Systematic Analysis of a New Emergency Medicine Ultrasound Rotation

Introduction: Emergency Ultrasound (EUS) is a vital tool for the diagnosis and management of emergency department patients. EUS training is mandated by the Accreditation Council for Graduate Medical Education (ACGME) for all Emergency Medicine (EM) residencies and each program is required to assess resident competence in EUS. We sought to determine the competence of EM residents at a new EM residency training center by evaluating technical accuracy after initial EUS training. Methods: We conducted a retrospective review of all ultrasound images saved before and after each EM resident's EUS rotation. Ultrasound images were evaluated for several imaging components (depth, gain, application type, measurements, adequate views) and rated for technical accuracy. Results: During the study period, 18 EM residents completed the introductory course and the two week first-year EUS rotation. A total of 1126 EUS exams were performed. 849 educational EUS exams were performed during resident training for educational purposes, and 211 clinical EUS exams were saved during clinical evaluation of ED patients. Of the clinical EUS exams performed prior to the rotation, 42 (62%; 95% Confidence interval [CI] 51% to 73%) were rated as excellent quality, 9 (13%; 95% CI 5 to 21%) were rated as good, 5 were rated as fair (7.3%; 95% CI 1.3 to 13%) and 12 (17.6%; 95% CI 8.6 to 26.6%) were rated as poor. Of the clinical EUS exams performed after the 2 week EUS rotation, 103 (72%, 95% CI 64 to 79%) were rated as excellent, 21 (14.6%; 95% CI 8.8 to 20%) were rated as good, 7 (4.8 %; 95% CI 1.3 to 8.3%) were rated as fair and 12 (8.3 %; 95% CI 3.8 to 12.8%) were rated as poor. Discussion: Our findings demonstrate that an introductory course and two-week EUS rotation improved resident technical accuracy with an increase in excellent quality exams and a reduction in poor quality exams post intervention.