Peer-Led Point-of-Care Ultrasound; A Potential Ally to Rural Medicine

Main Article Content

Michel Khoury
Shankar Sethuraman
Samuel Wilson




Point of care ultrasound (POCUS) is increasingly used in rural settings where it’s portability,and imaging capabilities make it effective clinically. POCUS teaching has traditionally relied on faculty instruction, which is limited by the small number of certified faculty members. The UOttawa POCUS interest group deployed peer-teaching since 2018, which overcomes the instructor barrier by employing experienced medical students to train preclerkship students. This paper will evaluate the efficacy of the peer-led POCUS workshops as a learning format.




3-hour POCUS workshops were held for Cardiac, MSK, Aorta, and eFAST scans from October 2018 to June 2019. Students with prior experience in POCUS were identified as peer-teachers, and were trained by an expert physician prior to the workshop. Peer-teachers taught a small group, with physician experts rotating through groups for technical support.

Surveys were sent out to students who participated in the workshops assessing the following categories:utility, learning experience,workshop efficacy, tutor competence, and interest. Descriptive statistics and thematic analysis was reported for the quantitative and qualitative data, respectively.




45 participants completed the survey. The surveys showed positive support for the aforementioned categories, with the average score being greater than 4. From the thematic analysis, the four main strengths of the peer-led format are: Trainer competence, learner comfort, situational teaching, and opportunity to practice. 




Peer-led workshops are an effective format for POCUS training in instructor-constrained settings. These workshops can be translated to rural settings in lieu of a formal POCUS training program.

