title: Number of Weeks Rotating in the Emergency Department Has a Greater Effect on Ultrasound Milestone Competency Than a Dedicated Ultrasound Rotation.
abstract: OBJECTIVE
  Ultrasound (US) is vital to modern emergency medicine (EM). Across residencies, there is marked variability in US training. The "goal-directed focused US" part of the Milestones Project states that trainees must correctly acquire and interpret images to achieve a level 3 milestone. Standardized methods by which programs teach these skills have not been established. Our goal was to determine whether residents could achieve level 3 with or without a dedicated US rotation.
  
  
  METHODS
  Thirty-three first- and second-year residents were assigned to control (no rotation) and intervention (US rotation) groups. The intervention group underwent a 2-week curriculum in vascular access, the aorta, echocardiography, focused assessment with sonography for trauma, and pregnancy. To test acquisition, US-trained emergency medicine physicians administered an objective structured clinical examination. To test interpretation, residents had to identify normal versus abnormal findings. Mixed-model logistic regression tested the association of a US rotation while controlling for confounders: weeks in the emergency department (ED) as a resident, medical school US rotation, and postgraduate years.
  
  
  RESULTS
  For image acquisition, medical school US rotation and weeks in the ED as a resident were significant (P = .03; P = .04) whereas completion of a US rotation and postgraduate years were not significant. For image interpretation, weeks in the ED as a resident was the only significant predictor of performance (P = .002) whereas completion of a US rotation and medical school US rotation were not significant.
  
  
  CONCLUSIONS
  To achieve a level 3 milestone, weeks in the ED as a resident were significant for mastering image acquisition and interpretation. A dedicated US rotation did not have a significant effect. A medical school US rotation had a significant effect on image acquisition but not interpretation. Further studies are needed to best assess methods to meet US milestones.
authors.affiliation: Emergency Services Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Smalley
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.|Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Thiessen
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.|Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Byyny
authors.affiliation: Department of Emergency Medicine, University of California Davis, Sacramento, California, USA.
authors.forename: Alyrene
authors.initials: A
authors.lastname: Dorey
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, Denver, Colorado, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: McNair
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.|Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Kendall
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D016037:Single-Blind Method; D013997:Time Factors; D014465:Ultrasonics / Q000193:education*
keywords: Accreditation Council for Graduate Medical Education; Next accreditation system; emergency medicine milestones; resident evaluation; ultrasound competency; ultrasound education