that participated in the summative single-station OSCE at the end of the hands-on session, the mean total OSCE score was 12.11 out of 15 (SD = 1.817). The OSCE demonstrated a wide distribution of scores (range: 8 to 15). There was no evidence of correlation between OSCE and post-MCQ scores ( r = 0.03, p = 0.84). Table 3 compares the 22 students that completed both OSCEs, with comparable probe, knowledge and total scores at both timepoints. Table 3 Scores were comparable for post-workshop and 6-week follow-up OSCEs. OSCE Domain Post-module Mean 6-week Follow-up Mean Mean Difference [95% CI] Paired t-test p-value Probe 4.86 ± 0.99 4.55 ± 0.91 0.31 [0.37, 0.99] 0.34 Knowledge 7.55 ± 1.26 7.41 ± 1.84 0.14 [1.10, 1.38] 0.75 Total 12.41 ± 1.74 11.95 ± 2.28 0.46 [0.87, 1.79] 0.49 An OSCE was performed immediately post-workshop and 6-weeks later. The maximum score for the test was 15. Mean difference is also shown. Error is presented as standard deviation and statistics was performed using a paired Student’s t-test. Wilcoxon signed-rank tests yielded comparable results throughout, supporting the findings from the paired t-tests. Attitudes towards curriculum integration 94.4% of students agreed PoCUS would enhance their physical examination skills. The majority agreed that PoCUS should be taught in conjunction with anatomy practicals (83.3%) and physical examination tutorials (63.9%), with a preference for introduction earlier in the curriculum, even before significant clinical/pathology exposure (Table 4 ). Table 4 The majority of students agreed that PoCUS should be taught earlier in medical school alongside anatomy and clinical skills and that it would enhance their physical examination skills. Attitude Statement Agree/Strongly Agree n (%) Neutral n (%) Disagree/Strongly Disagree n (%) PoCUS would enhance physical exam skills 34 (94.4%) 2 (5.6%) 0 (0%) PoCUS should be taught at same time as physical exam 23 (63.9%) 3 (8.3%) 10 (27.8%) PoCUS should be included in anatomy teaching 30 (83.3%) 1 (2.8%) 5 (13.9%) PoCUS should be taught early in the course 23 (63.9%) 4 (11.1%) 9 (25.0%) PoCUS should be taught later in medical school 12 (33.3%) 4 (11.1%) 20 (55.6%) Data was collected using a 5-point Likert scale. Agreement/disagreement was dichotomised (n = 36). User experience Students rated the module favourably in 5 of the 6 domains of the UEQ. Domains with the highest ratings were attractiveness, stimulation and efficiency. The only domain that was ranked as below average was perspicuity (Fig. 1) On completion of the 6-week follow-up session, students (n=22) were asked to rate their satisfaction with the pre-session materials, the individual stations in the hands-on session, and the module overall. 59.09% were very satisfied with the module, 31.82% were somewhat satisfied and 9.09% were neither satisfied nor dissatisfied. None reported being somewhat or very dissatisfied. Most participants rated the detail, interactivity, length and clarity of the online content as good or excellent (Figure 2 (a)). Most participants also rated all components of the hands-on workshop as good or excellent with >40% rating all aspects as excellent (Figure 2 (b)). No part of the online learning or hands-on session was rated as poor or very poor. Qualitative findings The key themes that emerged from survey text responses and the focus group were that of the learner experience, curriculum integration, clinical practice and governance. Learner Experience: Students valued interactive, hands-on resources above all, suggesting that “It would be better if we have some interactive software where we can see what the ultrasound looks like when you increase the gain or the depth. ” They felt simulation became especially meaningful with realistic models: “The surface model part was by far the most helpful and the most useful and the most interesting.” By contrast, some found the virtual reality simulation “far too detached from reality”, preferring physical practice for a genuine feel. Curriculum integration: There was a strong sense that PoCUS could be smoothly woven into several points of the curriculum, particularly anatomy and radiology: “There’s definitely many points in our curriculum where I think it could be very smoothly integrated… while we're doing the abdomen to be doing ultrasound… just having a go of it.” Students advocated for a gradual introduction, noting that “ we can’t learn everything in our first year of medicine” and suggesting skills like ultrasound-guided cannulation should come after basic techniques: “You need to know how to cannulate before using the ultrasound… that’s an extra level up.” Importantly, they stressed the need for integration rather than overload: “I would wonder about the cognitive capacity of anyone after three hours of inhaling formaldehyde,” highlighting the importance of thoughtful curriculum design. Clinical practice: Students recognised PoCUS as highly pragmatic on clinical placements after the hands-on session, especially for tasks like vascular access: “For an intern that's trying to get a line in for someone with bad access, like that's where it's useful.” However, experiences varied—while some consultants favoured it for procedures and specific bedside diagnoses, others found PoCUS less relevant when more specialised imaging was readily available: “I was in cardiology… and POCUS was also a foreign concept, it just didn't serve any utility, there was better imaging modalities, more specific ones.” Governance: Students acknowledged that “is a powerful technology that needs to be used correctly” , being used “in the right situations, not just ‘let me have a look at and see what I can find.’” Overconfidence was flagged as a risk, with one warning, “People can be quite gung-ho with especially like a newer technology… and it was really important for us to know we can't just scan everyone and take what we find as like written. Because… especially in amateur hands it's not the best.” Experience with PoCUS led to sharper insight into appropriate use and the need for training: “It is not accurate all the time, but if there is more training with PoCUS and with the advancement of ultrasound technology... we actually need more training." The main themes, subthemes and longer form quotations are shown in Table 5 (attached separately). Discussion This feasibility study demonstrates that a structured PoCUS module delivered to first-year medical students is both achievable and educationally valuable. Knowledge scores demonstrated a statistically significant immediate gain in knowledge across all domains with retention after six weeks. Similarly, practical skills were maintained as evidenced by similar OSCE scores at six weeks, indicating maintenance of competence despite limited subsequent practice. High levels of satisfaction were reported with the teaching overall, particularly in the FAST and VIMEDIX™ stations of the hands-on component. The IV access station was flagged as a component that could be deferred to a later stage in the curriculum. Qualitative comments highlighted the value of hands-on practice, desire for more time and images, appreciation of the balanced emphasis on governance and limitations, and growing confidence despite the recognition that more training is needed. These findings build on and extend existing literature. Prior surveys of UK medical schools have shown that while just over half of medical schools incorporate teaching, delivery can be limited and infrequent, with most focusing on normal anatomy and only one delivering a fiveyear curriculum 8 , 20 . The integration of imaging in the curriculum has been shown to improve student performance in areas of anatomy and pathology generally 5 , and in physical examination with ultrasound specifically 21 , 22 . It is not feasible to provide comprehensive PoCUS training to medical students, but it can be introduced effectively at an earlier stage in their education. Gains in knowledge and practical skills are consistent with other studies 23 – 26 , even though introduced at an earlier level than most. Our study contributes several novel elements. First, it targets a graduateentry cohort who may have fewer years of preclinical exposure than traditional students; the positive reception and improvement indicate that PoCUS can be introduced early without overwhelming these learners. Second, by incorporating a sixweek follow-up evaluation and showing preserved knowledge and skill, we address concerns that short courses produce only transient gains. Third, unlike most published curricula, our module explicitly covered governance, image archiving and indications and limitations (both technical and personal). Students remarked that understanding when not to use PoCUS was as important as learning how, aligning with recent calls from the Royal College of Radiologists and British Medical Ultrasound Society 27 . This is of particular importance as rapid adoption of the technology is outpacing existing safeguards 28 , 29 , with sparse literature looking at the