Beyond the Numbers: Assessing Competency in Point-of-Care Ultrasound.

Abstract

Point-of-care ultrasound (POCUS) has been a core component of emergency medicine practice and residency training for over a decade. 1 Beeson M.S. Ankel F. Bhat R. et al. The 2019 model of the clinical practice of emergency medicine. J Emerg Med. 2020; 59: 96-120 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar , 2 Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. American College of Emergency Physicians. https://www.acep.org/globalassets/new-pdfs/policy-statements/ultrasound-guidelines%5f-emergency-point-of-care-and-clinical-ultrasound-guidelines-in-medicine.pdfDate accessed: December 18, 2022 Google Scholar , 3 Emergency medicine defined key index procedure minimumsAccreditation Council for Graduate Medical Education. https://www.acgme.org/globalassets/pfassets/programresources/em_key_index_procedure_minimums_103117.pdfDate accessed: December 18, 2022 Google Scholar Emergency medicine resident and attending physicians must demonstrate POCUS competency prior to the independent utilization of this skill in clinical practice. Many established guidelines to define proficiency have been primarily based upon a set number of POCUS examinations. 2 Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. American College of Emergency Physicians. https://www.acep.org/globalassets/new-pdfs/policy-statements/ultrasound-guidelines%5f-emergency-point-of-care-and-clinical-ultrasound-guidelines-in-medicine.pdfDate accessed: December 18, 2022 Google Scholar ,3 Emergency medicine defined key index procedure minimumsAccreditation Council for Graduate Medical Education. https://www.acgme.org/globalassets/pfassets/programresources/em_key_index_procedure_minimums_103117.pdfDate accessed: December 18, 2022 Google Scholar However, POCUS is a multifaceted skill set that involves technical ability and medical knowledge extending across over a dozen diverse organ systems. Learning curves can differ substantially between ultrasound applications. For example, mastering right upper quadrant image interpretation has been shown to require significantly more practice than soft tissue image acquisition. 4 Jang T. Ruggeri W. Dyne P. et al. Learning curve of emergency physicians using emergency bedside sonography for symptomatic first-trimester pregnancy. J Ultrasound Med. 2010; 29: 1423-1428 Crossref PubMed Scopus (32) Google Scholar ,5 Blehar D.J. Barton B. Gaspari R.J. Learning curves in emergency ultrasound education. Acad Emerg Med. 2015; 22: 574-582 Crossref PubMed Scopus (107) Google Scholar Threshold numbers needed to demonstrate acceptable image quality or interpretation accuracy can also vary significantly across different users. 6 Kwan C. Weerdenburg K. Pusic M. et al. Learning pediatric point-of-care ultrasound: how many cases does mastery of image interpretation take?. Pediatr Emerg Care. 2022; 38: e849-e855 Crossref PubMed Scopus (1) Google Scholar In recent years, medical education has sought to shift beyond purely numerical or time-based metrics, toward competency-based medical education models that emphasize predefined abilities that learners and educators can use as milestones toward becoming an independent practitioner. 7 Frank J.R. Snell L.S. Cate O.T. et al. Competency-based medical education: theory to practice. Med Teach. 2010; 32: 638-645 Crossref PubMed Scopus (1187) Google Scholar ,8 Holmboe E.S. Sherbino J. Long D.M. et al. The role of assessment in competency-based medical education. Med Teach. 2010; 32: 676-682 Crossref PubMed Scopus (480) Google Scholar However, the application of these models to POCUS education has been limited.