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J Ultrasound Med. 2011 Mar;30(3):371-5.

Development and validation of a web-based assessment tool for the extended focused assessment with sonography in trauma examination.

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Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.



Extended focused assessment with sonography in trauma (EFAST) examinations are routinely performed by emergency physicians and general surgeons as an integral part of trauma care. Although guidelines for competency in the EFAST examination exist, tools to assess competency are lacking. Our goal was to develop and validate a Web-based competency assessment tool to evaluate providers who perform the EFAST examination.


A multiple-choice test regarding the performance and interpretation of the EFAST examination was developed following National Board of Medical Examiner guidelines. Five emergency physician experts with fellowship training in emergency ultrasound established face and content validity. The test was administered to emergency medicine residents and ultrasound fellows. Concurrent validity was evaluated by assessing the correlation of scores on our test with guidelines set by the American College of Emergency Physicians (ACEP) for emergency ultrasound. Scores were analyzed, and statistical analysis was performed.


Sixty-three emergency medicine residents and 2 ultrasound fellows from 2 residency programs completed the assessment tool. Examinees who met ACEP guidelines scored significantly higher than those who had not: 70.4% (95% confidence interval, 67.3%-73.4%) versus 48.3% (43.2%-53.5%). Evaluation of scores showed a significant correlation between an increased level of training, participation in an ultrasound rotation, and the number of EFAST and total ultrasound examinations performed with higher test scores. However, overall test scores were lower than initially anticipated.


Use of this assessment tool for interpretation of EFAST images showed face and content validity. Score trends showed a significant correlation with existing ACEP guidelines, ultrasound experience, and the training level. Scores continued to improve with experience beyond ACEP recommended guidelines.

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