 |
|
Institutional Learning Curve of Surgeon-Performed Trauma Ultrasound
R. Stephen Smith, MD, RDMS;
Steven J. Kern, MD;
William R. Fry, MD, RVT, RDMS;
Stephen D. Helmer, PhD
Arch Surg. 1998;133:530-536.
Background Sonography has become the primary mode for the initial evaluation of abdominal injury in many trauma centers. However, the rate at which nonradiologists become proficient in this technique remains controversial.
Objective To assess the learning curve for this technique in a single institution.
Design Retrospective review of sonographic examinations for trauma performed by senior surgical residents during a 24-month period at an American College of Surgeons–verified level I trauma center.
Setting University-affiliated private hospital.
Patients and Methods Before the initiation of a program of surgeon-performed trauma ultrasound, senior surgical residents (postgraduate years 4 and 5) received 11.5 hours of hands-on and didactic instruction in the focused ultrasound examination for trauma. This examination then became a standard component of the evaluation of injured patients. Subsequent groups of senior residents received 8 hours of instruction at the onset of new academic years, 6 and 18 months, respectively, after the initial course. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were then calculated for each 6-month period after the introduction of trauma sonography.
Results During the 24-month study period, 902 sonographic examinations were performed. No statistically significant differences were noted in sensitivity, specificity, accuracy, positive predictive value, or negative predictive value for any 6-month period of study when compared with the other 6-month periods or with the values calculated for the entire study period.
Conclusions Senior surgical residents are capable of performing the focused ultrasound examination for trauma with a high level of skill after a concise introductory course. A learning curve was not apparent in our series. Criteria for being permitted to perform trauma sonography that include the requirement of a large number of examinations or extensive proctoring should be reassessed.
From the Department of Surgery, University of Kansas School of Medicine–Wichita (Drs Smith, Kern, and Helmer); and Trauma Service, Penrose–St Francis Hospital, Colorado Springs, Colo (Dr Fry).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Focused assessment with sonography for trauma: the FAST scan
Christie-Large et al.
Trauma 2008;10:93-101.
ABSTRACT
Residents Should Not Independently Perform Focused Abdominal Sonography for Trauma After 10 Training Examinations
Jang et al.
J Ultrasound Med 2004;23:793-797.
ABSTRACT
| FULL TEXT
Musculoskeletal sonography by rheumatologists: the challenges
Speed and Bearcroft
Rheumatology (Oxford) 2002;41:241-242.
FULL TEXT
Imaging in abdominal trauma
Wherry and Punzalan
Trauma 2000;2:283-290.
ABSTRACT
Physician Training Requirements in Sonography: How Many Cases Are Needed for Competence?
Hertzberg et al.
Am. J. Roentgenol. 2000;174:1221-1227.
ABSTRACT
| FULL TEXT
"Alternative" Surgery in Trauma Management
Britt and Cole
Arch Surg 1998;133:1177-1181.
ABSTRACT
| FULL TEXT
Accuracy of Surgeon-Performed Trauma Ultrasound
Lazzaron and de Souza
Arch Surg 1998;133:1254-1254.
FULL TEXT
|
