K. A. Boyle1, T. W. Carver1, A. Brandolino1, P. N. Redlich2, M. J. Malinowski2, R. W. Treat3, P. J. Schenarts4 1Medical College Of Wisconsin,Division Of Trauma And Acute Care Surgery, Department Of Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Division Of Education, Department Of Surgery,Milwaukee, WI, USA 3Medical College Of Wisconsin,Department Of Academic Affairs,Milwaukee, WI, USA 4University Of Nebraska College Of Medicine,Department Of Surgery,Omaha, NE, USA
Introduction: Skill decay is relevant in general surgery given the procedural nature of this specialty. Since the introduction of the FAST exam, surgeon educators have debated how to teach novices this technique. FAST training is typically done as massed practice, which can introduce basic concepts, but considerable hands-on skill and knowledge must be maintained for the correct interpretation of a FAST. There is no literature regarding skill decay following initial FAST training and no clear recommendations for maintenance of competency.
Methods: This was a prospective observational study on skill degradation and knowledge loss following an introductory FAST training which consisted of an in-person didactic session followed by hands-on education with model patients. First and second-year surgery residents were assessed pre-training, post-training, at 1 month, 3 months, and 6 months. At each time point, subjects completed a survey of their experience and confidence performing a FAST, a written assessment, and a hands-on assessment. The Quality of Ultrasound Imaging and Competence (QUICk) score, comprised of a Global Rating Scale (GRS) and a Task Specific Checklist (TSC), was used to grade the learner’s performance. Two reviewers scored the performances retrospectively. Statistical analyses were performed using SPSS, and analytical modeling was generated with repeated measures analysis of variance (RM-ANOVA) to assess mean scores across the five points in time.
Results: Nineteen surgery residents (12 PGY-1, 7 PGY-2) were followed for 6 months with 100% retention until the 6-month test when two were lost to follow up. Seven residents (36.8%) had previous FAST training. There were no differences noted for year of training and no correlation of performance to either previous FAST experience or confidence. Resident performance of the FAST significantly deteriorated by 1 month, but this decay stabilized at 3 months and 6 months. Knowledge decay was not significant until the 3-month test.
Conclusion: Traditional ultrasound education has focused on achieving short-term competency, however, this study shows that massed training is associated with a significant decline in hands-on performance at 1 month and knowledge at 3 months. While further deterioration was not appreciated at 6 months, the nature of this study design limits that finding. Additional studies must be performed to determine the best strategy to combat skill and knowledge decay in FAST education.
