Duanmu Youyou, Henwood Patricia C, Takhar Sukhjit S, Chan Wilma, Rempell Joshua S, Liteplo Andrew S, Koskenoja Viktoria, Noble Vicki E, Kimberly Heidi H
Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road Suite 350, Palo Alto, CA, 94304, USA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Ultrasound J. 2019 Mar 5;11(1):3. doi: 10.1186/s13089-019-0118-7.
Point-of-care ultrasound (POCUS) is an important clinical tool for a growing number of medical specialties. The current American College of Emergency Physicians (ACEP) Ultrasound Guidelines recommend that trainees perform 150-300 ultrasound scans as part of POCUS training. We sought to assess the relationship between ultrasound scan numbers and performance on an ultrasound-focused observed structured clinical examination (OSCE).
This was a cross-sectional cohort study in which the number of ultrasound scans residents had previously performed were obtained from a prospective database and compared with their total score on an ultrasound OSCE. Ultrasound fellowship trained emergency physicians administered a previously published OSCE that consisted of standardized questions testing image acquisition and interpretation, ultrasound machine mechanics, patient positioning, and troubleshooting. Residents were observed while performing core applications including aorta, biliary, cardiac, deep vein thrombosis, Focused Assessment with Sonography in Trauma (FAST), pelvic, and thoracic ultrasound imaging.
Twenty-nine postgraduate year (PGY)-3 and PGY-4 emergency medicine (EM) residents participated in the OSCE. The median OSCE score was 354 [interquartile range (IQR) 343-361] out of a total possible score of 370. Trainees had previously performed a median of 341 [IQR 289-409] total scans. Residents with more than 300 ultrasound scans had a median OSCE score of 355 [IQR 351-360], which was slightly higher than the median OSCE score of 342 [IQR 326-361] in the group with less than 300 total scans (p = 0.04). Overall, a LOWESS curve demonstrated a positive association between scan numbers and OSCE scores with graphical review of the data suggesting a plateau effect.
The results of this small single residency program study suggest a pattern of improvement in OSCE performance as scan numbers increased, with the appearance of a plateau effect around 300 scans. Further investigation of this correlation in diverse practice environments and within individual ultrasound modalities will be necessary to create generalizable recommendations for scan requirements as part of overall POCUS proficiency assessment.
即时超声检查（POCUS）对于越来越多的医学专业而言是一项重要的临床工具。美国急诊医师学会（ACEP）当前的超声检查指南建议，作为POCUS培训的一部分，学员应进行150 - 300次超声扫描。我们试图评估超声扫描次数与以超声为重点的客观结构化临床考试（OSCE）成绩之间的关系。
这是一项横断面队列研究，从一个前瞻性数据库中获取住院医师先前进行的超声扫描次数，并将其与他们在超声OSCE中的总成绩进行比较。接受过超声专科培训的急诊医师实施了一项先前发表的OSCE，该考试由测试图像采集与解读、超声机器操作、患者体位摆放及故障排除的标准化问题组成。在住院医师进行包括主动脉、胆道、心脏、深静脉血栓、创伤超声重点评估（FAST）、盆腔及胸部超声成像等核心应用检查时对他们进行观察。
29名三年级（PGY - 3）和四年级（PGY - 4）急诊医学（EM）住院医师参加了OSCE。OSCE的中位数成绩为354分[四分位间距（IQR）343 - 361]，满分是370分。学员先前进行的超声扫描总数中位数为341次[IQR 289 - 409]。超声扫描次数超过300次的住院医师OSCE中位数成绩为355分[IQR 351 - 360]，略高于超声扫描总数少于300次组的OSCE中位数成绩342分[IQR 326 - 361]（p = 0.04）。总体而言，局部加权散点平滑估计（LOWESS）曲线显示扫描次数与OSCE成绩之间呈正相关，对数据的图形回顾表明存在平台效应。
这项针对单个住院医师培训项目开展的小型研究结果表明，随着扫描次数增加，OSCE成绩呈现改善趋势，在300次扫描左右出现平台效应。有必要在不同的实践环境以及个体超声检查方式中进一步研究这种相关性，以便为作为整体POCUS熟练程度评估一部分的扫描要求制定可推广的建议。
