The learning curve of resident physicians using emergency ultrasonography for @entity2963 and XXXX .

@entity1 @entity2963 @entity253 @entity2679
BACKGROUND: Emergency department bedside ultrasonography (EUS) can expedite treatment for @entity1 . However, it is unknown how much experience is required for competency in the sonographic diagnosis of @entity2963 and @entity2679 . OBJECTIVES: The objective was to assess the learning curve of physicians training in right upper quadrant (RUQ) EUS. METHODS: This was a prospective study at an urban, academic emergency department from August 1999 to July 2006. @entity1 with suspected @entity253 underwent RUQ EUS followed by abdominal ultra sonography (AUS) by the Department of Radiology. Results of EUS were compared to AUS using a predesigned, standardized data sheet. RESULTS: A total of 1,837 @entity1 underwent EUS by 127 physicians. The overall sensitivity and specificity of EUS for @entity2963 were 84% (95% confidence interval [CI] = 81% to 86%) and 86% (95% CI = 83% to 88%), respectively. The overall sensitivity of EUS for ductal dilation, gallbladder wall thickening, pericholecystic fluid, and sludge were each < 60%. When analyzing the EUS test characteristics, for every increase in 10 examinations up to 50 examinations, there was no significant improvement in the sensitivity or specificity for any of these sonographic findings. Moreover, on probit regression analysis, accounting for clustering or correlation among the examinations performed by each of the operators, there was no improvement for detecting any of the sonographic findings except for pericholecystic fluid for every 10 additional examinations performed. CONCLUSIONS: When adjusting for operator dependence, performing up to 50 EUS examinations appears to have little effect on the accuracy of RUQ EUS. Rather than simply requiring an arbitrary number of examinations, another method of competency assessment may be necessary.
