Competency-based instruction to improve the surgical resident technique and accuracy of the trauma ultrasound

In a surgical trauma center, programs and workshops have improved the perfo rmance on focused abdominal sonogram for trauma (FAST). The purpose of this single-blind study was to prove that a cadaver laboratory competency-based instruction program may be an effective method of FAST training to acquire the skills that would be applied in the trauma room. The study was divided in two parts, laboratory and clinical. Nine surgical residents were divide d into two groups: Group I performed the test only once, and Group II perfo rmed the training twice. A third "group" was the senior ultrasound technici an, whose readings served as our "gold standard" with which to compare the resident readings (Group III). Using cadavers, a 2-cm catheter was introduc ed into the peritoneal cavity. Sequential aliquots of normal saline were in troduced into the abdominal cavity at 0-, 200-, 400-, 600-, and 1000-cc inc rements in each group tested. The residents were asked to describe their ex aminations for the presence or absence of fluid in the abdomen. The ultraso und examination was then performed with the cadaver in three different posi tions to study if there was any difference of fluid detection in varied pos itions. True positive, true negative, and accuracy were then calculated com paring the three different groups of test sonographers. In the second part of the study, the same residents were then followed in the trauma room, whe re they performed the FAST in the absence of the ultrasound technician duri ng emergencies. As in the laboratory, the accuracy of their reading compare d with that of the ultrasound technician was also evaluated. From 400 cc an d upward, Group II began having an overall significantly superior accuracy than the first group and the technician in most quadrants examined. The tre nd was apparent for more accurate results in all quadrants and positions by all groups as the fluid was increased. Overall, group II was most superior in detection of intra-abdominal fluid in the cadaver. In the clinical scen ario, the residents as a whole had similar accuracy (92% vs 96%) in reading FAST as the ultrasound technician. Our results suggest that surgical resid ents have the ability to detect fluid in the abdomen, there exists a fast l earning curve, and the minimum detection level of fluid was between 200 and 400 cc in the peritoneal cavity in the laboratory. Surgical residents were able to detect intra-abdominal fluid in the trauma situation, as shown by the 92 per cent accuracy of the FAST in the emergency situation. We conclud e that a cadaver laboratory training program is an important adjunct to imp rove the skills of the resident in performing and reading FAST.