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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.

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



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.


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.


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.


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.


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

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