Kunafa Knife and Play Dough for Ultrasound Training

Around two years ago, Prof. Abu-Zidan came with a plastic triangular shape spatula to one of our morning meetings. He said that

Alper, I found this as cheap as 30 cents each, and I bought 20 of them. There are metals too, but they are used as a Kunafa knife (Kunafa is sweet in middle east region). They are a little bit heavier. Because I want to use this in ultrasound training of 5th-year medical students, I need something light, easy to carry. What do you think?

It was not a surprise for me seeing such a sample proposed from a person who always thinks simple educational options. The process which started that day improved with the addition of play dough into the core discussions. After two years of discussions their values in ultrasound skills education, we wrote a methodology paper which accepted by World Journal of Emergency Surgery with unexpectedly valued comments by reviewers [1].

You can download this article from here.

As a bottom line, this article says there is no need for expensive simulators for ultrasound training. The tools which can be created less than 10 USD and used repeatedly can help to teach ultrasound enjoyably and effectively, especially in the limited resourced settings.

Triangular shaped Kunafa knife is the almost identical reflection of the view of the ultrasound on the screen. The thickness of the knife represents the 1 mm slice of the actual image that we see on the screen. 

Students understand the actual views and windows easily while they fan or tilt the knife. In addition to this practice, when the play dough added, the joy starts. Students create normal and pathologic anatomical samples and apply different angles with their triangular shape knife. This practice helps them to understand more about the image that they acquire on the screen. Then, real ultrasound practice follows on real patients or human models. You can imagine how it is enjoyable and effective for their learning. One of the advantages of this simple, cheap simulator is that its reusability. Less than 10 USD, but you can use it for 70-100 students during all academic year.

We found only three educational papers/posts about play dough usage for medical education. The first, Dr. Eftekhar and his group published a paper showing effective use of play dough for visualization of complicated cerebral aneurysm anatomy [2]. The second, Dr. Herur and her team published an article regarding play dough modeling of neurologic anatomy by students as an active learning tool [3]. The third, Dr. Adam Bystrzycki used this method to teach heart anatomy in the Echo in Life Support courses [4].

Yes, we enjoyed a lot while we were writing this paper. However, applying and testing it during the sessions was amazing. And, I shared the article in social media which I have no significant number of followers. However, even with this small attempt, we started to hear some feedback, recommendations, and samples shared by other groups and individuals who are using these tools.

Even one of the biggest ultrasound congresses, WINFOCUS, announced that they are going to use these simple teaching tool in their student course the first time.

These are promising news.

The chambers of the heart (Courtesy of Gregor Prosen)

As we all know, radiology and emergency medicine are the two leading specialties that implement ultrasound training into the student curriculum [5, 6]. As the iEM Education project, it is our aim to promote emergency medicine and provide free educational resources. Therefore, we just wanted to share in case you may think to use it in your ultrasound sessions.

This tool is so cheap. It can be created by anyone, anywhere, anytime. We are looking to hear more feedback from world ultrasound experts regarding the effectiveness and joy of this tool.

References

  1. Abu-Zidan FM, Cevik AA. Kunafa knife and play dough is an efficient and cheap simulator to teach diagnostic Point-of-Care Ultrasound (POCUS). World J Emerg Surg. 2019 Jan 8;14:1. doi: 10.1186/s13017-018-0220-3. eCollection 2019. PubMed  PMID: 30636969; PubMed Central PMCID: PMC6325793.
  2. Eftekhar B, Ghodsi M, Ketabchi E, Ghazvini AR. Play dough as an educational tool for visualization of complicated cerebral aneurysm anatomy. BMC Med Educ. 2005 May 10;5(1):15. PubMed PMID: 15885141; PubMed Central PMCID: PMC1274244.
  3. Herur A, Kolagi S, Chinagudi S, Manjula R, Patil S. Active learning by play dough modeling in the medical profession. Adv Physiol Educ. 2011 Jun;35(2):241-3. doi: 10.1152/advan.00087.2010. PubMed PMID: 21652511.
  4. Zedu Ultrasound Training Methods. Heart anatomy taught using state of the art methods. Accessed from https://www.ultrasoundtraining.com.au/news/heart-anatomy-taught-using-state-of-the-art-methods, January 9, 2019
  5. Cook T, Hunt P, Hoppman R. (2007) Emergency medicine leads the way for training medical students in clinician-based ultrasound: a radical paradigm shift in patient imaging. Acad Emerg Med. 14(6):558-61. PubMed PMID: 17535978.
  6. Phelps A, Wan J, Straus C, Naeger DM, Webb EM. Incorporation of Ultrasound Education Into Medical School Curricula: Survey of Directors of Medical Student Education in Radiology. Acad Radiol. 2016 Jul;23(7):830-5. doi: 10.1016/j.acra.2016.02.012. Epub 2016 Apr 8. PubMed PMID: 27311803.