FIRST TRIMESTER OBSTETRICAL ULTRASOUND COMPETENCY – BASED TRAINING FOR FAMILY PHYSICIANS Christopher Orsello, MD, LT, MC, USNR, Naval Hospital Bremerton, Bremerton, WA, 98312, Ronald Dommermuth, MD, CDR, MC, USN, Naval Hospital Bremerton, Bremerton, WA, 98312. Robert Marshall, MD, CAPT, MC, USN, Naval Hospital Bremerton, Bremerton, WA, 98312.
Introduction/Background: A recent Cochrane Database review supports routine early ultrasounds, including first trimester ultrasounds, as an intervention in pregnancy that may result in improved outcomes at or beyond term. Despite this recommendation, a thorough literature search reveals absence of a standardized first trimester competency-based training curriculum for family physicians. It also reveals that of first trimester ultrasound scanning carried out in community-based practices, only 4 to 15% meet all of the American Institute for Ultrasound in Medicine (AIUM) criteria, considered the standard. These criteria hold family physicians and obstetricians to the same standards expected of radiologists credentialed in first trimester ultrasounds.
Methods/Intervention: This training intervention is designed to establish a competency – based curriculum for training family physicians in the performance of first trimester ultrasounds that meet AIUM criteria.
Design: Single group, post-intervention only
Setting: Naval Hospital Bremerton Residency Program
Study Populations: XX family medicine residents
Interventions: Family medicine residents underwent structured competency-based first-trimester ultrasound training through scheduled ultrasound clinics with a board-certified, Obstetric-fellowship trained family physician.
Main Outcome Measures: After demonstration of competency within the clinic, a fully credentialed radiologist using the same AIUM criteria evaluated the residents. Total number of sessions necessary per resident to achieve objective levels of competency was measured.
Statistical Tests Used: Descriptive statistics for categorical variables.
Evaluation: A standardized competency-based curriculum utilizing AIUM criteria for training family physicians in first-trimester ultrasounds was implemented in a residency training program. This model for training demonstrates that family practice residents can meet AIUM standards in the performance of first trimester ultrasounds. Its emphasis on the demonstration of competency by objective evaluation of resident skill using AIUM criteria provides credible support as to when each family physician may independently perform first trimester ultrasounds.
Conclusion/Discussion: This project established a competency-based model for training family practice residents in performing first trimester ultrasounds. The model is simple, effective and efficient, objectively defining an AIUM point of competence for the family physicians’ performance of first trimester ultrasounds.
CURRICULUM CHANGES TO INCREASE RESEARCH IN A FAMILY MEDICINE RESIDENCY PROGRAM Anna Oberhofer, MD, LT, MC USN, Naval Hospital Jacksonville, Jacksonville, FL, 32214
Objective: Participation in scholarly activity is required for residents in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME ). Yet balancing the demands of other training requirements and professional obligations with scholarly pursuits can be challenging. It has become imperative to equip residents with the support and tools needed to perform scholarly activity. The objective of this study was to study the impact of the implementation of a series of curriculum initiatives on scholarly productivity.
Methods: Beginning in 2010, educational interventions to increase resident scholarly activity were implemented in three parts.
Design: historical cohort, retrospective
Setting: Naval Hospital Jacksonville Residency Program
Study Populations: family medicine residents
Interventions: 1) a faculty research coordinator (FRC) was established; 2) a scholarly activity point system was adapted from one published by Seehusen et al, along with a research tracking system and a medical conference schedule tracking system; and 3) a resident research coordinator (RRC) position was created. The FRC and RRC acted as liaisons between residents, faculty, and non-faculty staff interested in working with residents on scholarly activity, and created an annual scholarly activity workshop.
Main Outcome Measures: Number of resident scholarly products, defined as peer-reviewed publications and posters/presentations at regional or national events
Statistical Tests Used: Descriptive statistics used to analyze scholarly productivity.
Results: In 2009, prior to the rollout of these curriculum changes, the number of resident scholarly projects per capita was 0.07. In 2012, the research per capita was 0.91 (nearly 1 per resident per year), representing a 13-fold increase.
Conclusions: Our study reveals a positive impact on scholarly activity production coinciding with implementation of research curricular initiatives. This model could be implemented in other residency programs to support scholarly activity requirements.
USING A SIMULATED SURGICAL SKILLS STATION TO ASSESS LACERATION MANAGEMENT AMONG SURGICAL AND NON-SURGICAL RESIDENTS Matthew V. Fargo, MAJ, MC, Eisenhower Army Medical Center, Fort Gordon, GA 30905; John A. Edwards, LTC, MC; Bernard J. Roth, MD; Matthew W. Short, MAJ, MC; Madigan Army Medical Center, Tacoma, WA
Introduction: Laceration management is traditionally taught using apprenticeship with subjective impressions regarding competence. The purpose of this study was to objectively assess laceration management performance among surgical and non-surgical interns and test for interval improvement.
Methods: From 2006 to 2008, 106 interns from were evaluated before and after internship on laceration management performance using a simulated surgical skills station using pigs’ feet. Trainees were given 11 minutes to choose the proper suture, prepare and close the wound, and answer laceration management questions.
Design: single group, pretest-posttest
Setting: multiple residency sites
Study Populations: 106 interns, 10 medical specialties, classified as surgical (emergency med, gen surg, OB, ortho, and ENT) and non-surgical (fam med, int med, neuro, peds, and transitional).
Interventions: a simulated surgical skills station
Main Outcome Measures: skills station score
Statistical Tests Used: Scores between groups and score improvements were compared using a non-paired and paired t-test. Mann-Whitney U and Chi-Square were used to compare demographics.
Results: There were 41 surgical (mean age 28.5 years; 29 (71%) men; 36 (88%) MD) and 65 non-surgical interns (mean age 28.8; 41 (63%) men; 39 (60%) MD) and gender and age were not significantly different between groups. Surgical group scores improved from 78.4% to 87.7% (p < 0.001). Non-surgical improved from 67.2% to 73.1% (p < 0.001). Surgical outscored non-surgical interns before (p < 0.001) and after (p < 0.001) internship. There was similar improvement between groups (surgical 9.4%, non-surgical 5.9%; p = 0.21).
Conclusions: Surgical residents outperformed non-surgical residents before and after internship with similar score improvement. A simulated surgical skills station may serve as a useful tool to objectively evaluate procedure performance and test for interval improvement.