improvement of PoCUS documentation, and evidence of variable to poor local documentation practices at baseline 30 . In the aforementioned national survey 8 , governance is only discussed in reference to management of unexpected findings in surface models and no reference is made to safe use outside of this. Similarly, in the systematic review of PoCUS in the UK 9 , only one 20 references governance in a meaningful way. Additionally, this is the first study to our knowledge to assess an educational activity as a whole using Schrepp et al. ’s UEQ 15 . Students rated the module highly in five of the six UEQ domains, particularly attractiveness, stimulation and efficiency. These dimensions align with critical factors for successful short-form education interventions, namely engagement and perceived value. Our institution has good access to simulation equipment and ultrasound devices which may not be universally available. However, the development and delivery of this module were carried out by existing teaching staff and near-peer tutors within standard timetabled hours, without requiring protected time or external funding. At its most basic, implementation requires only a surface model (routinely hired for other clinical examination sessions) and a standard ultrasound machine. Furthermore, a clear curricular framework for PoCUS already exists 31 and can be tailored to suit the scope and resources of individual institutions. Limitations This study was conducted in a single institution with a relatively small, self-selected cohort, which may introduce bias towards students more motivated or interested in PoCUS. Additionally, participants were older than the average undergraduate medical student, which may limit the generalisability. The same standardised MCQ was used across the three timepoints, which may introduce test-retest bias, and Bonferroni correction was not applied, as this was a feasibility study. Additionally, the single station OSCE does not reflect the complexity of PoCUS in clinical practice. Finally, long term retention or the impact on future clinical behaviours or competence were beyond the scope of this study. Future studies should explore longitudinal outcomes over greater periods. Conclusion In summary, our intervention reflects a scalable introduction not just to the concepts of PoCUS and its application, but also its limitations and governance issues. While large-scale roll-out requires coordination and investment, this study demonstrates that a feasible, low-cost introduction is possible with existing infrastructure. All pillars (knowledge, technical skill, governance and decision making) can be vertically integrated into the curriculum in later years to align with the broadening understanding of pathology and clinical experience. Overall, our study provides new evidence that PoCUS teaching can be effectively integrated into early graduateentry medicine curricula and underscores the importance of combining skill acquisition with governance and critical appraisal of the modality’s appropriate use. Declarations Ethics approval and consent to participate Ethical approval was obtained from the RCSI’s Research Ethics Committee (REC202411008). Participation was voluntary, and informed consent was obtained from all participants. Questionnaire data was collected online using MS Forms anonymously. All test data were pseudonymised by the gatekeeper prior to analysis. Consent for publication Not applicable Availability of data and materials The materials supporting the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare they have no competing interests. Funding This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions Each author has made substantial contributions to the work, approved the submitted version (and any substantially modified version involving their contribution), and agrees to be personally accountable for their own contributions as well as ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RC was principal investigator; conceived and designed the study; coordinated recruitment, ethics submission, and delivery of the educational intervention; oversaw data acquisition; drafted and revised the manuscript. AD Contributed to study conception and design; led participant recruitment and ethics submission; acted as gatekeeper and data controller; contributed to drafting and revision of the manuscript. IO and OT contributed to the development of teaching and assessment materials; delivered teaching sessions; facilitated data acquisition. SS contributed to the development of teaching materials; acted as OSCE examiner; contributed to study supervision and revision of the manuscript. FB advised on study methodology; conducted statistical analyses; contributed to interpretation of data. MHW, DA, IA and JN acted as near-peer facilitators during the teaching sessions; contributed to development of teaching materials; assisted with data acquisition; contributed to manuscript revision. JK, OK, MB, SS, CC and NH were senior authors; provided supervisory oversight of study design, teaching materials, and delivery; facilitated institutional support and governance; critically revised the manuscript for important intellectual content. Acknowledgements Not applicable References Wenger J, Steinbach TC, Carlbom D, Farris RW, Johnson NJ, Town J. Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system. J Clin Ultrasound. 2020 Oct;48(8):443–51. 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Anderssen LM, Petersen MS, Wang AG, Mohr M, Fjallheim AS. The efficacy of ultrasound-guided peripheral intravenous cannulation versus the landmark technique in emergency department patients with difficult intravenous access: A systematic review and meta-analysis. J Vasc Access. 2025 Jun 26;11297298251347816. Egan G, Healy D, O’Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J. 2013 Jul 1;30(7):521. Schrepp M, Hinderks A, Thomaschewski J. Applying the User Experience Questionnaire (UEQ) in Different Evaluation Scenarios. In: Marcus A, editor. Design, User Experience, and Usability Theories, Methods, and Tools for Designing the User Experience [Internet]. Cham: Springer International Publishing; 2014 [cited 2024 Nov 5]. p. 383–92. (Hutchison D, Kanade T, Kittler J, Kleinberg JM, Kobsa A, Mattern F, et al., editors. Lecture Notes in Computer Science; vol. 8517). Available from: http://link.springer.com/10.1007/978-3-319-07668-3_37 Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020 Aug 2;42(8):846–54. Stata Statistical Software. College Station, TX: StataCorp LLC.; 2025. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan;3(2):77–101. Schrepp M. Enhancing the UEQ heuristic for data cleansing by a threshold for the number of identical responses [Internet]. Unpublished; 2023 [cited 2025 Aug 4]. Available from: https://rgdoi.net/10.13140/RG.2.2.35853.00480 Wakefield RJ, Weerasinghe A, Tung P, Smith L, Pickering J, Msimanga T, et al. The development of a pragmatic, clinically driven ultrasound curriculum in a UK medical school. Med Teach. 2018 Jun 3;40(6):600–6. Liu RB, Suwondo DN, Donroe JH, Encandela JA, Weisenthal KS, Moore CL. Point‐of‐Care Ultrasound: Does it Affect Scores on Standardized Assessment Tests Used Within the Preclinical Curriculum? J Ultrasound Med. 2019 Feb;38(2):433–40. Rathbun KM, Patel AN, Jackowski JR, Parrish MT, Hatfield RM, Powell TE. Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting. BMC Med Educ [Internet]. 2023 Apr 19 [cited 2025 Jul 20];23(1). Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04227-y Hagood NL, Srivastava R, Heincelman ME, Thomas MK. Building a Point of Care Ultrasound (POCUS) Curriculum in Undergraduate Medical Education Through Stepwise Development and Assessment. POCUS J. 2025 Apr;10(1):32–7. Al-Absi DT, Simsekler MCE, Omar MA, Soliman-Aboumarie H, Abou Khater N, Mehmood T, et al. Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study. Ultrasound J [Internet]. 2024 Feb 21 [cited 2025 Jul 27];16(1). Available from: https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-023-00350-5 Gogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P. Is Basic Emergency Ultrasound Training Feasible as Part of Standard Undergraduate Medical Education? J Surg Educ. 2010 May;67(3):152–6. Okereke CD, Tung P, Weerasinghe A. Medical student Ultra Sound Training – a MUST. MedEdPublish. 2017 Jun 5;6:91. The Royal College of Radiologists. Recommendations for specialists practising ultrasound independently of radiology departments: safety, governance and education. [Internet]. 2023. Available from: https://www.rcr.ac.uk/media/pwxpdxr2/rcr-publications_recommendations-for-specialists-practising-ultrasound-independently-of-radiology-departments-safety-governance-and-education_april-2023.pdf ECRI Institute. Adoption of point-of-care ultrasound is outpacing safeguards. Hazard No. 2—2020 top 10 health technology hazards. [Internet]. Health Devices; 2019. Available from: https://www.ecri.org/EmailResources/Health%20Devices/Top_10_hazards_2020_No_2_POCUS.pdf Taylor JC. Mitigating Diagnostic Errors With Point-of-Care Ultrasonography: A New Framework. Tex Heart Inst J. 2023 Aug 25;50(4):e238234. Aziz S, Bottomley J, Mohandas V, Ahmad A, Morelli G, Thenabadu S. Improving the documentation quality of point-of-care ultrasound scans in the emergency department. BMJ Open Qual. 2020 Mar;9(1):e000636. Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, et al. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J. 2022 Dec;14(1):31. Table 5 Table 5 is available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Table5.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor invited by journal 10 Sep, 2025 Editor assigned by journal 09 Sep, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 24 Aug, 2025 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-7448244","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530627089,"identity":"8af31f53-3980-444a-9820-1a86516ef1c3","order_by":0,"name":"Rory 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1","display":"","copyAsset":false,"role":"figure","size":122998,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003e\u003cstrong\u003eUser experience scores were above average in the areas of attractiveness, efficiency, stimulation, dependability and novelty.\u003c/strong\u003e\u003c/u\u003e\u003cu\u003e \u003c/u\u003e\u003cem\u003e(A) Mean score in each domain relative to the validated dataset are presented (n=36). (B) The mean values with the benchmarked interpretation when comparing to the dataset for 468 other products from 21,175 persons \u003c/em\u003e\u003csup\u003e19\u003c/sup\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7448244/v1/bab8c57da24c8d418ceec429.png"},{"id":93764132,"identity":"23e45390-bc6f-41d3-a421-c00b3667c855","added_by":"auto","created_at":"2025-10-17 10:19:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46127,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cu\u003e\u003cstrong\u003eThe majority of students rated pre-session learning and each workshop station as good or excellent.\u003c/strong\u003e\u003c/u\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cem\u003eTop panel (A): Student satisfaction with online learning, shown by specific domain. Bottom panel (B): Student satisfaction with individual hands-on workshop stations. Responses were rated as Excellent, Good, Fair, Poor or Very Poor, with percentages for each response category stacked horizontally.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7448244/v1/788d57676a29254e91c60079.png"},{"id":93765579,"identity":"21afdb6e-f1cc-41f9-ab30-9bff2bfbd922","added_by":"auto","created_at":"2025-10-17 10:35:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1054327,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7448244/v1/d4fe47b0-9112-4419-87e1-9255ffaf7026.pdf"},{"id":93765183,"identity":"2496a023-b7d0-477e-a48a-1406401a7ab9","added_by":"auto","created_at":"2025-10-17 10:27:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20074,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-7448244/v1/b61fe366b2f1373f98a58c1b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eIntroducing point-of-care ultrasound (PoCUS) to first-year graduate-entry medical students: a mixed methods feasibility study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePoint-of-Care Ultrasound (PoCUS) has become an increasingly prevalent tool in modern clinical practice across a variety of medical disciplines, in both the hospital and primary care settings\u0026nbsp;\u003csup\u003e1,2\u003c/sup\u003e. Its utility in enhancing diagnostic accuracy, procedural safety and clinical decision making has led to it being referred to as\u0026nbsp;a “need skill”\u003csup\u003e1\u003c/sup\u003e. Commonly cited barriers included insufficient training, competency assurance and credentialing pathways\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e. The increasing ubiquity of PoCUS in multiple departments and wards of the hospital has led to the moniker of “the new stethoscope”\u0026nbsp;\u003csup\u003e3\u003c/sup\u003e or the “fifth pillar” to physical examination after inspection, palpation, percussion and auscultation\u0026nbsp;\u003csup\u003e4\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGiven this expansion in the use of PoCUS, medical educators have responded by incorporating imaging-based learning into medical curricula to improve both knowledge of disease processes and diagnoses\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e, as well as competence in interpreting and performing PoCUS\u0026nbsp;\u003csup\u003e6\u003c/sup\u003e.\u0026nbsp;The United States leads the way in terms of integration, but the degree to which this is integrated, and at what stage, is variable\u0026nbsp;\u003csup\u003e7\u003c/sup\u003e. \u0026nbsp;In the UK, a recent national survey of anatomy departments found 55% of medical schools reported using ultrasound (US) in their teaching, though only 26% of these had teaching monthly or more frequently\u0026nbsp;\u003csup\u003e8\u003c/sup\u003e. A systematic review of the UK landscape found evidence of formal integration in only 8 medical schools\u0026nbsp;\u003csup\u003e9\u003c/sup\u003e. Of the 15 eligible studies in that review, most targeted clinical-year students, and the majority included hands-on sessions. Teaching staff included clinicians in 11 of the studies, academic staff in 4 and near-peer facilitators in 1. Assessment of the utility of PoCUS education varied depending on the scope of each paper, where 4 studies were purely qualitative in their assessment. Of the remaining 11, a mixed-methods approach was employed using MCQs, practical assessments and student questionnaires, with most of these studies showing either improvement of practical skills or achievement of minimum competency requirement along with near unanimous support from students for the teaching’s relevance and utility. Less than half of the included studies focused on PoCUS or US-guided procedures specifically, with most of the remaining studies integrating US into anatomy teaching.\u003c/p\u003e\n\u003cp\u003eIn contrast, undergraduate PoCUS instruction in Ireland remains limited. \u0026nbsp;The Royal College of Surgeons in Ireland (RCSI) integrated PoCUS into the pre-clinical undergraduate curriculum in 2021, with vertical integration into clinical modules including obstetrics and gynaecology, clinical medicine and anaesthetics\u0026nbsp;\u003csup\u003e10\u003c/sup\u003e, as has University College Dublin (UCD) more recently. This stands in contrast to students across multiple Irish medical schools participating in ultrasound training in an extra-curricular context as evidenced by their participation in the intercollegiate SonoGames. It is presently neither part of the Irish Intern curriculum\u0026nbsp;\u003csup\u003e11\u003c/sup\u003e, or the UK’s General Medical Council’s curriculum\u0026nbsp;\u003csup\u003e12\u003c/sup\u003e despite its proven ability to improve a required curriculum element, intravenous (IV) cannulation\u0026nbsp;\u003csup\u003e13,14\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo ensure that future clinicians adopt PoCUS responsibly and effectively, we feel that formal exposure during undergraduate training will be necessary. Introducing students to the modality early may improve foundational knowledge, foster appropriate clinical reasoning and highlight both the strengths and limitations of PoCUS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis mixed-methods feasibility study addresses the limited formal adoption of PoCUS in medical curricula by piloting a small-scale, structured intervention aimed at pre-clinical students. It aims to assess the intervention’s acceptability, educational impact and student perceptions, and seeks to inform broader curricular integration of PoCUS in medical education, with particular emphasis on appropriate governance and use.\u0026nbsp;\u003c/p\u003e"},{"header":"Methodology","content":"\u003ch2\u003eEthics\u003c/h2\u003e\n\u003cp\u003eEthical approval was obtained from the RCSI’s Research Ethics Committee (REC202411008). Participation was voluntary, and informed consent was obtained from all participants. Questionnaire data was collected online using MS Forms anonymously. All test data were pseudonymised by the gatekeeper prior to analysis.\u003c/p\u003e\n\u003ch2 id=\"_Toc206956208\"\u003eContext\u003c/h2\u003e\n\u003cp\u003eThis was a mixed-methods, single-arm, pre-post feasibility study. An invitation to participate in this study was extended by a gatekeeper to students in the 1\u003csup\u003est\u003c/sup\u003e year of the Graduate Entry Medicine (GEM) programme in RCSI. Students have limited formal exposure to ultrasound during the pre-clinical phase of training, despite increasing reliance on PoCUS in contemporary clinical practice. The intervention was designed to address this gap by providing structured introductory training in PoCUS during the elective week of the curriculum. The intervention was embedded within two elective modules (Emergency Medicine and Introduction to Radiology) but was also offered to students not enrolled in these streams.