Ultrasound Competency Assessment in Emergency Medicine Residency Programs

Abstract

Objectives: In the Model of the Clinical Practice of Emergency Medicine (EM), bedside ultrasound (US) is listed as one of the essential procedural skills. EM milestones released by Accreditation Council for Graduate Medical Education and American Board of Emergency Medicine require residents to demonstrate competency in bedside US. The purpose of this study was to assess the current methods used by EM residency training programs to evaluate resident competency in bedside US.Methods: This was a cross-sectional survey study. A questionnaire on US education and competency assessment was electronically sent to all EM residency program directors and emergency US directors. The survey consisted of questions regarding the US rotation, structure of US curriculum, presence of US fellowship, image archiving, quality assurance methods, feedback, competency assessment tools, and frequency of assessment. The survey responses are reported as the percentages of total respondents along with 95% confidence intervals (CIs).Results: A total of 124 of 161 EM residency programs participated in this study, representing a 77% response rate. Twenty-six percent (95% CI = 18% to 34%) of programs assess competency only at the end of the US rotation. Eight percent (95% CI = 3% to 13%) assess competency only every 6 months, and 13% (95% CI = 7% to 19%) assess competency only annually. Eight percent (95% CI = 3% to 13%) assess competency only during the final year of training. Thirty percent (95% CI = 22% to 38%) of programs assess competency with a combination of the above intervals, and 16% (95% CI = 10% to 22%) do not assess US competency. Fourteen percent (95% CI = 8% to 20%) use objective structured clinical examinations (OSCEs), and 21% (95% CI = 14% to 28%) use standardized direct observation tools (SDOTs) to assess resident competency in US. Approximately one-third (33%, 95% CI = 24% to 41%) of standardized testing for US competency is conducted with multiple-choice questions. Thirty percent (95% CI = 21% to 38%) administer practical examinations to assess US skills.Conclusions: Currently, a majority of EM residency programs assess resident competency in bedside US. However, there is significant variation in the methods of competency assessment. The Accreditation Council for Graduate Medical Education (ACGME) recently introduced the concept of educational milestones for resident assessment, and subsequently the EM Milestones Working Group developed specialty-specific milestones. 4 In October 2012, the ACGME and the American Board of Emergency Medicine (ABEM) finalized 23 milestones, and US was designated patient care skill number 12.4 This patient care skill requires EM residents to demonstrate competency in performing bedside US. [5][6][7] To successfully implement

Ultrasound‐Guided Nerve Blocks in Emergency Medicine Practice

“…A recent study on femoral nerve blocks demonstrated that 63% of emergency medicine attending physicians reported learning US‐guided nerve blocks from a colleague, course, or workshop 23 . Our study indicates that most emergency departments have some form of US‐guided nerve block education, which is consistent with previous literature demonstrating the extent of US training during emergency medicine residency 9 . Although our data show that most (84%) of academic emergency departments use US guidance to perform peripheral nerve blocks, it is unknown whether residents are receiving sufficient exposure to US‐guided nerve blocks to achieve competency.…”

“…[6][7][8] Due to the mandated point-of-care US training requirements in all emergency medicine residency programs, access to US systems and US education have increased over the past few decades. 9,10 Although the growing body of evidence in the emergency medicine literature demonstrates the utility of US-guided nerve blocks for pain control in various clinical scenarios (laceration repair, incision and drainage, exploration for a foreign body, joint dislocation, and fracture management), it is unknown whether USguided nerve blocks are actively taught and performed in academic emergency medicine training programs. 1,11,12 Knowledge of current practice patterns, emergency department-based collaborations/protocols, and educational pathways could help formulate practice standards for the use of US-guided nerve blocks in emergency medicine.…”

Cadaver-based Necrotizing Fasciitis Model for Medical Training

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Emergency Ultrasound: Leveling the Training and Assessment Landscape

“…In this issue of Academic Emergency Medicine, Amini et al 1 present the results of a survey of EM residency and US directors to ascertain the current methods of education, quality assurance, and competency assessment in existing US programs. They received surveys from 77% of residency programs, 87% of which have required rotations in emergency US.…”

“…Although the literature has begun to lay the groundwork for a standardized US curriculum and the development of US assessment tools, Amini et al 1 still describe a very heterogeneous training landscape.…”