Detection of sialolithiasis by point-of-care ultrasound at ED

Abstract

Immediate feedback and hands-on teaching were provided after the observer's official classification. In order to evaluate the number of scans needed to gain proficiency, the learning curve using the cumulative sum (LC-CUSUM) was utilized. The acceptable performance rate (proficiency) was set at 15% failure, the unacceptable performance rate was set at 30%, and the equivalence zone was set at 5%. Results: One hundred and fifty learning curve TVS examinations were performed. Twenty-six (17.3%) patients had rectal DE and 34 (22.7%) had a negative sliding sign by the reference standard. Each observer performed 50 scans supervised by the reference standard. The overall accuracy of presence or absence of rectal DE was 90%, ranging from 82À94% amongst the three observers. The accuracy of POD state classification was 92.7%, ranging from 90À96% amongst the three observers. LC-CUSUM for rectal DE demonstrated observer 1 did not reach proficiency, whereas observers 2 and 3 required 32 and 20 TVS examinations, respectively. For POD obliteration state classification, observer 1 did not reach proficiency, whereas observers 2 and 3 required 46 and 30 TVS examinations, respectively. Conclusion: For two of the three gynaecological sonology trainees, proficiency in diagnosing rectal DE and POD obliteration was attainable in less than the 50 planned supervised ultrasounds. Contrary to other studies on the topic, this study suggests that not all trainees can reach proficiency during a program based upon a pre-defined number of scans. Overall, we demonstrate that a one-size-fits-all approach may not be appropriate for teaching trainees these advanced ultrasound skills.