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc206956209\"\u003eIntervention\u003c/h2\u003e\n\u003cp\u003eThe PoCUS teaching module consisted of three core components, designed to address the learning outcomes for the intervention. The learning outcomes were:\u003c/p\u003e\n\u003cp\u003ea)\u0026nbsp; \u0026nbsp;Demonstrate an understanding of the basics of POCUS knobology \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb)\u0026nbsp; \u0026nbsp;Identify and select the appropriate ultrasound probes for different clinical scenarios\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ec)\u0026nbsp; \u0026nbsp;\u0026nbsp;List the indications for using POCUS in emergency medicine \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ed)\u0026nbsp; \u0026nbsp;Understand the limitations and potential pitfalls of POCUS \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ee)\u0026nbsp; \u0026nbsp;\u0026nbsp;Demonstrate the different ultrasound probe movements using appropriate terminology (sliding, rocking, fanning, rotation, compression)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ef)\u0026nbsp; \u0026nbsp; \u0026nbsp;List the key areas to scan during a FAST exam \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eg)\u0026nbsp; \u0026nbsp;\u0026nbsp;Perform a basic POCUS assessment (e.g., FAST scan, cardiac, or abdominal).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eh)\u0026nbsp; \u0026nbsp;Demonstrate ultrasound-guided IV access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePre-session online learning\u003c/strong\u003e (self-directed): covering the physics of ultrasound, probe selection, basic knobology, and the clinical application of FAST (Focused Assessment with Sonography for Trauma) and RUSH (Rapid Ultrasound for Shock and Hypotension) exams. Online teaching materials were provided ahead of the session using free open access medical education (FOAM) resources, combining video demonstrations and long-form text (see Related Files for full list of resources). Students were guided towards “essential” and additional resources to review, where the essential resources (usually videos) would take 1 hour to review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn-person didactic session\u003c/strong\u003e: a group lecture delivered at the start of the hands-on component, covering appropriate indications and principles of governance for PoCUS use. The session was led by the primary author, a clinical lecturer and incoming radiology trainee, alongside an emergency medicine physician.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHands-on workshop\u003c/strong\u003e: a 2-hour session structured around four rotating stations:\u003c/p\u003e\n\u003cp\u003eo Station 1: Introduction to knobology (basic machine controls and probe handling)\u003c/p\u003e\n\u003cp\u003eo Station 2: IV access using ultrasound-guided phantoms\u003c/p\u003e\n\u003cp\u003eo Station 3: FAST scanning on surface models\u003c/p\u003e\n\u003cp\u003eo Station 4: Ultrasound simulator (CAE VIMEDIX ™) with side-by-side ultrasound and 3D anatomical visualisation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStations were facilitated by a mix of faculty members and students including emergency medicine clinicians, radiology trainees, and near peer facilitators. Near peers were senior medical students involved in facilitating stations and were active members of the university’s Radiology and Emergency Medicine societies who had previously participated in national ultrasound competitions, providing them with substantial PoCUS training and experience prior to the event.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRequired equipment included Mindray TE9 ultrasounds equipped with a curvilinear probe (1–5.7 MHz) and linear probes (3.5-16 MHz) (Shenzhen Mindray Bio-Medical Electronics Co., China), VIMEDIX\u003csup\u003eTM\u003c/sup\u003e Ultrasound Simulator (CAE Healthcare, United States) and ultrasound phantoms (for vascular access and thoracoabdominal anatomy).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach group of students (4-5) rotated through all four stations in equal time blocks (30 minutes per station). The module concluded with a single-station OSCE-style assessment designed to reinforce and assess applied clinical skills in ultrasound.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc206956210\"\u003eQuantitative data collection\u003c/h2\u003e\n\u003cp\u003eKnowledge acquisition was assessed using a 25-item multiple-choice questionnaire (MCQ) administered immediately before and after the intervention. The MCQ was developed by the research team and aligned with the intended learning outcomes of the session (see Related Files). Questions were categorised into four thematic domains: ultrasound physics and knobology (6 questions), anatomical identification (8 questions), pathology recognition (6 questions), and principles of PoCUS governance (5 questions). Each completed MCQ was scored by the main author using a standardised, pre-made marksheet reviewed by the senior author, a Consultant Radiologist and Professor of Radiology. Participants received one point for every correct answer for a maximum possible score of 25. Additionally, the number of correct responses in each domain were totalled to generate domain-specific scores. The same pool of questions was used in both pre- and post-workshop tests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePractical performance was evaluated via a single-station Objective Structured Clinical Examination (OSCE) conducted under exam conditions at the conclusion of the hands-on session. Students were provided with a brief clinical vignette. Then, using a Mindray TE9 ultrasound system (Mindray Medical International Limited, Shenzhen, China) were asked to conduct a scan on a mannequin phantom where their probe selection, handling and image optimisation were assessed. They were then asked to identify a pathology using the VIMEDIX\u003csup\u003eTM\u003c/sup\u003e simulator and identify anatomical structures on display in the region of interest. The OSCE was scored out of 15 points: 6 for probe technique and image optimisation, 4 for anatomical and pathological identification, and 5 for a global performance rating. The OSCE was examined by the same examiner who was not involved in the teaching component of the module using a pro forma rubric. The OSCE marksheet is shown in the Supplementary Information section. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudent attitudes were assessed using a 5-item Likert-style questionnaire, developed to explore views on the integration of PoCUS into the medical curriculum. Students rated their agreement with statements regarding the timing, relevance, and perceived value of PoCUS instruction.\u003c/p\u003e\n\u003cp\u003eThe MCQ and OSCE were repeated 6 weeks after the session to assess medium term retention.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc206956211\"\u003eQualitative data collection\u003c/h2\u003e\n\u003cp\u003eLikert scale and free-text responses were collected through the post-session survey. Students were prompted to comment on what worked well, what could be improved, their perceived utility of the module and attitudes towards curricular integration. These questions aimed to elicit feedback on the online preparatory materials, didactic teaching, practical stations, and OSCE. Likert responses were dichotomised for descriptive analysis.\u003c/p\u003e\n\u003cp\u003eAdditionally, a validated User Experience Questionnaire (UEQ)\u0026nbsp;\u003csup\u003e15\u003c/sup\u003e was used to evaluate student satisfaction, usability of the teaching format, and perceived educational value of the session. This was administered at the conclusion of the hands-on workshop\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA voluntary focus group was held after the final OSCE. This took the form of a semi-structured, in-person debrief session designed to allow richer exploration of student reflection beyond the confines of survey tools. The session was facilitated by a member of the research team not directly involved in teaching. With participant consent, the session was audio-recorded and transcribed verbatim for thematic analysis\u0026nbsp;\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e\n\u003ch2 id=\"_Toc206956212\"\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eQuantitative data were analysed using Stata v18.\u003csup\u003e17\u003c/sup\u003e\u0026nbsp; Appropriate descriptive analysis were used to describe participants and summarise Likert responses. A repeated measures analysis was conducted initially using data from participants who completed all three time points (pre-intervention, post-intervention, and 6-week follow-up) to compare total MCQ (for each domain and overall). Paired t-tests and Wilcoxon signed rank tests were then used to compare total MCQ (for each domain and overall) and OSCE scores at the relevant time points using all available data. Both paired t-tests and Wilcoxon signed-rank tests were conducted, with the latter included to ensure robustness of findings in cases of potential violations of normality assumptions.