Representation of sonographic learning objectives in the NKLM 2.0

Question The integration of ultrasound education in medical studies is implemented very heterogeneously across Germany. In the National Competence-Based Learning Objectives Catalogue for Medicine (NKLM) of 2015, sonography was already integrated, predominantly as a knowledge competence and with later integration in the study. On April 27th, 2021, the new NKLM 2.0 was published with extensive revisions of the sonographic learning objectives [1].

Methods At the faculty of Bonn and Mannheim, where a longitudinal ultrasound curriculum is already integrated, the following questions regarding the practicability of the NKLM 2.0 for ultrasound education were addressed:

• Which competencies are covered?

• What level of competence should be achieved (knowledge vs. action competence)?

• At what point in training should this level be achieved?

Results The analysis of the NKLM 2.0 shows a broad distribution of sonographic learning objectives with many cross-links. Main aspects can be found in Chapter VII Diagnostic Procedures with a separate section on sonography (VII.2-03.1). The new NKLM 2.0 proposes integration of practical teaching starting in the 5th semester (VII.2-03 1.4). At the beginning of the practical year (PJ), all students should be able to perform an ultrasound examination of the abdomen and neck under supervision, as well as detect free fluid (pleural effusion; FAST protocol). After the PJ, graduates should be able to perform these examinations independently.

In Chapter VI Diseases, sonography is mentioned in 80 diseases. 44% of the learning objectives for the diagnosis of these diseases are assigned to knowledge competence, 55% to action competence. In further narrowing down, 60% of the learning objectives in the category of action competence use terms that describe knowledge competence (e.g., 22% know, 11% explain, 9% name). Only 31% of the learning objectives use terms that express action competence (22% perform, 9% interpret). In 9% of the cases, the assignment was unclear. Only 50% of the learning objectives that used the term "perform" in the explanations linked VII.2-03.1.4. "(...) perform a B-scan sonography.". In 33% of the learning objectives that linked to VII.2-03.1.4., knowledge competency terms were used in the further delineation (e.g., know, explain).

Discussion Chapter VII.2-03.1 in the new NKLM 2.0 contains learning objectives for ultrasound education from preclinical to the end of the PJ. Especially the additional explanations of this chapter, which propose a longitudinal curriculum with early integration of theoretical and practical ultrasound training, are in line with international recommendations [2]. Important for the practicability of the learning objectives is the clear assignment to action and knowledge competence which is not yet given.

Publication History

Article published online:
20 June 2022

• References

• 1 https://nklm.de/zend/menu
• 2 Dietrich CF, Hoffmann B, Abramowicz J, Badea R, Braden B, Cantisani V. et al. Medical student ultrasound education: A WFUMB position paper, part I. Ultrasound Med Biol. 2019; 45: 271-81