Managing Incidental Findings from Educational Ultrasound: Best Practice Guidelines from a Scottish Medical School

Varsou, O. , Hughes, A., Humphreys, R. and Laidlaw, A. (2019) Managing Incidental Findings from Educational Ultrasound: Best Practice Guidelines from a Scottish Medical School. ASME ASM 2019, Glasgow, UK, 03-05 Jul 2019.

Abstract

Background & Purpose The incorporation of ultrasound training in undergraduate curricula is increasing at a fast pace (1). The serendipitous discovery of a potential incidental finding (IF) in student volunteers, who participate in ultrasound sessions as peer models for demonstration purposes, is an important aspect not to be neglected. These IFs could be defined as “unexpected findings with potential health implications, that also include false positives most likely resulting from ultrasound artefacts, identified on the person being scanned” (1). As educationalists, it is our professional and ethical duty to have processes in place for the management of IFs. Standardised mechanisms will mitigate undue distress (2) resulting from potential variability in practice (1). We have produced best practice guidelines as a written policy exploring consent processes, debriefing sessions, and our role as teachers in this context. Our aim was to ensure that a standardised mechanism is in place at the University of St Andrews School of Medicine, Scotland UK for the management of IFs involving student volunteers and simulated patients participating in clinical skills sessions not only limited to ultrasound scanning. We would like to disseminate our experience and preliminary results with the wider medical education community. Methodology The planning stage was an integral part of this process including literature search, seeking expert opinions, on-going discussions with the local risk advisor and safety officer, and independent review by the School of Medicine Ethics committee (approval code: MD13175). This stage flushed out important logistical and ethical concerns that we addressed in the guidelines. The annual signing of the School Agreement/Student Contract, according to which our medical students confirm their participation as peer models in clinical skills sessions, alongside tailored pre-sessional information linked to each ultrasound sessions are viewed as written informed consent. In the pre-sessional information, it is emphasised that such sessions do not carry any diagnostic value and instead they are used purely for educational purposes in terms of consolidating scientific knowledge and linking this to related clinical applications. It is also stated that there may be a possibility of identifying a potential IF and that participation in ultrasound scanning is voluntary. In the case of an IF, the student volunteer is invited to attend a face-to-face debriefing session with the lead tutor during which they are advised about follow up steps and are given a template letter for their general practitioner (GP). This session mitigates any immediate fears without providing a false sense reassurance. The template letter, which does not contain any medical information, standardises the written information provided. Confidentially and privacy are maintained at all times during the above discussions and thereafter. It is important to highlight that teaching staff, clinical or non-clinical, do not make a diagnosis as this is outwith our role as teachers. The same process applies to simulated patients with potential IFs. Results The written policy has been implemented since October 2017 (3) with no complaints from student volunteers, simulated patients, educationalists, and GPs. In this presentation, we will endeavour to discuss our local guidelines with preliminary data collected on IFs since the introduction of the above written policy including summary statistics on reported cases, cohorts involved (i.e. students volunteers or simulated patients), and teaching sessions. Discussion & Conclusions The above guidelines have allowed us to standardise the management of IFs in educational ultrasound and throughout all clinical skills sessions. Consensus recommendations from a multidisciplinary panel of experts – medical educationalists, ethicists, risk/liability advisors – are needed with the aim of standardising IF mechanisms across all institutions (1). References 1. Varsou O. Chapter 1: The Use of Ultrasound in Educational Settings: What Should We Consider When Implementing this Technique for Visualisation of Anatomical Structures?. In: Rea PM, Editor. Biomedical Visualisation Volume 3 2019 (in press). Switzerland: Springer International Publishing. 2. Siegel‐Richman Y, Kendall JL. Incidental Findings in Student Ultrasound Models: Implications for Instructors. J Ultrasound Med 2017;36(8):1739–43. 3. School of Medicine Handbook. Management of Incidental Findings in BSc (Hons) Medicine Practical Sessions [online]. University of St Andrews School of Medicine. 2019. Available from: http://medhandbook.st-andrews.ac.uk/wp-content/uploads/2017/10/UG-teaching_management-of-teaching_incidental-findings-BSc-Hons.pdf [accessed 12 Jan 2019].

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Varsou, Dr Ourania
• Authors: Varsou, O., Hughes, A., Humphreys, R., and Laidlaw, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Life Sciences
• Copyright Holders: Copyright © 2019 The Authors
• Publisher Policy: Reproduced with the permission of the Authors

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