\u003c/p\u003e\n\u003cp\u003eResponses to the UEQ were entered into the official UEQ data analysis Excel tool (version 12) which calculates means, standard deviations, and confidence intervals for each of the six UEQ scales: Attractiveness, Perspicuity, Efficiency, Dependability, Stimulation, and Novelty. The tool also generates benchmark comparisons using a validated reference dataset, benchmarked against 468 other products using responses from 21175 persons.\u003c/p\u003e\n\u003cp\u003eFree-text responses and focus group transcripts were analysed thematically following the Braun and Clarke framework\u003csup\u003e16,18\u003c/sup\u003e. Two researchers independently reviewed and coded the data, developing recurring themes related to student experience, perceived value, and suggested improvements.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eParticipant demographics\u003c/p\u003e\n\u003cp\u003eOf the 82 students enrolled in the 1st year of the GEM programme, 40 students consented to participate in the study and completed the baseline MCQ. 36 students went on to attend the hands-on session, with 22 of these attending for the follow-up assessment. The mean age of participants was 25.6 (SD: 4.7), Range: 21\u0026ndash;46, with 61% female (22 participants), 36.1% male (13 participants) and 2.8% non-binary (1 participant).\u003c/p\u003e\n\u003cp\u003eOf the 36 participants, the majority (83%) self-reported minimal or no familiarity with US (38% no familiarity, 44.4% minimal familiarity, 8.3% moderate familiarity and 8.3% good familiarity).\u003c/p\u003e\n\u003cp\u003eQuantitative findings\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge acquisition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the hands-on session, a mean increase in total MCQ score of 37.8% (4.2, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was observed, pre to post module, which was reflected across all sub-domains (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Knobology scores increased by 84%, anatomy by 19%, pathology by 44.7% and governance by 21.3%, all of which were statistically significant.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePost-module knowledge check scores increased after completion of the PoCUS module.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDomain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre-module Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-module Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Difference [95% CI]\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePaired t-test p-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal MCQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.11\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2 [3.11, 5.28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnobology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.89 [1.30, 2.48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnatomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.70 [0.23, 1.16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.97 [0.46, 1.48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.64 [0.16, 1.12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ePre-module vs post-module MCQ raw scores are presented (n\u0026thinsp;=\u0026thinsp;36). The maximum score for the test was 25. Mean difference (post \u0026ndash; pre scores) is also shown. Error is presented as standard deviation and statistics was performed using paired Student\u0026rsquo;s t-test.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThese gains in knowledge were largely retained by the 22 returning participants when comparing the post-workshop MCQ scores with the 6-week follow-up MCQ results (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), with no significant differences observed between the post-workshop scores and 6-week follow-up scores.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eKnowledge gains were maintained after 6 weeks.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDomain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-module Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6-week follow-up Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Difference [95% CI]\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePaired t-test p-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal MCQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.95 [0.26, 2.17]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnobology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50 [0.32, 1.32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnatomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.32 [0.44, 1.07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.45 [0.15, 1.07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.32 [0.14, 0.78]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ePost-module knowledge check MCQ raw scores are presented with scores 6 weeks after the workshops (n\u0026thinsp;=\u0026thinsp;22). The maximum score for the test was 25. Mean difference (post \u0026ndash; pre scores) is also shown. Error is presented as standard deviation and statistics was performed using a paired Student\u0026rsquo;s t-test.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eRepeated measures ANOVA was conducted to assess changes in MCQ scores across three time points (pre-intervention, post-intervention, and 6-week follow-up) using data from participants who completed all three time points (n\u0026thinsp;=\u0026thinsp;22). There was a significant effect of time on total MCQ scores (F(2,42)\u0026thinsp;=\u0026thinsp;22.26, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating a change over time. When examined by domain, knobology scores showed a significant improvement across time points (F(2, 42)\u0026thinsp;=\u0026thinsp;14.60, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), as did anatomy (F(2, 42)\u0026thinsp;=\u0026thinsp;3.98, p\u0026thinsp;=\u0026thinsp;0.03), pathology (F(2, 42)\u0026thinsp;=\u0026thinsp;8.53, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and governance (F(2, 42)\u0026thinsp;=\u0026thinsp;2.29, p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical skill\u003c/strong\u003e: Of the 36 students that participated in the summative single-station OSCE at the end of the hands-on session, the mean total OSCE score was 12.11 out of 15 (SD\u0026thinsp;=\u0026thinsp;1.817). The OSCE demonstrated a wide distribution of scores (range: 8 to 15). There was no evidence of correlation between OSCE and post-MCQ scores (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03, p\u0026thinsp;=\u0026thinsp;0.84).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e compares the 22 students that completed both OSCEs, with comparable probe, knowledge and total scores at both timepoints.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eScores were comparable for post-workshop and 6-week follow-up OSCEs.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOSCE Domain\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-module Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6-week Follow-up Mean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean Difference [95% CI]\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePaired t-test p-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProbe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.31 [0.37, 0.99]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.14 [1.10, 1.38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46 [0.87, 1.79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eAn OSCE was performed immediately post-workshop and 6-weeks later. The maximum score for the test was 15. Mean difference is also shown. Error is presented as standard deviation and statistics was performed using a paired Student\u0026rsquo;s t-test.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eWilcoxon signed-rank tests yielded comparable results throughout, supporting the findings from the paired t-tests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAttitudes towards curriculum integration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e94.4% of students agreed PoCUS would enhance their physical examination skills. The majority agreed that PoCUS should be taught in conjunction with anatomy practicals (83.3%) and physical examination tutorials (63.9%), with a preference for introduction earlier in the curriculum, even before significant clinical/pathology exposure (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe majority of students agreed that PoCUS should be taught earlier in medical school alongside anatomy and clinical skills and that it would enhance their physical examination skills.