Article Details



1. Topping KJ. The effectiveness of peer tutoring in further and higher education: A typology and review of the literature. High Educ. 1996 Oct 1;32(3):321–45.
2. Benè KL, Bergus G. When learners become teachers: a review of peer teaching in medical student education. Fam Med. 2014 Dec;46(10):783–7.
3. Yu T-C, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school. Adv Med Educ Pract. 2011;2:157–72.
4. Soriano RP, Blatt B, Coplit L, CichoskiKelly E, Kosowicz L, Newman L, et al. Teaching medical students how to teach: a national survey of students-as-teachers programs in U.S. medical schools. Acad Med. 2010 Nov;85(11):1725–31.
5. Tayler N, Hall S, Carr NJ, Stephens JR, Border S. Near peer teaching in medical curricula: integrating student teachers in pathology tutorials. Med Educ Online [Internet]. 2015 Jun 30 [cited 2019 Aug 25];20. Available from:
6. Hall S, Stephens J, Andrade T, Davids J, Powell M, Border S. Perceptions of junior doctors and undergraduate medical students as anatomy teachers: Investigating distance along the near-peer teaching spectrum. Anat Sci Educ. 2014 Jun;7(3):242–7.
7. Nelson AJ, Nelson SV, Linn AMJ, Raw LE, Kildea HB, Tonkin AL. Tomorrow’s educators … today? Implementing near-peer teaching for medical students. Med Teach. 2013;35(2):156–9.
8. DesJardin JT, Ricceri SK, Brown SD, Webb EM, Naeger DM, Teismann NA. A Near-peer Point-of-care Ultrasound Elective for Medical Students: Impact on Anatomy Knowledge, Perceptions About Ultrasound, and Self-reported Skill Level. Academic Radiology. 2017 Jun;24(6):772–9.
9. Shankar H, Pagel PS. Potential Adverse Ultrasound-related Biological EffectsA Critical Review. Anesthes. 2011 Nov 1;115(5):1109–24.
10. Jeppesen KM, Bahner DP. Teaching bedside sonography using peer mentoring: a prospective randomized trial. J Ultrasound Med. 2012 Mar;31(3):455–9.
11. Knobe M, Münker R, Sellei RM, Holschen M, Mooij SC, Schmidt-Rohlfing B, et al. Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound. Med Educ. 2010 Feb;44(2):148–55.
12. Kühl M, Wagner R, Bauder M, Fenik Y, Riessen R, Lammerding-Köppel M, et al. Student tutors for hands-on training in focused emergency echocardiography – a randomized controlled trial. BMC Med Educ. 2012 Oct 29;12:101.
13. Dickerson J, Paul K, Vila P, Whiticar R. The role for peer-assisted ultrasound teaching in medical school. Clin Teach. 2017 Jun;14(3):170–4.
14. Ahn JS, French AJ, Thiessen MEW, Kendall JL. Training peer instructors for a combined ultrasound/physical exam curriculum. Teach Learn Med. 2014;26(3):292–5.
15. Fox JC, Chiem AT, Rooney KP, Maldonaldo G. Web-based lectures, peer instruction and ultrasound-integrated medical education. Med Educ. 2012 Nov;46(11):1109–10.
16. Rempell JS, Saldana F, DiSalvo D, Kumar N, Stone MB, Chan W, et al. Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience. West J Emerg Med. 2016 Nov;17(6):734–40.
17. H SA, Q S, M D, M K, J P, V M, et al. Structured, Small-group Hands-on Teaching Sessions Improve Pre-clerk Knowledge and Confidence in Point-of-care Ultrasound Use and Interpretation. Cureus [Internet]. 2018 Oct 23 [cited 2019 Sep 1];10(10). Available from:
18. Weyrich P, Celebi N, Schrauth M, Möltner A, Lammerding-Köppel M, Nikendei C. Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ. 2009 Feb;43(2):113–20.
19. Tolsgaard MG, Gustafsson A, Rasmussen MB, Høiby P, Müller CG, Ringsted C. Student teachers can be as good as associate professors in teaching clinical skills. Med Teach. 2007 Sep;29(6):553–7.
20. Fahey A, Day NA, Gelber H. Tele-education in child mental health for rural allied health workers. J Telemed Telecare. 2003;9(2):84–8.
21. DuBose TJ, Bittengle J, Donaldsont R. Diagnostic Medical Sonography, Interactive Video, and Distance Learning. Journal of Diagnostic Medical Sonography. 1997 May 1;13(3):146–52.
22. Berndt A, Murray CM, Kennedy K, Stanley MJ, Gilbert-Hunt S. Effectiveness of distance learning strategies for continuing professional development (CPD) for rural allied health practitioners: a systematic review. BMC Med Educ. 2017 Jul 12;17(1):117.
23. de Menezes S, Premnath D. Near-peer education: a novel teaching program. Int J Med Educ. 2016 May 30;7:160–7.
24. Edgar L, Fraccaro L, Park L, MacIsaac J, Pageau P, Ramnanan C, et al. MP16: Which PoCUS skills are retained over time for medical students? Canadian Journal of Emergency Medicine. 2019 May;21(S1):S47–8.
25. Hayward M, Chan T, Healey A. Dedicated time for deliberate practice: one emergency medicine program’s approach to point-of-care ultrasound (PoCUS) training. CJEM. 2015 Sep;17(5):558–61.
