TF12 The Online Emergency Ultrasound Microsimulator: A Novel Approach to Assessing Resident Emergency Ultrasound Competency

Abstract

Competency in emergency ultrasound (EUS) requires the application of an increasingly sophisticated knowledge and skill set that parallels the performance of any EUS exam. Clinicians must first recognize the indications for a particular EUS exam and then apply knowledge of EUS physics and protocols to acquire adequate images. Next they must interpret images across a continuum that includes normal, common variants and subtle-to-gross pathology. Finally, they need to effectively utilize use these results for individual patient and departmental management. The traditional set number benchmarks provide the opportunity for residents to demonstrate proficiency in image acquisition and interpretation. However, educators today struggle with how to best assess knowledge of indications, subtleties of interpretation and advanced medical decisionmaking. To better provide both individualized instruction and standardized outcomes for these components of EUS competency, we created a novel online microsimulator for EUS. We provide an assessment measure of resident EUS competency to supplement traditional set number benchmarks. The simulator presents the resident with a clinical vignette and associated question which focuses on a chief complaint, but does not insinuate the diagnosis. The simulator will then allow the resident to select which body systems to examine with a bedside ultrasound (US). For example, if the patient is presenting with chest pain from a pneumothorax, the resident may choose to US the patient's lungs, which will demonstrate a lack of lung sliding. However, the resident may also choose to evaluate the patient's gallbladder, which will reveal a normal exam. The simulator will force the resident to not only select which US exams are pertinent to the patient's presentation, but also to differentiate normal from pathologic findings on the exams displayed. After the resident submits an answer, the program will display whether it was correct or incorrect and then provide a brief explanation of the disease process and associated US findings. When the module is completed, the simulator will calculate statistics on how the resident performed which his or her US director may use to assess their US knowledge. We created an assessment measure of EUS trainee knowledge, application of indications, image interpretation and medical decisionmaking. The pilot of this project will be centered around the common clinical presentation of shortness of breath and chest pain. Future work will expand to other presenting signs and symptoms as well.