247: Observed Structured Clinical Examination to Determine Competency In Abdominal Aorta Ultrasonographic Examination Performed by Emergency Physicians

Abstract

Abdominal aorta emergencies are associated with significant morbidity and mortality. Bedside abdominal aorta ultrasonography (BAAU) can rapidly and effectively diagnose potentially catastrophic conditions when utilized by experienced, qualified practitioners. The ACEP recommended guidelines of twenty-five recorded and reviewed BAAU examinations for considered competency has not been methodologically studied. The objective of this study is to evaluate the experience and abilities of resident and attending physicians in performing abdominal aorta ultrasonographic examinations to validate current ACEP recommendations and guidelines. Attending and resident physicians from a 3-year emergency medicine residency program were shown abdominal aorta ultrasonography examination video clips and asked to identify basic anatomical structures in a written examination. They also performed BAAU practical examinations on a standardized patient. Their performance in the written examination and proficiency in performing bedside ultrasonographic examinations were correlated with their level of training and BAAU experience. 11 attending and 34 resident physicians participated in the study with mean prior experience of 35.4 (SD: 43.6) and 15.6 (SD:9.0) BAAU examinations respectively. There was no significant difference among study participants between written, practical, or combined scores when stratified by training level and/or BAAU experience (P =.146 and P = .649). However, using ROC analysis, there is suggestion that between 10-13 BAAU examinations, performers reach an optimal cut-off point for scoring 75% or greater combined score. While neither level of training nor prior BAAU experience were statistically significant in relationship to performance on written and practical examinations, our findings suggest that between 10-13 BAAU examinations are associated with examination scores > 75%. This small study provides evidence that the ACEP recommendation of 25 abdominal aortic ultrasonography scans is more than sufficient to score well on a simulated examination.