A Multicenter Study on Extended Focused Assessment With Sonography for Trauma Longitudinal Learning Curves for Emergency Medicine Residents Using Cumulative Summation Analysis (AEUS and CDEM Sponsored)
Background and Objectives: The eFAST (Extended Focused Assessment with Sonography in Trauma) is a core emergency ultrasound (EUS) scan used to detect intraperitoneal fluid, pericardial fluid, pneumothorax, and hemothorax. Emergency medicine (EM) interns
must complete a minimum of 25 eFAST scans approved through a quality assessment (QA) process by EUS faculty. This requirement is not supported by robust evidence. We hypothesize that learners regardless of prior experience in EUS will achieve eFAST
competency in less than 25 scans.
Methods: This is a multicenter retrospective review of prospectively gathered QA data from eFAST scans performed by EM interns during their EUS rotation at three different institutions between August
to December 2024. Each site had its own EUS program and faculty conducting QA, but all used the same eFAST curriculum, QA rubric, and end-of-rotation standardized direct observation tool (SDOT). Inter-rater reliability (IRR) of the rubric was assessed
between all four EUS faculty who performed QA within all sites using 30 sample eFASTs of variable quality and pathology. Interns were assigned unique study numbers to anonymize their survey responses on demographics and prior EUS experience, and to
create a de-identified QA database. Learning curve cumulative summation (LC-CUSUM) analysis, a statistical method for evaluating learning curves, was employed to calculate the mean number of eFAST scans required to achieve competency.
Results: There
were 29 EM interns, 10 male, 19 female; 31.0% (9/29) with no prior EUS experience, all but one completed at least 25 eFAST scans during the 4-week rotation. All achieved competency on the SDOT assessment. IRR for the QA rubric completed by all four
EUS faculty doing eFAST QA was one. The average number of scans to achieve competency was 8.03 (SD = 3.01, 95% CI [6.89-9.18]). Using a Wilcoxon rank sum analysis alpha = 0.05, no significant difference was found in the number of eFAST scans required
for competency between interns with and without prior EUS experience (p=0.45).
Conclusion: Using LC-CUSUM analysis, the average EM intern can demonstrate competency after 8 eFAST scans, much less than the 25 that is currently required.
The second phase of our study will evaluate long-term retention of eFAST scanning competency post-EUS rotation. LC-CUSUM analysis may also be applied to other required core EUS scans, potentially redefining competency requirements for EM residents.
Presenter:
- Lynn P. Roppolo, MD
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John Peter Smith Hospital; Adjunct Professor University of North Texas and Texas Christian University
Dr. Roppolo is a retired Professor of Emergency Medicine from the University of Texas Southwestern (UTSW) and is currently core faculty and the Assistant Ultrasound Director at John Peter Smith Hospital in Fort Worth Texas. She is an Adjunct Professor at the University of North Texas and Texas Christian University. She is a Senior Editor for the Journal of Emergency Medicine and has published numerous peer reviewed papers as first or senior author. She has assisted with coordinating the Research Learning Series for the last two years. Her scholarly and research interests involve anything related to ultrasound and managing acutely agitated patients to reduce physical assaults on ED staff. She is a graduate of the University of California, San Diego School of Medicine, did her emergency medicine residency at the George Washington University and an emergency ultrasound fellowship at UTSW after being part of the residency leadership for 15 years.