A Multicenter Study to Determine Initial Emergency Medicine Resident Extended Focused Assessment With Sonography for Trauma and Focused Cardiac Longitudinal Learning Curves Using Cumulative Sum Analysis

The eFAST (Extended Focused Assessment with Sonography in Trauma) and focused cardiac exams are core point-of-care ultrasound (POCUS) scans required for emergency medicine (EM) residency training. The Accreditation Council for Graduate Medical Education (ACGME) recently recommended that competency determination be based on individualized assessment instead of a numeric POCUS standard. We hypothesize that learners will achieve initial eFAST and focused cardiac scan competency in less than 25 scans, the number previously required for all of our EM residents.

This is a multicenter retrospective review of prospectively gathered quality assurance (QA) data from eFAST and focused cardiac scans performed by EM interns during their ultrasound rotation at three different institutions between August to December 2025. Each site has its own EM residency but use the same ultrasound curriculum, QA rubrics, and end-of-rotation standardized direct observation tool (SDOT). Interns were assigned unique study numbers to create a de-identified QA database. Cumulative summation (CUSUM) analysis, a statistical method for evaluating procedural learning curves, was employed to calculate the mean number of these scans to achieve initial competency.

There were 31 EM interns, 14 male, 17 female; 10% (3/30) with no prior POCUS experience (one learner did not report), all completed an average of 18 eFAST scans and 19 focused cardiac scans during the one-month rotation. All achieved competency on the SDOT assessment. The average number of scans to achieve initial competency was 9.7 (SD = 3.9, 95% CI [8.1-11.3]) for eFAST and 7.8 (SD = 3.8, 95% CI [6.4-9.2]) for focused cardiac. Using a Wilcoxon rank sum analysis, alpha = 0.05, no significant difference was found in the number of eFAST scans (p=0.67) or focused cardiac scans (p=0.28) required for competency between interns with and without prior ultrasound experience.

Using CUSUM analysis, the average EM intern can demonstrate initial competency after 9.7 eFAST scans and 7.8 focused cardiac scans, much less than the 25 that had been required. Future studies and implications: The second phase of our study will evaluate long-term retention of scanning competency post-ultrasound rotation and inter-rater QA reliability on a 10% randomized sample. CUSUM analysis can be used to evaluate initial POCUS competency and long-term retention of these skills.