Evaluation of Point-of-Care Ultrasound Use in Emergency Medicine Residents: An Observational Study

TL;DR

This study examines how emergency medicine residents use point-of-care ultrasound and finds that their skills remain consistent over time.

Contribution

The study provides evidence that POCUS skills are maintained by residents throughout their training without significant decline.

Findings

Accuracy of POCUS exams remained consistently high at 97.1% across all timepoints.

No significant changes in technically limited scans or exam acceptability were observed over time.

Residents maintained consistent performance in cardiac and trauma ultrasound exams.

Abstract

Point-of-care ultrasound (POCUS) is integral to emergency medicine (EM) training. It is unclear how EM residents use POCUS and how these skills are maintained as they progress in residency training. The purpose of this study was to evaluate resident use of POCUS at various timepoints in EM training.

This was a retrospective cohort study of EM residents at a single, three-year training program between July 1, 2014–June 30, 2022. Residents were included if they had completed three consecutive years of training and an ultrasound rotation in their postgraduate year (PGY)-1. The following time points were assessed: PGY-1 rotation and 3-, 6-, 12-, 18-, and 24-months post-rotation. Number of scans, accuracy of interpretation, acceptability for credit, and percentage of technically limited studies (TLS) were collected at each point. We analyzed performance characteristics using mixed-effects binomial logistic regression with time as a fixed effect and resident as a random effect. Models were fit separately for each performance characteristic and likelihood ratio tests were performed to determine whether performance varied over time.

A total of 65 residents were included with a total of 13,229 exams performed during the study period. Cardiac and focused assessment with sonography in trauma examinations were performed most commonly. Overall accuracy of all exams during the examination period was 97.1% (95% confidence interval [CI] 96.2–98.0%), TLS was 14.5% (95% CI 9.7–20.6%), and acceptability was 82.9% (95% CI 76.3–88.2%). Trend over time (3, 6, 12, 18, and 24 months) found no differences in accuracy (P = 0.84), TLS (P = 0.20), or acceptability (P = 0.28). Further analyses by individual exam types also showed no significant differences in accuracy, acceptability, nor TLS.

Accuracy, acceptability, and percentage of technically limited scans did not significantly vary over time, suggesting that POCUS skills are maintained from PGY-1 rotation to each time point evaluated in this study.

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