Learning Objective: Attendees will learn about how development of a digital ultrasound curriculum can be used to address knowledge gaps in resident education and is associated with improved confidence with performing and interpreting ultrasound exams.

Background: Ultrasound is a key competency for EM residents and has numerous applications. It is not clear if residents gain sufficient experience with less frequently used ultrasound exam types through traditional teaching methods. A digital curriculum may provide additional learning opportunities and help to address these knowledge gaps.

Objectives: The primary goal was to identify current gaps in resident ultrasound education by assessing confidence in performing and interpreting various U/S studies. A secondary goal was to determine if a digital ultrasound curriculum was feasible.

Methods: This prospective observational study was performed at a 3-year EM residency program located at a level 1 trauma center in a large metropolitan area. A pre-implementation survey evaluated resident utilization and confidence with various U/S exams using multiple choice and Likert scale questions. After implementation of a digital ultrasound curriculum, which included monthly cases and self-paced modules, a post-implementation survey was conducted.

Results: There were 12 and 18 respondents in the pre and post implementation surveys respectively. In both surveys, FAST and cardiac exams had the highest confidence and utilization scores. Ocular, pelvic, DVT, and renal U/S had low pre-implementation confidence and utilization scores that increased significantly on post implementation surveys (Figures 1 and 2). Initially, PGY3’s used U/S most frequently but post-implementation PGY2’s had the highest overall usage. Overall, the digital curriculum post-implementation survey showed an 88% increase in interpretation confidence score and a 28% increase in utilization.

Conclusions: Confidence with performing and interpreting various ultrasound exams was low for infrequently used exam types and increased significantly following the implementation of a digital curriculum. These are feasible interventions and could improve knowledge of less commonly used exams.

Introduction: Approximately two million people present to the emergency department (ED) with eye-related complaints each year in the United States. Differentiating pathologies that need urgent consultation from those that do not is imperative. For some physicians, ocular ultrasound has eclipsed the dilated fundoscopic exam as the standard posterior segment evaluation in the ED.

Case report: A 60-year-old female presented with sudden onset visual disturbance in her right eye. Point-of-care ultrasound showed a hyperechoic band in the posterior segment concerning for a retinal detachment. Ophthalmology was consulted and diagnosed the patient with a condition known as Valsalva retinopathy. The patient was discharged from the ED with expectant management.

Conclusion: This case highlights an important differential diagnosis that should be considered when ocular ultrasound demonstrates a hyperechoic band in the posterior segment. While previous literature has demonstrated that emergency physicians are able to accurately identify posterior segment pathology using ultrasound, there is limited information regarding their ability to differentiate between pathologies, some of which may not require urgent consultation. We highlight the important differentials that should be considered when identifying posterior segment pathology on point-of-care ultrasound and their appropriate dispositions.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) specifically notes multisource feedback (MSF) as a recommended means of resident assessment in the emergency medicine (EM) Milestones. High-fidelity simulation is an environment wherein residents can receive MSF from various types of healthcare professionals. Previously, the Queen’s Simulation Assessment Tool (QSAT) has been validated for faculty to assess residents in five categories: assessment; diagnostic actions; therapeutic actions; interpersonal communication, and overall assessment. We sought to determine whether the QSAT could be used to provide MSF using a standardized simulation case.

Methods: Prospectively after institutional review board approval, residents from a dual ACGME/osteopathic-approved postgraduate years (PGY) 1-4 EM residency were consented for participation. We developed a standardized resuscitation after overdose case with specific 1-5 Likert anchors used by the QSAT. A PGY 2-4 resident participated in the role of team leader, who completed a QSAT as self-assessment. The team consisted of a PGY-1 peer, an emergency medical services (EMS) provider, and a nurse. Two core faculty were present to administer the simulation case and assess. Demographics were gathered from all participants completing QSATs. We analyzed QSATs by each category and on cumulative score. Hypothesis testing was performed using intraclass correlation coefficients (ICC), with 95% confidence intervals. Interpretation of ICC results was based on previously published definitions.

Results: We enrolled 34 team leader residents along with 34 nurses. A single PGY-1, a single EMS provider and two faculty were also enrolled. Faculty provided higher cumulative QSAT scores than the other sources of MSF. QSAT scores did not increase with team leader PGY level. ICC for inter-rater reliability for all sources of MSF was 0.754 (0.572-0.867). Removing the self-evaluation scores increased inter-rater reliability to 0.838 (0.733-0.910). There was lesser agreement between faculty and nurse evaluations than from the EMS or peer evaluation.

Conclusion: In this single-site cohort using an internally developed simulation case, the QSAT provided MSF with excellent reliability. Self-assessment decreases the reliability of the MSF, and our data suggest self-assessment should not be a component of MSF. Use of the QSAT for MSF may be considered as a source of data for clinical competency committees.