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAttitude Statement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAgree/Strongly Agree n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNeutral n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDisagree/Strongly Disagree n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoCUS would enhance physical exam skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34 (94.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoCUS should be taught at same time as physical exam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (63.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoCUS should be included in anatomy teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoCUS should be taught early in the course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (63.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoCUS should be taught later in medical school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003eData was collected using a 5-point Likert scale. Agreement/disagreement was dichotomised (n\u0026thinsp;=\u0026thinsp;36).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUser experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents rated the module favourably in 5 of the 6 domains of the UEQ. Domains with the highest ratings were attractiveness, stimulation and efficiency. The only domain that was ranked as below average was perspicuity (Fig.\u0026nbsp;1)\u003c/p\u003e\n\u003cp\u003eOn completion of the 6-week follow-up session, students (n=22) were asked to rate their satisfaction with the pre-session materials, the individual stations in the hands-on session, and the module overall. 59.09% were very satisfied with the module, 31.82% were somewhat satisfied and 9.09% were neither satisfied nor dissatisfied. None reported being somewhat or very dissatisfied. Most participants rated the detail, interactivity, length and clarity of the online content as good or excellent (Figure 2 (a)). \u0026nbsp; Most participants also rated all components of the hands-on workshop as good or excellent with \u0026gt;40% rating all aspects as excellent (Figure 2 (b)). No part of the online learning or hands-on session was rated as poor or very poor.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eQualitative findings\u003c/h2\u003e\n\u003cp\u003eThe key themes that emerged from survey text responses and the focus group were that of the learner experience, curriculum integration, clinical practice and governance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLearner Experience:\u0026nbsp;\u003c/strong\u003eStudents valued interactive, hands-on resources above all, suggesting that \u003cem\u003e\u0026ldquo;It would be better if we have some interactive software where we can see what the ultrasound looks like when you increase the gain or the depth.\u003c/em\u003e\u0026rdquo; They felt simulation became especially meaningful with realistic models: \u003cem\u003e\u0026ldquo;The surface model part was by far the most helpful and the most useful and the most interesting.\u0026rdquo;\u0026nbsp;\u003c/em\u003eBy contrast, some found the virtual reality simulation \u003cem\u003e\u0026ldquo;far too detached from reality\u0026rdquo;,\u003c/em\u003e preferring physical practice for a genuine feel.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCurriculum integration:\u0026nbsp;\u003c/strong\u003eThere was a strong sense that PoCUS could be smoothly woven into several points of the curriculum, particularly anatomy and radiology: \u003cem\u003e\u0026ldquo;There\u0026rsquo;s definitely many points in our curriculum where I think it could be very smoothly integrated\u0026hellip; while we\u0026apos;re doing the abdomen to be doing ultrasound\u0026hellip; just having a go of it.\u0026rdquo;\u003c/em\u003e Students advocated for a gradual introduction, noting that \u0026ldquo;\u003cem\u003ewe can\u0026rsquo;t learn everything in our first year of medicine\u0026rdquo;\u0026nbsp;\u003c/em\u003eand suggesting skills like ultrasound-guided cannulation should come after basic techniques: \u003cem\u003e\u0026ldquo;You need to know how to cannulate before using the ultrasound\u0026hellip; that\u0026rsquo;s an extra level up.\u0026rdquo;\u003c/em\u003e Importantly, they stressed the need for integration rather than overload: \u003cem\u003e\u0026ldquo;I would wonder about the cognitive capacity of anyone after three hours of inhaling formaldehyde,\u0026rdquo;\u003c/em\u003e highlighting the importance of thoughtful curriculum design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical practice:\u0026nbsp;\u003c/strong\u003eStudents recognised PoCUS as highly pragmatic on clinical placements after the hands-on session, especially for tasks like vascular access: \u003cem\u003e\u0026ldquo;For an intern that\u0026apos;s trying to get a line in for someone with bad access, like that\u0026apos;s where it\u0026apos;s useful.\u0026rdquo;\u003c/em\u003e However, experiences varied\u0026mdash;while some consultants favoured it for procedures and specific bedside diagnoses, others found PoCUS less relevant when more specialised imaging was readily available: \u003cem\u003e\u0026ldquo;I was in cardiology\u0026hellip; and POCUS was also a foreign concept, it just didn\u0026apos;t serve any utility, there was better imaging modalities, more specific ones.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGovernance:\u0026nbsp;\u003c/strong\u003eStudents acknowledged that \u003cem\u003e\u0026ldquo;is a powerful technology that needs to be used correctly\u0026rdquo;\u003c/em\u003e, being used \u003cem\u003e\u0026ldquo;in the right situations, not just \u0026lsquo;let me have a look at and see what I can find.\u0026rsquo;\u0026rdquo;\u003c/em\u003e Overconfidence was flagged as a risk, with one warning, \u003cem\u003e\u0026ldquo;People can be quite gung-ho with especially like a newer technology\u0026hellip; and it was really important for us to know we can\u0026apos;t just scan everyone and take what we find as like written. Because\u0026hellip; especially in amateur hands it\u0026apos;s not the best.\u0026rdquo;\u003c/em\u003e Experience with PoCUS led to sharper insight into appropriate use and the need for training: \u003cem\u003e\u0026ldquo;It is not accurate all the time, but if there is more training with PoCUS and with the advancement of ultrasound technology... we actually need more training.\u0026quot;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe main themes, subthemes and longer form quotations are shown in Table 5 (attached separately).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis feasibility study demonstrates that a structured PoCUS module delivered to first-year medical students is both achievable and educationally valuable. Knowledge scores demonstrated a statistically significant immediate gain in knowledge across all domains with retention after six weeks. Similarly, practical skills were maintained as evidenced by similar OSCE scores at six weeks, indicating maintenance of competence despite limited subsequent practice. High levels of satisfaction were reported with the teaching overall, particularly in the FAST and VIMEDIX\u0026trade; stations of the hands-on component. The IV access station was flagged as a component that could be deferred to a later stage in the curriculum. Qualitative comments highlighted the value of hands-on practice, desire for more time and images, appreciation of the balanced emphasis on governance and limitations, and growing confidence despite the recognition that more training is needed.\u003c/p\u003e\u003cp\u003eThese findings build on and extend existing literature. Prior surveys of UK medical schools have shown that while just over half of medical schools incorporate teaching, delivery can be limited and infrequent, with most focusing on normal anatomy and only one delivering a fiveyear curriculum \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The integration of imaging in the curriculum has been shown to improve student performance in areas of anatomy and pathology generally \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and in physical examination with ultrasound specifically \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. It is not feasible to provide comprehensive PoCUS training to medical students, but it can be introduced effectively at an earlier stage in their education. Gains in knowledge and practical skills are consistent with other studies \u003csup\u003e\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e, even though introduced at an earlier level than most.