W. Teeter1, M. Lauerman1, D. Haase1, T. Scalea1, S. Murthi1 1University of Maryland R A Cowley Shock Trauma Center,Surgical Critical Care,Baltimore, MD, USA
Introduction
Point of care ultrasound (POCUS) allows bedside diagnostics and procedural guidance in a wide variety of clinical scenarios. Emergency medicine residents are required to demonstrate competency using ultrasound before graduation through a formal evaluation process including 150 quality-verified exams. There are no requirements or guidelines for ultrasound training in general surgery residency. We hypothesize that the knowledge and skills of emergency medicine residents surpass those of their general surgery colleagues.
Methods:
Over a two year period, current graduates from differing residencies in either General Surgery or Emergency Medicine who were about to start a critical care fellowship at our institution were enrolled. Participants completed a survey of self-perceived confidence and anticipated future use in practice, a thirty question exam testing ultrasound knowledge, and a hands-on skills assessment judged by experienced ultrasound faculty. Participants confidence, skills, and anticipated future use were graded using a previously published 5-point Likert scale. Knowledge was assessed using 4-option multiple choices questions.
Results:
GS and EM residents had the lowest self-assessments in competency with Advanced Cardiac US at 1.06±0.25 and 2.13±0.84 (p=0.008), and the highest in Line Placement at 4.56±0.89 and 4.63±0.74 (p=0.86), respectively (Table 1). The knowledge assessment between the two groups showed that EM performed significantly better than GS on many individual subgroups of US, and an overall mean composite score of 46.5±12.2% vs 74.4%±14.9 (p<0.001). Observed competence was significantly better in EM than GS in all measured cardiac US tasks, lung US tasks, FAST, and overall composite scores (2.76±0.49 and 4.1±0.53, p <0.001). All participants identified FAST as “a must” (5.0) to be used in their future practice, but mean observed competence was 3.56±1.15 and 4.9±0.32 (GS vs EM, p=0.02).
Conclusion:
Compared to their EM colleagues, general surgery graduates have high confidence in using ultrasound, but are not competent in basic ultrasound knowledge or skills despite strong plans to use it in their clinical practice. Specifically, they demonstrated lack of skills in acquisition of adequate images for a FAST. It is time for general surgery educators to develop and include formal ultrasound training as part of basic residency requirements.
