Zac Feilchenfeld1,2, Ayelet Kuper1,2,3, Cynthia Whitehead3,4,5. 1. Department of Medicine, University of Toronto, Toronto, ON, Canada. 2. Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 3. The Wilson Centre, Toronto, ON, Canada. 4. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. 5. Women's College Hospital, Toronto, ON, Canada.
Abstract
CONTEXT: In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education. METHODS: We conducted a Foucauldian critical discourse analysis (CDA) to identify and analyse discourses that legitimise and privilege the use of POCUS in medical education. We assembled an archive of 473 texts published between 1980 and 2017. Each article in the archive was analysed to identify frequently occurring truth statements (expressing concepts whose truths are unquestioned within particular discourses) that we used to characterise the major discourses that construct representations of POCUS in medical education. RESULTS: We identified three dominant discourses: (i) a visuo-centric discourse prioritising the visual information as truth over other clinical data; (ii) a utilitarian discourse emphasising improvements in patient care; and (iii) a modernist discourse highlighting the current and future needs of clinicians in our technological world. These discourses overlap and converge; the core discursive effect makes the further elevation of POCUS in medical education, and the resulting attenuation of other curricular priorities, appear inevitable. CONCLUSIONS: The three dominant discourses identified in this paper engender ideal conditions for the proliferation of POCUS in medical education through curricular guidelines, surveys of adherence to these guidelines and authoritative position statements. By identifying and analysing these dominant discourses, we can ask questions that do not take for granted the assumed truths underpinning the discourses, highlight potential pitfalls of proposed curricular changes and ensure these changes truly improve medical education.
CONTEXT: In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education. METHODS: We conducted a Foucauldian critical discourse analysis (CDA) to identify and analyse discourses that legitimise and privilege the use of POCUS in medical education. We assembled an archive of 473 texts published between 1980 and 2017. Each article in the archive was analysed to identify frequently occurring truth statements (expressing concepts whose truths are unquestioned within particular discourses) that we used to characterise the major discourses that construct representations of POCUS in medical education. RESULTS: We identified three dominant discourses: (i) a visuo-centric discourse prioritising the visual information as truth over other clinical data; (ii) a utilitarian discourse emphasising improvements in patient care; and (iii) a modernist discourse highlighting the current and future needs of clinicians in our technological world. These discourses overlap and converge; the core discursive effect makes the further elevation of POCUS in medical education, and the resulting attenuation of other curricular priorities, appear inevitable. CONCLUSIONS: The three dominant discourses identified in this paper engender ideal conditions for the proliferation of POCUS in medical education through curricular guidelines, surveys of adherence to these guidelines and authoritative position statements. By identifying and analysing these dominant discourses, we can ask questions that do not take for granted the assumed truths underpinning the discourses, highlight potential pitfalls of proposed curricular changes and ensure these changes truly improve medical education.
Authors: Richard A Hoppmann; Jeanette Mladenovic; Lawrence Melniker; Radu Badea; Michael Blaivas; Miguel Montorfano; Alfred Abuhamad; Vicki Noble; Arif Hussain; Gregor Prosen; Tomás Villen; Gabriele Via; Ramon Nogue; Craig Goodmurphy; Marcus Bastos; G Stephen Nace; Giovanni Volpicelli; Richard J Wakefield; Steve Wilson; Anjali Bhagra; Jongyeol Kim; David Bahner; Chris Fox; Ruth Riley; Peter Steinmetz; Bret P Nelson; John Pellerito; Levon N Nazarian; L Britt Wilson; Irene W Y Ma; David Amponsah; Keith R Barron; Renee K Dversdal; Mike Wagner; Anthony J Dean; David Tierney; James W Tsung; Paula Nocera; José Pazeli; Rachel Liu; Susanna Price; Luca Neri; Barbara Piccirillo; Adi Osman; Vaughan Lee; Nitha Naqvi; Tomislav Petrovic; Paul Bornemann; Maxime Valois; Jean-Francoise Lanctot; Robert Haddad; Deepak Govil; Laura A Hurtado; Vi Am Dinh; Robert M DePhilip; Beatrice Hoffmann; Resa E Lewiss; Nayana A Parange; Akira Nishisaki; Stephanie J Doniger; Paul Dallas; Kevin Bergman; J Oscar Barahona; Ximena Wortsman; R Stephen Smith; Craig A Sisson; James Palma; Mike Mallin; Liju Ahmed; Hassan Mustafa Journal: Ultrasound J Date: 2022-07-27
Authors: Ana Yoe-Cheng Chang Chan; Coen P M Stapper; Ronald L A W Bleys; Maarten van Leeuwen; Olle Ten Cate Journal: Adv Med Educ Pract Date: 2022-10-01