Echocardiography has been introduced recently into the first year Medicine course (cardiothoracic anatomy module) at Queen’s University Belfast (QUB), where students gain hands-on experience of obtaining images from live subjects. Currently, this only involves male subjects, although we hope to include females soon. Meanwhile, to mitigate the lack of representation of female physiology in the curriculum, we produced a video resource of echocardiography on a female volunteer after consultation with currently practicing senior cardiac physiologists. This study aimed to assess efficacy and perceptions in 1^st year medical students of the resource designed to demonstrate appropriate communication, consent, and professional conduct when conducting echocardiography in female patients, along with sex-based anatomical differences in cardiac anatomy.

Students for the 1^st year medicine cardiothoracic anatomy module at QUB were invited to complete an anonymous pre- and post-resource viewing questionnaire, assessing understanding of informed consent, professionalism, patient empathy, communication, confidence in performing echocardiography on a female subject, and awareness of sex-related anatomical differences. Questions were in the form of Lickert scale responses and open-ended questions. Academic staff involved in teaching delivery were invited to review the resource through a focus group to determine whether intended learning objectives were met and to provide recommendations for further refinement. The work was approved by the Faculty of Health and Life Sciences Ethics Committee, QUB.

Twenty-nine students responded (21 female, 8 male) with a mean age 19.2 years (range 18-23 years). After viewing the resource, all students reported an increase in awareness of sex differences in cardiac anatomy (pre: 2.6±1.1 vs post: 4.5±0.5, Lickert score ± S.D.; P<0.001, Student’s paired t-test), confidence in gaining informed consent (4.1±0.8 vs 4.5±0.5, P<0.001), comfort performing sensitive procedures (3.3±0.2 vs 4.7±0.5, P<0.001), and confidence identifying general cardiac structures (3.5±4.2 vs 4.2±0.5), P<0.01). Viewing the resource had no effect understanding patient dignity (4.8±0.8 vs 4.8±0.5). Other positive outcome included 100 % of students agreeing that the video increased awareness of empathy during intimate procedures, communication during intimate procedures, dignity when handling breast tissue and understanding patient dignity and comfort. Furthermore, all students felt the resource promoted professionalism and respect, 28/29 students agreed it helped with inclusive learning through female representation and all students felt it should be included in future teaching.

The staff focus group (4 members) felt unanimously the resource fulfilled its aims and provided several suggestions for improving the resource such as camera angles and additional images and points for narration.

We conclude that in the absence of hands-on experience for students of echocardiography with female subjects, a video resource is an effective way to convey anatomical differences between male and female cardiac anatomy along with sensitive and professional handling of breast tissue and considering patient comfort and dignity. It is an excellent means of increasing appreciation and understanding issues around intimate examinations in general. We found feedback from students and staff extremely constructive to allow the resource to evolve further, making a significant contribution to redressing the balance of female representation in this area of learning.