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Point of Care UltraSound (PoCUS) is used bedside as part of the clinical examination. Although its clinical integration is currently being promoted in the medical world and facilitated by the improved portability and reduced cost of ultrasound machines, there is still a pressing need to evaluate its diagnostic accuracy, its impact on the diagnostic approach, as well as PoCUS education.

PoCUS can be used in many ways during the clinical examination. The following analysis mainly focuses on PoCUS use to assess the right upper quadrant (RUQ) of the abdomen by collecting data about PoCUS diagnostic accuracy for gallbladder assessment, evaluating the impact of PoCUS of the RUQ on the diagnostic approach, and exploring PoCUS teaching opportunities among undergraduate medical students along with the current state of PoCUS education in medical faculties throughout Europe.

In some cases, the boundaries between comprehensive ultrasound performed in radiology and PoCUS are difficult to define, which may lead to tensions between different medical societies. This seems particularly true for PoCUS of the abdomen. Although cardiac ultrasound is mainly performed by cardiologists, and X-ray and computed tomography are favored over ultrasound for lung monitoring, abdominal ultrasound is still the modality of choice to investigate the abdomen, especially in the case of RUQ pain. Differentiating the need for abdominal PoCUS instead of comprehensive ultrasound can therefore be difficult. PoCUS is nevertheless part of the clinical examination and therefore differs from comprehensive ultrasound on account of its bedside use during the clinical examination prior to the planning of other complementary investigations in the overall diagnostic approach.

Among other estimates, sensitivity and specificity are essential to appreciate the diagnostic accuracy of a diagnostic tool and to estimate post-test results integrated into the clinical approach. To address this specific issue, the initial research intention of this PhD was the conduct of a systematic review, which aimed to determine the agreement between PoCUS and RADUS in the evaluation of the gallbladder to identify cholelithiasis or cholecystitis in the ED. These estimates are nevertheless not the only aspect to consider when evaluating the overall diagnostic approach, which raised the issue of the clinical utility of PoCUS rather than its diagnostic accuracy alone. Differential diagnosis is not the only substantial item of the overall diagnostic approach. Therefore, as any effective diagnostic approach should have a differential diagnosis list, treatment plan, and choice of complementary diagnostic tests deemed to be consistent with the final diagnosis, the second research intention of this PhD was to investigate the contribution of PoCUS to the overall diagnostic approach in the case of RUQ abdominal pain in the ED. As it was shown that PoCUS enhances the overall diagnostic approach bedside and consequently the clinical examination, this could support the inclusion of PoCUS training in medical school curricula, as all medical students should be taught the best possible diagnostic approach. At present, medical schools are beginning to progressively introduce PoCUS into their curricula following the spread of its clinical use. In a position statement published in 2015, the American Academy of Emergency Medicine followed by the European Federation of Societies for Ultrasound in Medicine and Biology in 2016 recommended including PoCUS training in medical school undergraduate curricula to improve the learning of core concepts and to develop students’ understanding of physical examinations. Despite these recommendations, there is limited literature about how to effectively teach PoCUS to large numbers of students. Focusing on the RUQ of the abdomen and based on the importance of gallstone findings when using PoCUS, as a third research intention, this PhD evaluated the feasibility of teaching gallbladder PoCUS to undergraduate students according to a method of practical teaching using exclusively normal PoCUS patterns. Studying PoCUS undergraduate teaching raised the additional question of the state of undergraduate PoCUS teaching. To address this question, a questionnaire study sent to medical faculties in the European Union (EU) provided insights into the current state of PoCUS education in medical schools. This doctoral dissertation then put forward a perspective into how PoCUS could become part of clinical examination teaching.

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* F.Dupriez, P. Geukens, A. Penaloza ; D. Vanpee , G. Bekkering, X. Bobbia. Agreement of Emergency Physician-Performed Ultrasound versus Radiology- Performed Ultrasound for Cholelithiasis or Cholecystitis: A Systematic Review Eur J Emerg Med. 2021 Oct 1;28(5):344-351.

* Dupriez F, de Castro BR, Gendebien F, Fasseaux A, Gensburger M, Marissiaux L, Penaloza A, Bobbia X, Jarman R. Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial. Ultrasound J. 2023 Apr 10;15(1):18. doi: 10.1186/s13089-023-00317-6. PMID: 37036612.

* Dupriez F, Niset A, Couvreur C, Marissiaux L, Gendebien F, Peyskens L, Germeau B, Fasseaux A, Rodrigues de Castro B, Penaloza A, Vanpee D, Bobbia X. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med. 2023 Dec 2. doi: 10.1007/s11739-023-03480-9. Epub ahead of print. PMID: 38041765.

* Dupriez, F., Jarman, R. D. (2024). Normology: Is it Time to Rethink Point-of-Care Ultrasound Training? Journal of Medical Education and Curricular Development, 11.

* Dupriez F, Hall A, Diop T, Collard A, de Castro BR, Smets F, Penaloza A, Vanpee D. Point-of-Care Ultrasound training in undergraduate education in the European Union: current situation and perspectives. Ultrasound J. 2024 Feb 13;16(1):9. doi: 10.1186/s13089-024-00361-w. PMID: 38349580.