Now I See It-Building Expertise in Ocular Point of Care Ultrasound

Ocular point-of-care ultrasound (O-POCUS) is a valuable tool in the assessment of ocular and neurological conditions. However, there is currently no standardized training or competency assessment for O-POCUS. We evaluated the effectiveness of an O-POCUS image interpretation education intervention on emergency physician diagnostic accuracy. We also determined the rate of skill development, the participant image review processes associated with a correct diagnosis, and the imaging findings associated with diagnostic error.

This was a multicenter prospective cohort study conducted on an online educational intervention for O-POCUS interpretation. Participating emergency physicians deliberately practiced diagnosing 190 unique O-POCUS cases, receiving immediate feedback after every case. They practiced on as many cases as necessary to achieve a pre-defined performance standard.

We enrolled 152 emergency physicians and derived 17,944 total case interpretations. From participant initial 25 to final 25 cases, there were learning gains in diagnostic accuracy (+11.3%; 95% CI 9.4, 13.2), sensitivity (+8.6%; 95% CI 6.9, 10.3), specificity (+16.1%; 95% CI 14.5, 17.7), pathology location accuracy (+12.9% 95% CI 10.9, 14.9) and specific pathological diagnosis (+18%; 95% CI 15.2, 20.7). Of the 125 participants with analyzable data, 94 (75.2%) achieved the performance standard in a median of 94 cases (IQR 64, 132) or 29 min (IQR 19.7, 40.7). Participants had lower odds of correct diagnosis when they spent less time reviewing a case (OR = 0.96; 95% CI 0.94-0.98), but higher odds when they were certain of their response (OR = 4.25; 95% CI 3.73-4.84). The imaging findings most at risk of diagnostic error were ocular masses, cataracts, and indicators of raised ICP.

This study demonstrates that an online and performance-based education intervention can meaningfully improve O-POCUS image interpretation among emergency physicians and identifies sonographic pathology prone to diagnostic error.