From default to diverse; looking beyond 70kg man in ultrasound practical classes

Background: Medical education and literature have historically underrepresented females as subjects in ultrasound practical classes, particularly those involving partial exposure of the chest or breast tissue. This underrepresentation is reflective of a wider tendency to use ‘70 kg male’ as the default. This bias is evident in ultrasound practical classes, where female medical students rarely volunteer as subjects due to various concerns. Ultrasound technology is a valuable educational tool that allows students to visualise the heart in motion, observe blood flow, and assess cardiac function—enhancing their understanding of complex physiological concepts whilst improving clinical competency. However, when female students are excluded from participating as subjects, it not only limits the context and value of the learning experience but also experience of potential patient diversity.<br/>This study aimed to investigate the barriers that influence female students' willingness to participate as subjects and identify solutions to address gender disparities in ultrasound education.<br/>Methods: A mixed methods approach was used combining both electronic survey data and focus group discussions from 1st and 2nd year female medical students. The survey assessed students’ likelihood of participation in practical classes that required partial exposure of breast tissue, perceived barriers to participation and what supports could be implemented to encourage engagement and provide potential solutions to such barriers. It also explored the reasons why they thought it was important to create an inclusive learning environment for females to be recognised in medical education. Iterative thematic analysis of free text survey and focus group responses identified recurring themes relating to gender disparities in practical ultrasound classes. Ethical approval for the study was obtained from Queens University Faculty of Medicine, Health and Life Sciences research ethics committee MHLS 25_16.<br/>Results: Of a total of 382 female students provided with the opportunity to participate, 29 (7.6%) completed the survey, of which 4 (1%) agreed to a focus group. Results indicated main barriers were feelings of embarrassment from personal modesty and privacy issues and concerns about potential misconduct and discomfort from peers due to previous experiences which showed immaturity and a lack of professionalism. <br/>Students suggested that by using modesty preserving measures, smaller group sizes or utilising female simulated patients would increase likelihood of participation. Other recommendations of female only classes due to anxieties surrounding male peers or volunteering as a subject between different year groups where there would be a degree of anonymity. <br/>Students reported that due to the lack of opportunity to practice on diverse body types, both male and female students would be unprepared and disadvantaged as they would not know how to navigate female breast tissue confidently. <br/>Conclusion: Gender inequalities in practical ultrasound classes reflect much wider societal issues resulting in a gender data gap. Findings from this study revealed concerns that currently would prevent females from participating and has highlighted the need for medical education to be more inclusive so that all students, irrespective of gender, feel represented and receive comprehensive training to prepare them for the diverse patient population they will encounter in clinical practice.<br/><br/>