If you are involved in Emergency Medicine education in the United States you have heard about the new evaluation process for residents known as the Milestones project. As a quick summary the ACGME and the RRC for EM has developed several key areas residents should be evaluated in during their residency education with milestones they should reach before graduation. Now there are discussions back and forth over the utility of the milestones, how they correlate or don’t correlate with competency, why these particular items and milestones were picked and many other topics. In the end the Milestones are here and being implemented.
One of the Milestones is PC-12 which involves Emergency Ultrasound. Not every residency program has a ultrasound fellowship trained faculty (not that every program needs one). So there was a lot of discussion on how to meet this milestone. A joint taskforce was convened with the Academy of Emergency Ultrasound (AEUS), an Academy of the Society for Academic Emergency Medicine and the Council of Residency Directors in Emergency Medicine (CORD). There were also representatives from ACEP and EMRA.
In the July 2013 issue of Academic Emergency Medicine the consensus document was published to serve as a resource to programs. It is available at the journal website.
Lewis RE, Pearl M, Nomura JT, Baty G, Bengiamin R, Duprey K, Stone M, Theodoro D, Akhtar S, CORD-AEUS: Consensus Document for the Emergency Ultrasound Milestone Project. Acad Emerg Med:20;740-745.
The document discusses how the Milestone project relates to Emergency Ultrasound and brings some important topics and information. There are several data supplements that go along with the document which is what I wanted to mention and serve as resources.
One key area is the differentiation between what is basic and what is advanced emergency ultrasound applications. This list was developed through a modified Delphi method that also allowed input from educators and ultrasound practitioner from the involved groups (ACEP, SAEM, CORD). Now the differentiation was a consensus, so you may not agree with everything. The table of core vs advanced topics can be downloaded. Also to be clear this was to help define the educational base for an EM residency graduate; not to define Emergency Ultrasound as a whole.
The other supplement is the list of assessment methods and how they integrate in to the milestone. Programs currently have assessment methods in place and there is no single way to meet each milestone or evaluate competency. This assessment table lists different methods, what they assess, limitations, and which milestones they can evaluate.
Residents will perform many ultrasounds during their residency, at least 150 per the milestones, and the assessment of progress through the milestones could be done differently. One method is to evaluate ultrasound performed by the resident individually for education, feedback, and performance improvement. This could be done using the CORD US-SDOT forms.
Then the resident’s progress in the US milestone could be evaluated over time by examining their ultrasound performance in aggregate. This was the approach for the evaluation document by the Joint Milestone Task Force (they have a wiki) from CORD. The form that was created is available on the wiki and I have adapted it as a New Innovations questionnaire or evaluation form. The JMTF form allows you to add ultrasound studies to evaluate in addition to the FAST exam, in the example these are multi-view echo and abdominal aorta, but you can customize this to fit your program.
- Core vs Advanced Emergency Ultrasound for Residents
- Assessment methods with skills tested, limitations, and associated milestones
- CORD US-SDOT Forms
- New Innovations version of the JMTF US milestone evaluation form
As a disclaimer I was an author on the consensus document and served on the CORD-AEUS Task Force and the CORD JMTF.