MacVane Casey Z, Irish Christine B, Strout Tania D, Owens William B
Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA.
J Emerg Med. 2012 Jul;43(1):124-8. doi: 10.1016/j.jemermed.2011.05.099. Epub 2012 Jan 12.
Emergency physicians are increasingly performing transvaginal ultrasound (TVUS) to rule out ectopic pregnancy. However, little is known about appropriate educational pathways to train emergency medicine residents in TVUS.
To evaluate the ability of Emergency Medicine (EM) residents who underwent a training program in TVUS to detect the presence or absence of an intrauterine pregnancy (IUP) in patients of < 13 weeks gestation with vaginal bleeding or abdominal pain, as compared to the final interpretation of each study as determined by the Emergency Department (ED) Director of Ultrasound.
This was a prospective, observational study in a single residency program. Training included a lecture, competency examination, and 10 supervised TVUSs. The EM residents then performed TVUSs with the goal of determining the presence or absence of an IUP without input from an attending physician. Correlation with the ED Director of Ultrasound was assessed for the cohort, and stratified by year of training.
There were 22 residents who performed 75 TVUSs over 17 months. Correlation with the ED Director of Ultrasound was 93.3%. Differences in correlation with the ED Director of Ultrasound were noted when compared by year of training: post-graduate year (PGY)-3 (93.3%), PGY-2 (92.1%), and PGY-1 (100%); p < 0.001.
Residents were able to perform TVUSs to determine the presence or absence of an IUP in patients in whom the diagnosis of ectopic pregnancy was being considered with a high degree of correlation with the ED Director of Ultrasound after a brief training program. Correlation with the ED director of ultrasound was influenced by year of training.
急诊医生越来越多地使用经阴道超声（TVUS）来排除异位妊娠。然而，对于培训急诊医学住院医师掌握TVUS的合适教育途径知之甚少。
评估接受TVUS培训项目的急诊医学（EM）住院医师，在诊断妊娠小于13周且有阴道出血或腹痛的患者时，判断宫内妊娠（IUP）是否存在的能力，并与急诊科超声主任对每项研究的最终解读进行比较。
这是一项在单一住院医师培训项目中进行的前瞻性观察研究。培训内容包括一次讲座、能力考核以及10次带教下的TVUS检查。之后，EM住院医师在没有主治医生指导的情况下独立进行TVUS检查，目的是判断IUP是否存在。对整个队列与急诊科超声主任的诊断结果进行相关性评估，并按培训年份进行分层分析。
22名住院医师在17个月内共进行了75次TVUS检查。与急诊科超声主任诊断结果的相关性为93.3%。按培训年份比较，与急诊科超声主任诊断结果的相关性存在差异：研究生第3年（PGY-3，93.3%）、研究生第2年（PGY-2，92.1%）和研究生第1年（PGY-1，100%）；p<0.001。
经过简短培训后，住院医师能够通过TVUS检查来判断疑似异位妊娠患者是否存在IUP，且与急诊科超声主任的诊断结果高度相关。与急诊科超声主任诊断结果的相关性受培训年份的影响。
