Learning Curves in Emergency Ultrasonography

Brady, Kaitlyn

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Learning Curves in Emergency Ultrasonography

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This project utilized generalized estimating equations and general linear modeling to model learning curves for sonographer performance in emergency ultrasonography. Performance was measured in two ways: image quality (interpretable vs. possible hindrance in interpretation) and agreement of findings between the sonographer and an expert reviewing sonographer. Records from 109 sonographers were split into two data sets-- training (n=50) and testing (n=59)--to conduct exploratory analysis and fit the final models for analysis, respectively. We determined that the number of scans of a particular exam type required for a sonographer to obtain quality images on that exam type with a predicted probability of 0.9 is highly dependent upon the person conducting the review, the indication of the scan (educational or medical), and the outcome of the scan (whether there is a pathology positive finding). Constructing family-wise 95% confidence intervals for each exam type demonstrated a large amount of variation for the number of scans required both between exam types and within exam types. It was determined that a sonographer's experience with a particular exam type is not a significant predictor of future agreement on that exam type and thus no estimates were made based on the agreement learning curves. In addition, we concluded based on a type III analysis that when already considering exam type related experience, the consideration of experience on other exam types does not significantly impact the learning curve for quality. However, the learning curve for agreement is significantly impacted by the additional consideration of experience on other exam types.

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