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

• Published in: Journal of ultrasound in medicine 2017-02, Vol.36 (2), p.335-343
• Main Authors: Smalley, Courtney M., Thiessen, Molly, Byyny, Richard, Dorey, Alyrene, McNair, Bryan, Kendall, John L.
• Format: Article
• Language: English
• Subjects: Accreditation Council for Graduate Medical Education; Clinical Competence - statistics & numerical data; Emergency Medicine - education; emergency medicine milestones; Emergency Service, Hospital - statistics & numerical data; Humans; Internship and Residency - methods; Next accreditation system; resident evaluation; Single-Blind Method; Time Factors; Ultrasonics - education; ultrasound competency; ultrasound education
• ISSN: 0278-4297; 1550-9613
• DOI: 10.7863/ultra.15.12044

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.