\u003c/p\u003e\u003cp\u003eOur study contributes several novel elements. First, it targets a graduateentry cohort who may have fewer years of preclinical exposure than traditional students; the positive reception and improvement indicate that PoCUS can be introduced early without overwhelming these learners. Second, by incorporating a sixweek follow-up evaluation and showing preserved knowledge and skill, we address concerns that short courses produce only transient gains. Third, unlike most published curricula, our module explicitly covered governance, image archiving and indications and limitations (both technical and personal). Students remarked that understanding when not to use PoCUS was as important as learning how, aligning with recent calls from the Royal College of Radiologists and British Medical Ultrasound Society \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. This is of particular importance as rapid adoption of the technology is outpacing existing safeguards \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, with sparse literature looking at the improvement of PoCUS documentation, and evidence of variable to poor local documentation practices at baseline \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. In the aforementioned national survey \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, governance is only discussed in reference to management of unexpected findings in surface models and no reference is made to safe use outside of this. Similarly, in the systematic review of PoCUS in the UK \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, only one \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e references governance in a meaningful way.\u003c/p\u003e\u003cp\u003eAdditionally, this is the first study to our knowledge to assess an educational activity as a whole using Schrepp \u003cem\u003eet al.\u003c/em\u003e\u0026rsquo;s UEQ \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Students rated the module highly in five of the six UEQ domains, particularly attractiveness, stimulation and efficiency. These dimensions align with critical factors for successful short-form education interventions, namely engagement and perceived value.\u003c/p\u003e\u003cp\u003eOur institution has good access to simulation equipment and ultrasound devices which may not be universally available. However, the development and delivery of this module were carried out by existing teaching staff and near-peer tutors within standard timetabled hours, without requiring protected time or external funding. At its most basic, implementation requires only a surface model (routinely hired for other clinical examination sessions) and a standard ultrasound machine. Furthermore, a clear curricular framework for PoCUS already exists \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and can be tailored to suit the scope and resources of individual institutions.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eThis study was conducted in a single institution with a relatively small, self-selected cohort, which may introduce bias towards students more motivated or interested in PoCUS. Additionally, participants were older than the average undergraduate medical student, which may limit the generalisability. The same standardised MCQ was used across the three timepoints, which may introduce test-retest bias, and Bonferroni correction was not applied, as this was a feasibility study. Additionally, the single station OSCE does not reflect the complexity of PoCUS in clinical practice. Finally, long term retention or the impact on future clinical behaviours or competence were beyond the scope of this study. Future studies should explore longitudinal outcomes over greater periods.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, our intervention reflects a scalable introduction not just to the concepts of PoCUS and its application, but also its limitations and governance issues. While large-scale roll-out requires coordination and investment, this study demonstrates that a feasible, low-cost introduction is possible with existing infrastructure. All pillars (knowledge, technical skill, governance and decision making) can be vertically integrated into the curriculum in later years to align with the broadening understanding of pathology and clinical experience. Overall, our study provides new evidence that PoCUS teaching can be effectively integrated into early graduateentry medicine curricula and underscores the importance of combining skill acquisition with governance and critical appraisal of the modality\u0026rsquo;s appropriate use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the RCSI\u0026rsquo;s Research Ethics Committee (REC202411008). Participation was voluntary, and informed consent was obtained from all participants. Questionnaire data was collected online using MS Forms anonymously. All test data were pseudonymised by the gatekeeper prior to analysis.\u003c/p\u003e\n\u003cp id=\"_Toc206956222\"\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp id=\"_Toc206956223\"\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe materials supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp id=\"_Toc206956224\"\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc206956225\"\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp id=\"_Toc206956226\"\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eEach author has made substantial contributions to the work, approved the submitted version (and any substantially modified version involving their contribution), and agrees to be personally accountable for their own contributions as well as ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RC was principal investigator; conceived and designed the study; coordinated recruitment, ethics submission, and delivery of the educational intervention; oversaw data acquisition; drafted and revised the manuscript. AD Contributed to study conception and design; led participant recruitment and ethics submission; acted as gatekeeper and data controller; contributed to drafting and revision of the manuscript. IO and OT contributed to the development of teaching and assessment materials; delivered teaching sessions; facilitated data acquisition. SS contributed to the development of teaching materials; acted as OSCE examiner; contributed to study supervision and revision of the manuscript. FB advised on study methodology; conducted statistical analyses; contributed to interpretation of data. MHW, DA, IA and JN acted as near-peer facilitators during the teaching sessions; contributed to development of teaching materials; assisted with data acquisition; contributed to manuscript revision. JK, OK, MB, SS, CC and NH were senior authors; provided supervisory oversight of study design, teaching materials, and delivery; facilitated institutional support and governance; critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp id=\"_Toc206956227\"\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWenger J, Steinbach TC, Carlbom D, Farris RW, Johnson NJ, Town J. Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system. J Clin Ultrasound. 2020 Oct;48(8):443\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eStowell JR, Kessler R, Lewiss RE, Barjaktarevic I, Bhattarai B, Ayutyanont N, et al. Critical care ultrasound: A national survey across specialties. J Clin Ultrasound. 2018 Mar;46(3):167\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eBledsoe A, Zimmerman J. Ultrasound: The New Stethoscope (Point-of-Care Ultrasound). Anesthesiol Clin. 2021 Sep;39(3):537\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eNarula J, Chandrashekhar Y, Braunwald E. Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation. JAMA Cardiol. 2018 Apr 1;3(4):346. \u003c/li\u003e\n\u003cli\u003eMarsland MJ, Tomic D, Brian PL, Lazarus MD. Abdominal Anatomy Tutorial Using a Medical Imaging Platform. MedEdPORTAL. 2018 Aug 30;10748. \u003c/li\u003e\n\u003cli\u003eElhassan M, Gandhi KD, Sandhu C, Hashmi M, Bahl S. Internal medicine residents\u0026rsquo; point-of-care ultrasound skills and need assessment and the role of medical school training. Adv Med Educ Pract. 2019 May;Volume 10:379\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eDavis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in Undergraduate Medical Education: A Systematic Review. J Ultrasound Med. 2018 Nov;37(11):2667\u0026ndash;79. \u003c/li\u003e\n\u003cli\u003eTandon A, Moneim J, Hector L, Fletcher P, Moonga I, Fawcett S, et al. A national survey on the use of ultrasound as an educational tool to complement anatomy teaching at UK medical schools. Clin Anat. 2025 Jan;38(1):90\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eMcCormick E, Flanagan B, Johnson CD, Sweeney EM. Ultrasound skills teaching in UK medical education: A systematic review. Clin Teach. 2023 Sep;e13635. \u003c/li\u003e\n\u003cli\u003eKarp J, Voborsky M, Woodward C, McDermott C, Kirrane R, Gilmore R, et al. 72 Medical Student Attitudes Towards Point-of-Care Ultrasound in Undergraduate Medical Education. Int J Healthc Simul. 2021 Dec 23;ijohsj_ijaa016.015. \u003c/li\u003e\n\u003cli\u003eBoland J, Offiah G. Curriculum Framework for the Internship Programme in Ireland [Internet]. Health Service Executive; 2023. Available from: https://www.lenus.ie/handle/10147/638294\u003c/li\u003e\n\u003cli\u003eGeneral Medical Council. Practical skills and procedures. General Medical Council London; 2019. \u003c/li\u003e\n\u003cli\u003eAnderssen LM, Petersen MS, Wang AG, Mohr M, Fjallheim AS. The efficacy of ultrasound-guided peripheral intravenous cannulation versus the landmark technique in emergency department patients with difficult intravenous access: A systematic review and meta-analysis. J Vasc Access. 