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A Multi-Center Study on eFAST Learning Curves for Emergency Medicine Residents Using CUSUM Analysis
L P Roppolo1, S Newman1, N Saltarelli1
1John Peter Smith Health Network Fort Worth Texas USA.
AEM Education and Training
|May 11, 2026
Summary
Emergency medicine interns achieve initial Extended Focused Assessment with Sonography in Trauma (eFAST) competency in a median of 8 scans, significantly less than the 25-scan requirement. This finding suggests a revised benchmark for eFAST competency assessment in residency training.
Area of Science:
- Medical Education
- