Effectiveness of a Web-Based Training Intervention in Teaching Emergency Physicians First-Trimester Point-of-Care Ultrasound Image Interpretation - 20/02/25

Doi : 10.1016/j.annemergmed.2025.01.005

Lori Stolz, MD ^a, Gillian Sheppard, MD ^b, Jeremy Boyd, MD ^c, Jessica Baez, MD ^a, Patrick Minges, MD ^a, Martin Pusic, MD, PhD ^d, Mathew Swarm, MD ^c, Megan Hilbert, MD ^e, Marisa O’Brien, MD ^b, Katie Harris, MD ^b, Catherine Varner, MD ^f, Constance LeBlanc, MD ^g, Kathy Boutis, MD, BSc ^h,^⁎
^a Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
^b Discipline of Emergency Medicine, Memorial University, St. John’s, Newfoundland, Canada
^c Department of Emergency Medicine, Vanderbilt University, Nashville, TN
^d Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard University; Boston, MA
^e Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
^f Department of Emergency Medicine, Mt. Sinai Hospital, University of Toronto, Toronto, Canada
^g Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
^h Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 20 February 2025

Abstract

Study objective

To examine the effectiveness of an education intervention on emergency physician accuracy in identifying pregnancy-related findings from first-trimester point-of-care ultrasound. Case features associated with the odds of a correct response were also determined.

Methods

This was a multicenter prospective cross-sectional study in a convenience sample of emergency physicians in the United States and Canada. The unsupervised web-based education intervention included first-trimester point-of-care ultrasound cases acquired through the transabdominal (n=200 cases) or transvaginal (n=200 cases) approach. Physicians deliberately practiced identifying pregnancy-related imaging findings until they achieved a mastery standard.

Results

In 204 participants, there were learning gains in accuracy (15.2%; 95% confidence interval [CI] 14.6 to 15.8), sensitivity (15.1%; 95% CI 14.3 to 15.9), and specificity (14.3%; 95% CI 13.7 to 15.0). Of these, 132 (64.7%) achieved the mastery standard in a median of 60 cases (interquartile range 58 to 83). Case features associated with an increased odds of a correct intrauterine pregnancy “present” diagnosis were transvaginal versus transabdominal-acquired images (odds ratio [OR]=1.5; 95% CI 1.3 to 1.8) and fetal heartbeat (OR=4.3; 95% CI 3.4 to 5.5). A decreased odds was associated with an eccentrically located intrauterine pregnancy (OR=0.2; 95% CI 0.1 to 0.2), subchorionic hemorrhage (OR=0.5; 95% CI 0.4 to 0.6), adnexal mass (OR=0.7; 95% CI 0.6 to 0.9), and endometrial collection (OR=0.1; 95% CI 0.09 to 0.2).

Conclusions

This study’s intervention was effective in teaching first-trimester point-of-care ultrasound image interpretation and identified the specific variables that posed the greatest diagnostic challenges. The methods and results from this work can serve to expand learning opportunities for this critical skill in emergency medicine.

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Keywords : Pregnancy, Point of care ultrasound, Emergency medicine, Diagnosis, Competency

Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Developing the Education Intervention

Pilot Testing

Physician Participant Enrollment

Outcomes and Analyses

Overview

Sample Size Considerations

Participant-Level Outcomes

Item-Level Outcomes

Results

Participant-Level Results

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Peter C. Wyer, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: LS, GS, JB, CV, CL, MP, and KB conceived the study, designed the research, and all authors obtained research funding. LS, GS, JB, CV, MP, JB, PM, MS, MH, MO, KH, MP, and KB designed the education intervention. LS, KB, JB, and KB supervised the conduct of the trial and data collection and undertook recruitment of participating centers and study participants. KB and MP managed the data. KB and MP analyzed the data. LS, GS, and KB drafted the manuscript, and all authors contributed substantially to its revision. KB takes responsibility for the paper as a whole.
	Data sharing statement: This data will not be shared.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This study was funded by Emergency Medicine Foundation Memorial University Research Grant and the Seed, Bridge, Multidisciplinary Fund. The funding agencies had no role in the design and conduct of the study. ImageSim software was adapted for this study, and data used for this research was extracted from the ImageSim platform. Dr. Kathy Boutis is married to Dr. Martin Pecaric (Contrail Consulting Inc) who provides technical support services for ImageSim. This is managed under a formal relationship agreement with the Hospital for Sick Children. Dr. Boutis and Dr. Pusic are unpaid co-academic directors for ImageSim. The other investigators have nothing to declare.