How many is enough? Measuring the number of FAST exams needed by emergency medicine trainees to reach competence
Dublin Core
Title
How many is enough? Measuring the number of FAST exams needed by emergency medicine trainees to reach competence
Subject
Focused assessment with sonography, FAST, Ultrasound, Education, Competency
Description
Abstract
Background For patients with blunt abdominal trauma, the Focused Assessment with Sonography in Trauma
(FAST) exam is the initial imaging modality employed to diagnose and risk stratify. A positive FAST exam in this
patient population denotes intraperitoneal hemorrhage. In a hemodynamically unstable patient, it necessitates
rapid surgical intervention. Ultrasound is highly dependent on the operator’s ability to obtain quality images for
interpretation. Failure to obtain adequate images prevents accurate interpretation and reduce its diagnostic accuracy.
Previous studies evaluating whether the FAST exam can be improved solely by experience had conflicting results.
None of those studies used an objective method to evaluate the FAST exam’s quality. Our study aimed to objectively
determine the number of FAST exams required by an emergency medicine (EM) resident to reach sufficient quality for
independent scanning.
Methods 59 first-year EM residents from a single site were included in this study. All FAST exams that were saved
in the Qpath archival system by the 59 EM residents, whether the exam was performed for educational or clinical
purposes, were reviewed, and scored using a Task-Specific Checklist (TSC) score. This score is an objective way
to assess the proficiency and quality of the FAST scan. The TSC was based on whether the imaging of 24 specific
anatomic landmarks, split into four anatomic regions, was completed successfully or not. The AEMUS (Advanced EM
Ultrasonography) faculty provided feedback to trainees wither electronically via Qpath or at the bedside. According
to the quality of ultrasound imaging and competence (QUICK Score), if the average TSC score for the first 10 exams
was 18 or higher, the resident was considered an expert. However, if the resident failed to achieve that score, we
skipped the first exam performed by the resident and the average score for the second through eleventh exams was
then calculated. If the resident did not achieve the desired result, the first and second exams were skipped and the
average score for the remaining 10 exams was determined. This sequence was repeated until the resident achieved
an average score of 18 or higher on their TSC score.
Results In total, 663 FAST scans performed by EM residents were scored. The average number of FAST exams needed
for independent scanning is 11.23 (95% CI, 10.6-11.85). 66.1% of enrolled residents achieved an average score of 18
or higher in their first 10 FAST exams, and 33.8% of residents required more than 10 scans. The average scores for the
Background For patients with blunt abdominal trauma, the Focused Assessment with Sonography in Trauma
(FAST) exam is the initial imaging modality employed to diagnose and risk stratify. A positive FAST exam in this
patient population denotes intraperitoneal hemorrhage. In a hemodynamically unstable patient, it necessitates
rapid surgical intervention. Ultrasound is highly dependent on the operator’s ability to obtain quality images for
interpretation. Failure to obtain adequate images prevents accurate interpretation and reduce its diagnostic accuracy.
Previous studies evaluating whether the FAST exam can be improved solely by experience had conflicting results.
None of those studies used an objective method to evaluate the FAST exam’s quality. Our study aimed to objectively
determine the number of FAST exams required by an emergency medicine (EM) resident to reach sufficient quality for
independent scanning.
Methods 59 first-year EM residents from a single site were included in this study. All FAST exams that were saved
in the Qpath archival system by the 59 EM residents, whether the exam was performed for educational or clinical
purposes, were reviewed, and scored using a Task-Specific Checklist (TSC) score. This score is an objective way
to assess the proficiency and quality of the FAST scan. The TSC was based on whether the imaging of 24 specific
anatomic landmarks, split into four anatomic regions, was completed successfully or not. The AEMUS (Advanced EM
Ultrasonography) faculty provided feedback to trainees wither electronically via Qpath or at the bedside. According
to the quality of ultrasound imaging and competence (QUICK Score), if the average TSC score for the first 10 exams
was 18 or higher, the resident was considered an expert. However, if the resident failed to achieve that score, we
skipped the first exam performed by the resident and the average score for the second through eleventh exams was
then calculated. If the resident did not achieve the desired result, the first and second exams were skipped and the
average score for the remaining 10 exams was determined. This sequence was repeated until the resident achieved
an average score of 18 or higher on their TSC score.
Results In total, 663 FAST scans performed by EM residents were scored. The average number of FAST exams needed
for independent scanning is 11.23 (95% CI, 10.6-11.85). 66.1% of enrolled residents achieved an average score of 18
or higher in their first 10 FAST exams, and 33.8% of residents required more than 10 scans. The average scores for the
Creator
Ahmad Bakhribah1
, Jordan Leumas2
, Gregg Helland2
, Joshua Guttman2
, Yara Arfaj3
, Rawan Alharbi3
and
Abdullah Bakhsh1*
, Jordan Leumas2
, Gregg Helland2
, Joshua Guttman2
, Yara Arfaj3
, Rawan Alharbi3
and
Abdullah Bakhsh1*
Source
https://doi.org/10.1186/s12245-024-00742-x
Date
2024
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Ahmad Bakhribah1
, Jordan Leumas2
, Gregg Helland2
, Joshua Guttman2
, Yara Arfaj3
, Rawan Alharbi3
and
Abdullah Bakhsh1*, “How many is enough? Measuring the number of FAST exams needed by emergency medicine trainees to reach competence,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12503.