Third-year medical students' perceptions of confidence and readiness to perform EFAST after training

Abstract

Background: As Point-of-Care Ultrasound (POCUS) education is increasingly incorporated in undergraduate medical education (UME), evaluation of the effectiveness of various ultrasound-related curricula is a developing field. The Extended Focused Assessment with Sonography (EFAST) is a POCUS exam widely used in emergency medicine. This project examines third-year osteopathic medical (OMS III) students' perceptions of the impact of a focused introduction to EFAST training curriculum on their performance ability and utilization of EFAST during third-year clinical rotations. Furthermore, we assessed student perceptions of barriers to the use of POCUS during third-year clinical rotations.

Methods: The introduction to EFAST curriculum was developed using competency-based backward design and was delivered in July 2022 to incoming OMS III students. The curriculum involved didactics, hands-on ultrasound practice with standardized patients, and a comprehensive OSCE assessment, where students performed the EFAST exam. In July/August 2023, curriculum participants were anonymously surveyed regarding the effectiveness of the EFAST curriculum and perceived barriers to EFAST and POCUS utilization during their third-year clerkships. Descriptive and thematic analyses were performed on quantitative and qualitative data.

Results: Twenty-one of 69 (30.4%) participants responded to the survey, with 17 (24.6%) participants completing the entire survey. Respondents reported increased knowledge and confidence in performing and interpreting EFAST, with 82.4% indicating increased likelihood of performing EFAST and POCUS in general. 76.4% performed EFAST at least once during third-year clerkships, with 11.8% performing it 15 times or more. Students reported valuing the safe simulated learning environment of the EFAST training, and identified lack of patients with indications for EFAST, time constraints, lack of ultrasound machine availability and clinician comfort level as barriers to EFAST utilization.

Conclusions: This study presents the implementation of a focused EFAST curriculum developed through competency-based deliberate backward design based on professional guidelines and the anticipated educational needs of our institution and community. Student perceptions provided valuable insight into access and barriers to EFAST and POCUS use in subsequent clinical clerkships, indicating student perception of POCUS curriculum effectiveness may provide insight to continual curriculum improvement.

Keywords: Curriculum design; Extended focused assessment with sonography for trauma; Point-of-care ultrasound; Undergraduate medical education.

Fig. 1

Respondents’ rating of the quality of the EFAST curriculum. Respondents rated perceptions regarding the following aspects of the EFAST curriculum: usefulness, faculty knowledge, access to ultrasound equipment and standardized patients and appropriateness of the EFAST assessment

Fig. 2

Respondents’ perceptions of outcomes of the EFAST curriculum. Respondents rated perceptions regarding the following outcomes of the EFAST curriculum: increase in knowledge and appropriate use of the EFAST exam, confidence and ability to acquire and interpret EFAST images, likelihood to perform EFAST, and likelihood to perform bedside ultrasound in general

Fig. 3

POCUS machine availability on clerkships. POCUS availability on each clerkship rotation as reported by survey respondents. n = 21 respondents

Fig. 4

Respondents ranking of clinical setting in which POCUS was most available. Respondents ranked POCUS availability in the following clinical settings: clinic, emergency department, inpatient hospital and ICU (1 = most available, 5 = least available). n = 18 respondents

Fig. 5

Types of POCUS exams respondents participated in. POCUS exams performed during clerkship rotations, by respondents or supervising clinicians, as reported by respondents across all clerkships. n = 18 respondents