A Consensus Among Directors in the United States oint-of-care ultrasound imaging is an important technical skill being incorporated into the undergraduate medical education curricula at an increasing rate in recent years. 1,2 Studies have been published demonstrating how point-of-care ultrasound improves patient safety during procedures and facilitates enhanced diagnostic abilities. 3,4 The advantages of point-of-care ultrasound is that is safely used at the bedside, obviates the need for transport to computed tomography or magnetic resonance imaging suites, does not use radiation, and gives immediate results that can be interpreted and used by the operator. 5 With the increasing use of point-of-care ultrasound by all types of providers throughout Vi Am Dinh, MD, RDMS, RDCS, Daniel Lakoff, MD, Jamie Hess, MD, David P. Bahner, MD, RDMS, Richard Hoppmann, MD, Michael Blaivas, MD, John S. Pellerito, MD, Alfred Abuhamad, MD, Sorabh Khandelwal, MD Received July 30, 2015, ORIGINAL RESEARCHObjectives-Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed.Methods-An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires.Results-There was a 100% response rate from the 34 USMED directors in both rounds 1 and 2 of the modified Delphi protocol. After the first round, 2 milestones were revised to improve clarity, and 9 were added on the basis of comments from the USMED directors, resulting in 214 milestones forwarded to round 2. After the second round, only 90 milestones were found to have a high level of agreement and were included in the final medical student core clinical ultrasound milestones.Conclusions-This study established 90 core clinical milestones that all graduating medical students should obtain before graduation, based on consensus from 34 USMED directors. These core milestones can serve as a guide for curriculum deans who are initiating ultrasound curricula at their institutions. The exact method of implementation and competency assessment needs further investigation.

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Introduction: Entrustable professional activities (EPAs) are units of professional practice defined as tasks or responsibilities that trainees are entrusted to perform unsupervised. AAMC Core EPA 10 is defined as the ability to "recognize a patient who requires emergent care and initiate evaluation and management." We designed a simulation scenario to elicit EPA 10-related behaviors for learner assessment to guide entrustment decisions. Methods: This case presents a 61-year-old male with a complaint of feeling ill. The students need to diagnose an ST segment elevation myocardial infarction that leads to a pulseless ventricular tachycardia arrest. A simulation manikin is used, and students are assessed using a checklist. The tool is a set of critical actions that were proposed by a group of content experts, based on the following EPA 10 functions: recognizing unstable vital signs, asking for help, and determining appropriate disposition. In addition to case-specific behavioral items, an overall entrustment item was added to inform the entrustment decision. Results: This case was implemented in a mandatory fourth-year clerkship for 7 years prior to its adaptation for entrustment on EPA 10. In recent experience from one institution, about 14% of students failed to meet entrustment. Students rated the experience as valuable (average 5.0, on a 5-point Likert scale) and thought that it would change their performance in a clinical setting (average 4.95, on a 5-point Likert scale). Discussion: Faculty raters noted challenges regarding entrustment based on a single simulation and the implications that team role (supporting role vs. leader role) has on entrustment.

Introduction: The National Residency Matching Program (NRMP) allows post-interview contact between residency applicants and residency programs. Thank-you communications represent one of the most common forms, but data on their value to applicants and program directors (PD) are limited. The objective of this study was to assess the effect of thank-you communications on applicant- and residency-program rank lists. Methods: Two anonymous, voluntary surveys were sent after the 2018 NRMP Match, one to applicants who were offered an interview at a single academic site in the 2017-2018 Match cycle, and one to EM PDs nationwide. The surveys were designed in conjunction with a nationally-recognized survey center and piloted and revised based on feedback from residents and faculty. Results: Of 196 residency applicants, 97 (49.5%) responded to the survey. Of these, 73/95 (76.8%) reported sending thank-you communications. Twenty-two of 73 (30%) stated that they sent thank-you communications to improve their spot on a program’s rank list; and 16 of 73 (21.9%) reported that they changed their rank list based upon the responses they received to their thank-you communications. Of 163 PDs, 99 (60.7%) responded to the survey. Of those PDs surveyed, 22.6% reported that an applicant could be moved up their program’s rank list and 10.8% reported that an applicant could move down a program’s rank list based on their thank-you communications (or lack thereof). Conclusion: The majority of applicants to EM are sending thank-you communications. A significant minority of applicants and PDs changed their rank list due to post-interview thank-you communications.

Purpose: The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees.Methods: We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried.Results: We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time.Conclusion: The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.