Abstract
BackgroundOptimal training required for proficiency in bedside ultrasound is unknown. In addition, the value of proctored training is often assumed but has never been quantified.MethodsTo compare different training regimens for both attending physicians and first year residents (interns), a prospective study was undertaken to assess knowledge retention six months after an introductory ultrasound course. Eighteen emergency physicians and twelve emergency medicine interns were assessed before and 6 months after an introductory ultrasound course using a standardized, image-based ultrasound test. In addition, the twelve emergency medicine interns were randomized to a group which received additional proctored ultrasound hands-on instruction from qualified faculty or to a control group with no hands-on instruction to determine if proctored exam training impacts ultrasound knowledge. Paired and unpaired estimates of the median shift in test scores between groups were made with the Hodges-Lehmann extension of the Wilcoxon-Mann-Whitney test.ResultsSix months after the introductory course, test scores (out of a 24 point test) were a median of 2.0 (95% CI 1.0 to 3.0) points higher for residents in the control group, 5.0 (95% CI 3.0 to 6.0) points higher for residents in the proctored group, and 2.5 (95% CI 1.0 to 4.0) points higher for the faculty group. Residents randomized to undergo proctored ultrasound examinations exhibited a higher score improvement than their cohorts who were not with a median difference of 3.0 (95% CI 1.0 to 5.0) points.ConclusionWe conclude that significant improvement in knowledge persists six months after a standard introductory ultrasound course, and incorporating proctored ultrasound training into an emergency ultrasound curriculum may yield even higher knowledge retention.
Highlights
Optimal training required for proficiency in bedside ultrasound is unknown
The median difference in the pre-test scores between the control and proctored ultrasound training (PUT) groups was 0.5
Comparing pre- and post-test scores in the control group, the median improvement in score was 2.0
Summary
Optimal training required for proficiency in bedside ultrasound is unknown. In addition, the value of proctored training is often assumed but has never been quantified. With increased use by emergency physicians (EPs) has come mandated training during residency, and many guidelines have been proposed regarding training residents in the use of bedside US. In 1994, the Society for Academic Emergency Medicine (SAEM) proposed a bedside US curriculum consisting of 40 hours of didactic training and 150 proctored US examinations [7]. In 2001, the American College of Emergency Physicians (ACEP) published guidelines describing the scope of emergency US applications as well as recommendations for initial training to include 16 hours of didactic content and a minimum of 150 proctored scans [8]. Most academic emergency medicine (EM) residency programs have created curricula for ultrasound training ranging from 4 hours [12] to 16 hours [13], knowledge retention and on-going supplemental training methods have never been investigated. Should practicing EPs complete the same didactic curricula as residents? How does their knowledge retention compare?
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