Ultrasound competency assessment in emergency medicine residency programs.

Objectives In the Model of the Clinical Practice of Emergency Medicine (EM), bedside ultrasound (US) is listed as one of the essential procedural skills. EM milestones released by Accreditation Council for Graduate Medical Education and American Board of Emergency Medicine require residents to demonstrate competency in bedside US. The purpose of this study was to assess the current methods used by EM residency training programs to evaluate resident competency in bedside US. Methods This was a cross-sectional survey study. A questionnaire on US education and competency assessment was electronically sent to all EM residency program directors and emergency US directors. The survey consisted of questions regarding the US rotation, structure of US curriculum, presence of US fellowship, image archiving, quality assurance methods, feedback, competency assessment tools, and frequency of assessment. The survey responses are reported as the percentages of total respondents along with 95% confidence intervals (CIs). Results A total of 124 of 161 EM residency programs participated in this study, representing a 77% response rate. Twenty-six percent (95% CI = 18% to 34%) of programs assess competency only at the end of the US rotation. Eight percent (95% CI = 3% to 13%) assess competency only every 6 months, and 13% (95% CI = 7% to 19%) assess competency only annually. Eight percent (95% CI = 3% to 13%) assess competency only during the final year of training. Thirty percent (95% CI = 22% to 38%) of programs assess competency with a combination of the above intervals, and 16% (95% CI = 10% to 22%) do not assess US competency. Fourteen percent (95% CI = 8% to 20%) use objective structured clinical examinations (OSCEs), and 21% (95% CI = 14% to 28%) use standardized direct observation tools (SDOTs) to assess resident competency in US. Approximately one-third (33%, 95% CI = 24% to 41%) of standardized testing for US competency is conducted with multiple-choice questions. Thirty percent (95% CI = 21% to 38%) administer practical examinations to assess US skills. Conclusions Currently, a majority of EM residency programs assess resident competency in bedside US. However, there is significant variation in the methods of competency assessment. Resumen Objetivos En el modelo de practica clinica de la Medicina de Urgencias y Emergencias (MUE), la ecografia (Eco) a pie de cama se catalogo como una de las habilidades esenciales en procedimientos. Los hitos en MUE publicados por el Accreditation Council for Graduate Medical Education y la American Board of Emergency Medicine requieren que los residentes demuestren su competencia en Eco a pie de cama. El proposito de este estudio fue valorar los metodos actuales usados en los programas formativos en la residencia de MUE para evaluar las competencias del residente en Eco a pie de cama. Metodologia Estudio transversal basado en encuestas. Se envio electronicamente un cuestionario sobre la formacion en Eco y la evaluacion de las competencias a todos los directores de programas de residencia de MUE y los directores de Eco de urgencias. La encuesta consistio en preguntas relativas a la rotacion por el servicio de ecografia, la estructura del plan de estudios en Eco, la presencia de becarios en la Eco, el almacenamiento de imagenes, los metodos de control de calidad, la retroalimentacion, las herramientas de evaluacion de las competencias y la frecuencia de las evaluaciones. Las respuestas de la encuesta se documentaron en terminos de porcentaje del total de respondedores con sus intervalos de confianza (IC) al 95%. Resultados Ciento veinticuatro de un total de 161 programas de residencia de MUE participaron en este estudio (porcentaje de respuesta del 77%). Un 23% (IC 95% = 18% a 34%) de los programas solo valora las competencias al final de la rotacion por Eco. Un 8% (IC 95% = 3% a 13%) solo valora las competencias cada seis meses y un 13% (IC 95% = 7% a 19%) solo anualmente. Un 8% (IC 95% = 3% a 13%) solo valora las competencias durante el ultimo ano de formacion. Un 35% (IC 95% = 22% a 38%) de los programas valora las competencias con una combinacion de los intervalos descritos anteriormente y un 16% (IC 95% = 10% a 22%) no valora competencias en Eco. Un 14% (IC 95% = 8% a 20%) usa examenes clinicos estructurados objetivos y un 21% (IC 95% = 14% a 28%) usa herramientas estandarizadas de observacion directa para valorar las competencias de los residentes en Eco. Aproximadamente un tercio (33%, IC 95% = 24% a 41%) de los cuestionarios estandarizados para las competencias en Eco se lleva a cabo mediante preguntas de eleccion multiple. Un 30% (IC 95% = 21% a 38%) aplica un examen practico para valorar las habilidades en Eco. Conclusiones Actualmente, la mayoria de los programas de residencia de MUE valora las competencias en Eco a pie de cama. Sin embargo, existe una variacion significativa en los metodos de valoracion de competencias.