Emergency residency program learns from its alumni: Ultrasound among areas needing more emphasis

Getting alums of emergency-medicine training programs to evaluate their own practice skills can help directors of said programs strengthen their curriculum where it’s weak, according to a study published online Oct. 21 in Emergency Medicine Journal. Of interest to imaging observers, the researchers found that diagnostic ultrasound was one of several ER subcompetencies in need of attention at their institution.

Theodore J. Gaeta, DO, MPH, of New York-Presbyterian Brooklyn Methodist Hospital and colleagues adapted the emergency medicine milestones developed by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Emergency Medicine (ABEM) into an alumni self-assessment survey.

The aim of the project was specifically to identify parts of their training program that needed improving.

Nearly three-quarters of the past emergency-med residents who received the survey (69 of 93) responded.

The researchers found the physicians achieving target performance in five of six general competencies. The only one of these in which the field came up short was systems-based practice, indicating the alumni should be doing more strategizing on ways to improve overall healthcare delivery.

Meanwhile the alumni were meeting their performance targets on 17 of 23 subcompetencies.

The six in need of more targeting training were ultrasound, pharmacotherapy, wound management, patient safety, and systems-based management and technology.

The ACGME-ABEM subcompetency milestone for goal-directed focused ultrasound “for the bedside diagnostic evaluation of emergency medical conditions and diagnoses, resuscitation of the acutely ill or injured patient, and procedural guidance” invites alumni to place themselves in one of five levels:

Level 1 — Describes the indications for emergency ultrasound.

Level 2 — Explains how to optimize ultrasound images and identifies the proper probe for each of the focused ultrasound applications.

Level 3 — Performs goal-directed focused ultrasound exams and correctly interprets acquired images.

Level 4 — Performs a minimum of 150 focused ultrasound examinations.

Level 5 — Expands ultrasonography skills to include: advanced echo, transesophageal echocardiography, bowel, adnexal and testicular pathology, and transcranial Doppler.

A sixth box allows the self-evaluator to indicate that he or she has not achieved the first level.

In their discussion, Gaeta and colleagues write that alumni self-evaluation of competence using the ACGME-ABEM milestones “provides valuable information concerning confidence to practice independently; these data, coupled with regular milestone evaluation of existing trainees, can identify problem areas and provide a blueprint for targeted program improvement.”

Emergency Medicine Journal is a BMJ title published by the U.K.’s Royal College of Emergency Medicine.