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J Ultrasound Med. 2017 Feb;36(2):335-343. doi: 10.7863/ultra.15.12044. Epub 2016 Dec 10.

Number of Weeks Rotating in the Emergency Department Has a Greater Effect on Ultrasound Milestone Competency Than a Dedicated Ultrasound Rotation.

Author information

1
Emergency Services Institute, Cleveland Clinic, Cleveland, Ohio, USA.
2
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
3
Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
4
Department of Emergency Medicine, University of California Davis, Sacramento, California, USA.
5
Department of Biostatistics and Informatics, Colorado School of Public Health, Denver, Colorado, USA.

Abstract

OBJECTIVES:

Ultrasound (US) is vital to modern emergency medicine (EM). Across residencies, there is marked variability in US training. The "goal-directed focused US" part of the Milestones Project states that trainees must correctly acquire and interpret images to achieve a level 3 milestone. Standardized methods by which programs teach these skills have not been established. Our goal was to determine whether residents could achieve level 3 with or without a dedicated US rotation.

METHODS:

Thirty-three first- and second-year residents were assigned to control (no rotation) and intervention (US rotation) groups. The intervention group underwent a 2-week curriculum in vascular access, the aorta, echocardiography, focused assessment with sonography for trauma, and pregnancy. To test acquisition, US-trained emergency medicine physicians administered an objective structured clinical examination. To test interpretation, residents had to identify normal versus abnormal findings. Mixed-model logistic regression tested the association of a US rotation while controlling for confounders: weeks in the emergency department (ED) as a resident, medical school US rotation, and postgraduate years.

RESULTS:

For image acquisition, medical school US rotation and weeks in the ED as a resident were significant (P = .03; P = .04) whereas completion of a US rotation and postgraduate years were not significant. For image interpretation, weeks in the ED as a resident was the only significant predictor of performance (P = .002) whereas completion of a US rotation and medical school US rotation were not significant.

CONCLUSIONS:

To achieve a level 3 milestone, weeks in the ED as a resident were significant for mastering image acquisition and interpretation. A dedicated US rotation did not have a significant effect. A medical school US rotation had a significant effect on image acquisition but not interpretation. Further studies are needed to best assess methods to meet US milestones.

KEYWORDS:

Accreditation Council for Graduate Medical Education; Next accreditation system; emergency medicine milestones; resident evaluation; ultrasound competency; ultrasound education

PMID:
27943410
DOI:
10.7863/ultra.15.12044
[Indexed for MEDLINE]
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