Written by Chris Thom
Spoon Feed
This novel web-based training for first trimester POCUS was effective and found several variables that are key for achieving mastery.
POCUS competency is not just a numbers game
This was a multicenter prospective cross-sectional study of emergency physicians (EPs) evaluating the efficacy of a novel web-based educational intervention on first trimester POCUS mastery. Two hundred transabdominal (TAUS) and transvaginal (TVUS) cases were collated by the authors, with 50% of these being positive for intrauterine pregnancy (IUP). 204 individual EPs were recruited to work through either the TAUS cases (100 EPs) or TVUS cases (104 EPs). The EP evaluated each case and determined if IUP was present, the location of the IUP if present, and a selection of additional pregnancy-related findings. Learning curves were evaluated for individual users, and specific pathologies were evaluated to determine if they were associated with increased diagnostic error.
Initial accuracy was 77.6%, and final accuracy was 92.8% at the end of the educational intervention, an increase of 15.2% (95%CI 14.6-15.8). There was a steeper learning curve for TVUS cases compared to TAUS, as well as for those with IUP present. 64.7% of EPs achieved the mastery standard in a median of 60 cases (IQR 58-83). TVUS images were associated with a greater odds of correct identification of IUP presence (OR 1.5), as were the presence of an IUP (OR 3.9) and a fetal heartbeat (OR 4.3). Findings associated with a lower odds of correct IUP determination included eccentric location of an IUP (OR 0.2), subchorionic hemorrhage (OR 0.5), adnexal structure (OR 0.7), and endometrial fluid collection (OR 0.1).
How will this change my practice?
The authors should be commended for developing a robust case-based educational intervention that aids in our understanding of effective POCUS first trimester teaching. We see that a significant number of cases (60) are needed for achieving mastery in interpretation, though there was a notable degree of heterogeneity in the group, with some participants requiring 3 times the number of cases to achieve the mastery standard. TVUS was associated with quicker learning than TAUS, and cases with IUP present were diagnostically easier than IUP-absent cases. These are helpful clues about where to focus our education and highlight that some users will require more education and exposure to achieve the same test characteristics as others. An educational portfolio with individual competency assessments is ideal where feasible.
POCUS pro-tips and clips:
First trimester pregnancy ultrasound is particularly important for POCUS. Care is delivered accurately (1), more efficiently (2), and without the potential for unnecessary TVUS exams secondary to radiology protocols (3). Perhaps most importantly, it allows for the direct communication of results between the individual physician performing the ultrasound and the patient. This improves both the physician and patient experience, while affording a much more salient platform for shared understanding of the health care visit.
Source
Effectiveness of a Web-Based Training Intervention in Teaching Emergency Physicians First-Trimester Point-of-Care Ultrasound Image Interpretation. Ann Emerg Med. 2025 Feb 19:S0196-0644(25)00015-0. doi: 10.1016/j.annemergmed.2025.01.005. Epub ahead of print. PMID: 39985553
Works Cited
- Stein JC, Wang R, Adler N, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med. 2010;56(6):674-683.
- Panebianco NL, Shofer F, Fields JM, et al. The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy. Am J Emerg Med. 2015;33(6):743-748.
- Thom C, Livingstone K, Ottenhoff J, Han D, Martindale J, Moak J. Comparison of transvaginal ultrasound utilization between radiology and point of care ultrasound in first trimester pregnancy. Am J Emerg Med. 2024;80:143-148.
