Objectives Performing and interpreting endovaginal ultrasound is an important skill used during the evaluation of obstetric and gynecologic emergencies. This study aims to describe the level of proficiency and confidence achieved after performing 25 endovaginal examinations. Methods This is a prospective study at a single urban academic emergency department. Participants performed a minimum of 25 endovaginal ultrasounds under the supervision of a point‐of‐care ultrasound expert. Anatomical structures were identified by the expert under ultrasound prior to each session. Each examination was scored for agreement of findings between the participant and expert. The data were used to develop a performance curve identifying when proficiency was achieved, where experiential benefit diminished, and when participants felt confident. Results A total of 1117 endovaginal ultrasound examinations were performed by 50 participants. Agreement after 25 examinations was highest (>95%) for probe insertion and preparation, bladder and uterus identification, and directionality. Agreement was lowest for identification of the ovaries (76%). Experiential benefit plateaus occurred earliest (10 exams) for preparation and insertion followed by bladder identification and directionality. Surprisingly, ovarian experiential benefit plateaued at 16 exams. Participant confidence improved overall and was lowest for the identification of ovaries and abnormal pelvic anatomy. Conclusions There is a significant learning curve when performing endovaginal ultrasound. Our data do not support the use of 25 examinations as a minimum standard for identification of the ovaries or abnormal ovarian pathology.
Introduction: There has been a trend toward the use of alternative treatments to opioids for adequate pain management. This has paralleled a growing interest in the utilization of bedside point-of-care ultrasonography to guide placement of regional anesthesia in the emergency department. The purpose of this study was to establish the number of supervised examinations required for an emergency medicine resident to gain proficiency in accurately locating and identifying the nerves of the brachial plexus at the level of the interscalene space. Methods: Proficiency was defined as the number of attempts a resident required to accurately locate and identify the nerves of the brachial plexus on 10 separate, consecutive examinations. Didactic education was provided prior to the study and residents also participated in two instructional hands-on ultrasound examinations prior to the commencement of initial data collection. Count data are summarized using medians, means, and ranges. Random effects negative binomial regression was used for modeling panel count data where negative coefficients indicate increase in proficiency. Results: A total of 24 emergency medicine residents were enrolled in the study. Fourteen males and ten females participated. There were nine PGY-1 residents (37.5%), nine PGY-2 residents (37.5%), and six PGY-3 residents (25%). The median number of required supervised attempts and range for correctly performing both steps in the identification of the nerves of the brachial plexus was 2 (range 2–12). The median starting confidence level was 2 (range 1–4), and the median ending confidence level was 4 (range 1–5). Increases in confidence from start to finish were found to be statistically significant (P < 0.001). Conclusion: Emergency medicine residents are easily adept in the identification of the nerves of the brachial plexus at the level of the interscalene space following two supervised examinations. Residents made steady gains in confidence and proficiency throughout the study; statistical analysis found a significant association between the two.
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