26. Ramnanan CJ, Pound LD. Advances in medical education and practice: student perceptions of the flipped classroom. Adv Med Educ Pract. 2017 Jan 13;8:63–73.
27. Lyon M, Blaivas M, Brannam L. Use of emergency ultrasound in a rural ED with limited radiology services. Am J Emerg Med. 2005 Mar;23(2):212–4.
28. Moore CL, Copel JA. Point-of-Care Ultrasonography. New England Journal of Medicine. 2011 Feb 24;364(8):749–57.
29. Arienti V, Camaggi V. Clinical applications of bedside ultrasonography in internal and emergency medicine. Intern Emerg Med. 2011 Jun 1;6(3):195–201.
30. Thomas HA, Beeson MS, Binder LS, Brunett PH, Carter MA, Chisholm CD, et al. The 2005 Model of the Clinical Practice of Emergency Medicine: the 2007 update. Acad Emerg Med. 2008 Aug;15(8):776–9.
31. Emergency Ultrasound Guidelines. Annals of Emergency Medicine. 2009 Apr 1;53(4):550–70.
32. Leschyna M, Hatam E, Britton S, Myslik F, Thompson D, Sedran R, et al. Current State of Point-of-care Ultrasound Usage in Canadian Emergency Departments. Cureus. 2019 Mar 13;11(3):e4246.
33. Nixon G, Blattner K, Koroheke‐Rogers M, Muirhead J, Finnie WL, Lawrenson R, et al. Point-of-care ultrasound in rural New Zealand: Safety, quality and impact on patient management. Australian Journal of Rural Health. 2018;26(5):342–9.
34. Glazebrook R, Manahan D, Chater AB. Evaluation of an ultrasound program (intermediate obstetric and emergency medicine) for Australian rural and remote doctors. Aust J Rural Health. 2005 Oct;13(5):295–9.
35. Glazebrook R, Manahan D, Chater B, Barker P, Row D, Steele B, et al. Educational needs of rural and remote Australian non-specialist medical practitioners for obstetric ultrasound. Aust J Rural Health. 2004 Apr;12(2):73–80.
36. Léger P, Fleet R, Maltais-Giguère J, Plant J, Piette É, Légaré F, et al. A majority of rural emergency departments in the province of Quebec use point-of-care ultrasound: a cross-sectional survey. BMC Emerg Med. 2015 Dec 11;15:36.
37. Epstein D, Petersiel N, Klein E, Marcusohn E, Aviran E, Harel R, et al. Pocket-size point-of-care ultrasound in rural Uganda - A unique opportunity “to see”, where no imaging facilities are available. Travel Med Infect Dis. 2018 Jun;23:87–93.
38. Steinmetz P, Dobrescu O, Oleskevich S, Lewis J. Bedside ultrasound education in Canadian medical schools: A national survey. Can Med Educ J. 2016;7(1):e78-86.
39. Micks T, Sue K, Rogers P. Barriers to point-of-care ultrasound use in rural emergency departments. CJEM. 2016 Nov;18(6):475–9.
40. Wanjiku GW, Bell G, Wachira B. Assessing a novel point-of-care ultrasound training program for rural healthcare providers in Kenya. BMC Health Serv Res [Internet]. 2018 Aug 6 [cited 2019 Aug 30];18. Available from:
41. Cawthorn TR, Nickel C, O’Reilly M, Kafka H, Tam JW, Jackson LC, et al. Development and Evaluation of Methodologies for Teaching Focused Cardiac Ultrasound Skills to Medical Students. Journal of the American Society of Echocardiography. 2014 Mar;27(3):302–9.
42. Denny SP, Minteer WB, Fenning RTH, Aggarwal S, Lee DH, Raja SK, et al. Ultrasound curriculum taught by first-year medical students: A four-year experience in Tanzania. World J Emerg Med. 2018;9(1):33–40.
43. Dinh VA, Dukes WS, Prigge J, Avila M. Ultrasound Integration in Undergraduate Medical Education: Comparison of Ultrasound Proficiency Between Trained and Untrained Medical Students. Journal of Ultrasound in Medicine. 2015;34(10):1819–24.
44. Fu JY, Krause C, Krause R, Mccoy J, Schindler A, Udrea DS, et al. Integration of Point-of-Care Ultrasound Training into Undergraduate Medical Curricula–-A Perspective from Medical Students. J Med Educ Curric Dev [Internet]. 2016 May 29 [cited 2019 Jul 9];3. Available from:
45. Kobal SL, Trento L, Baharami S, Tolstrup K, Naqvi TZ, Cercek B, et al. Comparison of Effectiveness of Hand-Carried Ultrasound to Bedside Cardiovascular Physical Examination. The American Journal of Cardiology. 2005 Oct;96(7):1002–6.
46. Mai T, Woo MY, Boles K, Jetty P. Point-of-Care Ultrasound Performed by a Medical Student Compared to Physical Examination by Vascular Surgeons in the Detection of Abdominal Aortic Aneurysms. Annals of Vascular Surgery. 2018 Oct;52:15–21.
47. Shokoohi H, Boniface K, Kaviany P, Armstrong P, Calabrese K, Pourmand A. An Experiential Learning Model Facilitates Learning of Bedside Ultrasound by Preclinical Medical Students. Journal of Surgical Education. 2016 Mar;73(2):208–14.
48. Udrea DS, Sumnicht A, Lo D, Villarreal L, Gondra S, Chyan R, et al. Effects of Student-Performed Point-of-Care Ultrasound on Physician Diagnosis and Management of Patients in the Emergency Department. The Journal of Emergency Medicine. 2017 Jul;53(1):102–9.