Asteroid Hyalosis Seen on Ocular Point-of-Care Ultrasound.

We present a case of a patient who underwent ultrasound evaluation for potential blunt ocular trauma. She was found to have multiple, freely mobile, scintillating hyperechoic opacities within the vitreous that was diagnosed as asteroid hyalosis, a rare but benign condition easily confused with vitreous hemorrhage, retinal detachment, lens dislocation, or foreign body on ocular ultrasound.

Assessment methods and resource requirements for milestone reporting by an emergency medicine clinical competency committee.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) introduced milestones for Emergency Medicine (EM) in 2012. Clinical Competency Committees (CCC) are tasked with assessing residents on milestones and reporting them to the ACGME. Appropriate workflows for CCCs are not well defined. OBJECTIVE: Our objective was to compare different approaches to milestone assessment by a CCC, quantify resource requirements for each and to identify the most efficient workflow. DESIGN: Three distinct processes for rendering milestone assessments were compared: Full milestone assessments (FMA) utilizing all available resident assessment data, Ad-hoc milestone assessments (AMA) created by multiple expert educators using their personal assessment of resident performance, Self-assessments (SMA) completed by residents. FMA were selected as the theoretical gold standard. Intraclass correlation coefficients were used to analyze for agreement between different assessment methods. Kendall's coefficient was used to assess the inter-rater agreement for the AMA. RESULTS: All 13 second-year residents and 7 educational faculty of an urban EM Residency Program participated in the study in 2013. Substantial or better agreement between FMA and AMA was seen for 8 of the 23 total subcompetencies (PC4, PC8, PC9, PC11, MK, PROF2, ICS2, SBP2), and for 1 subcompetency (SBP1) between FMA and SMA. Multiple AMA for individual residents demonstrated substantial or better interobserver agreement in 3 subcompetencies (PC1, PC2, and PROF2). FMA took longer to complete compared to AMA (80.9 vs. 5.3 min, p < 0.001). CONCLUSIONS: Using AMA to evaluate residents on the milestones takes significantly less time than FMA. However, AMA and SMA agree with FMA on only 8 and 1 subcompetencies, respectively. An estimated 23.5 h of faculty time are required each month to fulfill the requirement for semiannual reporting for a residency with 42 trainees.

Adding new tools to the black bag--introduction of ultrasound into the physical diagnosis course.

INTRODUCTION: Ultrasound, a versatile diagnostic modality that permits real-time visualization at the patient's bedside, can be used as an adjunct in teaching physical diagnosis (PD). AIMS: (1) to study the feasibility of incorporating ultrasound into PD courses and (2) determine whether learners can demonstrate image recognition and acquisition skills. PROGRAM DESCRIPTION: Three hundred seven second-year medical students were introduced to cardiovascular and abdominal ultrasound scanning after training in the physical examination. This consisted of a demonstration of the ultrasound examination, followed by practice on standardized patients (SPs). Pre-post tests were administered to evaluate students' knowledge and understanding of ultrasound. Students performed an ultrasound examination during the PD final examination. PROGRAM EVALUATION: Pre-post test data revealed significant improvements in image recognition. On the final exam, the highest scores (98.4%) were obtained for the internal jugular vein and lowest scores (74.6%) on the Focused Assessment with Sonography for Trauma images. Eighty-nine percent of students' surveyed felt ultrasound was a valuable tool for physicians. DISCUSSION: An introductory ultrasound course is effective in improving medical students' acquisition and recognition of basic cardiovascular and abdominal ultrasound images. This innovative program demonstrates the feasibility of incorporating portable ultrasound as a learning tool during medical school.