2025 Jun 26;11297298251347816. \u003c/li\u003e\n\u003cli\u003eEgan G, Healy D, O\u0026rsquo;Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J. 2013 Jul 1;30(7):521. \u003c/li\u003e\n\u003cli\u003eSchrepp M, Hinderks A, Thomaschewski J. Applying the User Experience Questionnaire (UEQ) in Different Evaluation Scenarios. In: Marcus A, editor. Design, User Experience, and Usability Theories, Methods, and Tools for Designing the User Experience [Internet]. Cham: Springer International Publishing; 2014 [cited 2024 Nov 5]. p. 383\u0026ndash;92. (Hutchison D, Kanade T, Kittler J, Kleinberg JM, Kobsa A, Mattern F, et al., editors. Lecture Notes in Computer Science; vol. 8517). Available from: http://link.springer.com/10.1007/978-3-319-07668-3_37\u003c/li\u003e\n\u003cli\u003eKiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020 Aug 2;42(8):846\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eStata Statistical Software. College Station, TX: StataCorp LLC.; 2025. \u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan;3(2):77\u0026ndash;101. \u003c/li\u003e\n\u003cli\u003eSchrepp M. Enhancing the UEQ heuristic for data cleansing by a threshold for the number of identical responses [Internet]. Unpublished; 2023 [cited 2025 Aug 4]. Available from: https://rgdoi.net/10.13140/RG.2.2.35853.00480\u003c/li\u003e\n\u003cli\u003eWakefield RJ, Weerasinghe A, Tung P, Smith L, Pickering J, Msimanga T, et al. The development of a pragmatic, clinically driven ultrasound curriculum in a UK medical school. Med Teach. 2018 Jun 3;40(6):600\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eLiu RB, Suwondo DN, Donroe JH, Encandela JA, Weisenthal KS, Moore CL. Point‐of‐Care Ultrasound: Does it Affect Scores on Standardized Assessment Tests Used Within the Preclinical Curriculum? J Ultrasound Med. 2019 Feb;38(2):433\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eRathbun KM, Patel AN, Jackowski JR, Parrish MT, Hatfield RM, Powell TE. Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting. BMC Med Educ [Internet]. 2023 Apr 19 [cited 2025 Jul 20];23(1). Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-023-04227-y\u003c/li\u003e\n\u003cli\u003eHagood NL, Srivastava R, Heincelman ME, Thomas MK. Building a Point of Care Ultrasound (POCUS) Curriculum in Undergraduate Medical Education Through Stepwise Development and Assessment. POCUS J. 2025 Apr;10(1):32\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eAl-Absi DT, Simsekler MCE, Omar MA, Soliman-Aboumarie H, Abou Khater N, Mehmood T, et al. Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study. Ultrasound J [Internet]. 2024 Feb 21 [cited 2025 Jul 27];16(1). Available from: https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-023-00350-5\u003c/li\u003e\n\u003cli\u003eGogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P. Is Basic Emergency Ultrasound Training Feasible as Part of Standard Undergraduate Medical Education? J Surg Educ. 2010 May;67(3):152\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eOkereke CD, Tung P, Weerasinghe A. Medical student Ultra Sound Training \u0026ndash; a MUST. MedEdPublish. 2017 Jun 5;6:91. \u003c/li\u003e\n\u003cli\u003eThe Royal College of Radiologists. Recommendations for specialists practising ultrasound independently of radiology departments: safety, governance and education. [Internet]. 2023. Available from: https://www.rcr.ac.uk/media/pwxpdxr2/rcr-publications_recommendations-for-specialists-practising-ultrasound-independently-of-radiology-departments-safety-governance-and-education_april-2023.pdf\u003c/li\u003e\n\u003cli\u003eECRI Institute. Adoption of point-of-care ultrasound is outpacing safeguards. Hazard No. 2\u0026mdash;2020 top 10 health technology hazards. [Internet]. Health Devices; 2019. Available from: https://www.ecri.org/EmailResources/Health%20Devices/Top_10_hazards_2020_No_2_POCUS.pdf\u003c/li\u003e\n\u003cli\u003eTaylor JC. Mitigating Diagnostic Errors With Point-of-Care Ultrasonography: A New Framework. Tex Heart Inst J. 2023 Aug 25;50(4):e238234. \u003c/li\u003e\n\u003cli\u003eAziz S, Bottomley J, Mohandas V, Ahmad A, Morelli G, Thenabadu S. Improving the documentation quality of point-of-care ultrasound scans in the emergency department. BMJ Open Qual. 2020 Mar;9(1):e000636. \u003c/li\u003e\n\u003cli\u003eHoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, et al. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J. 2022 Dec;14(1):31. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 5","content":"\u003cp\u003eTable 5 is available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Point-of-Care Ultrasound, Simulation, Curriculum Development, Graduate Entry Medicine, OSCE, Ultrasound Teaching, Focused Assessment with Sonography for Trauma","lastPublishedDoi":"10.21203/rs.3.rs-7448244/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7448244/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003cbr\u003e\nPoint-of-Care Ultrasound (PoCUS) is increasingly recognised as an essential clinical tool, yet there is limited formal exposure in medical school. This study introduced first-year Graduate Entry Medicine (GEM) students to PoCUS through structured teaching, simulation-based workshops, and guided practice, evaluating changes in knowledge, confidence, and attitudes toward curriculum integration, with emphasis on appropriate application and stewardship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e:\u003cbr\u003e\nThis was a mixed-methods, single-arm pre-post study. GEM Year 1 students (n = 36) were provided a teaching intervention, preparatory online learning, a didactic introduction to PoCUS governance, and a two-hour hands-on workshop across four stations: knobology, ultrasound-guided vascular access, FAST scanning, and simulator-based pathology recognition. Pre- and post PoCUS knowledge were assessed using a 25-item multiple-choice questionnaire (MCQ) covering physics, anatomy, pathology and governance. Practical skills in probe handling, knobology, normal anatomy and pathology recognition were assessed. Attitudes toward PoCUS integration were evaluated, along with a post-session User Experience Questionnaire (UEQ), survey and focus group. Medium term retention was assessed with a repeat MCQ and OSCE 6-weeks post intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003cbr\u003e\nMCQ scores improved by 37.8% (mean change: 4.2, p\u0026lt;0.001), and all subdomains demonstrated statistically significant gains (p\u0026lt;0.001). The median practical skill score (max 15) was 13 (range, 8 –15). Students rated the experience highly on the UEQ in terms of novelty, efficiency and attractiveness. Thematic analysis of feedback highlighted enthusiasm for hands-on learning, the multimodal teaching format, and relevance to clinical practice. Students expressed a desire for more practice time and the majority (64%, n = 23) supported early integration of PoCUS into the curriculum. There was no significant decline in knowledge or practical scores at 6 weeks, indicating satisfactory medium term retention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:\u003cbr\u003e\n This feasibility study demonstrates that structured PoCUS teaching for early medical students is practical, well received, and educationally beneficial. Significant knowledge and skills gains were achieved with retention at six weeks. Importantly, governance emerged as a key educational theme, underscoring the need to teach when not to use PoCUS alongside technical competence. With modest resource requirements, early integration of PoCUS into undergraduate curricula is achievable and may promote responsible adoption in clinical practice.\u003c/p\u003e","manuscriptTitle":"Introducing point-of-care ultrasound (PoCUS) to first-year graduate-entry medical students: a mixed methods feasibility study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 10:19:04","doi":"10.21203/rs.3.rs-7448244/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-31T01:35:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222077204611898777194657901351082602883","date":"2025-10-13T04:54:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-06T11:55:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-10T13:14:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T06:23:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T06:22:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-24T20:49:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70c2e344-b3a2-4564-b40c-60571146e2f8","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-17T10:19:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 10:19:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7448244","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7448244","identity":"rs-7448244","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}