Skills Determination, Decay and Delay Study: Development of Extended Focused Assessment With Sonography for Trauma Examination Proficiency Performance Criteria.

INTRODUCTION: The E-FAST is a clinical ultrasound examination used to identify free fluid and free air in anatomic compartments. There are currently no standardized proficiency performance criteria for this examination to guide the development, maintenance and retention of this skill. MATERIALS AND METHODS: Using the Delphi method, a standardized 58-point proficiency performance checklist for the E-FAST examination was generated. Forty participants were recruited into four E-FAST experience groups: novice, beginner, intermediate, and expert. Participants viewed a 30-minute training video, then performed an E-FAST examination on a live model. Investigators observed each subject, and recorded checklist elements as they were completed along with exam start and end times. The mean value for number of checklist elements completed and total exam time were calculated for each cohort and compared using ANOVA analysis. After institutional IRB review this study was determined to be exempt. RESULTS: ANOVA analysis showed significant differences among the experience level groups for both the proficiency checklist score (P < .001) and time to completion (P = .003). Pairwise comparisons showed novice participants had significantly lower proficiency checklist scores when compared to intermediate (40.1 ± 8.3 vs. 51.3 ± 5.1, P = .002) and expert (52.5 ± 4.0, P < .001) participants. Beginner participants also had significantly lower proficiency checklist scores when compared to intermediate (43.1 ± 11.0 vs. 51.3 ± 5.1, P = .021) and expert (52.5 ± 4.0, P = .009, Figure 4.15.2) participants. Novice participants had significantly slower E-FAST completion times compared to intermediate and expert participants. CONCLUSIONS: The developed proficiency performance checklist was able to identify and stratify providers with no experience and novice experience from those with intermediate and expert level experience. Further studies are needed to determine training criteria necessary to attain targeted proficiency in this skill, determine how skill decays over time, and develop methods to mitigate that decay.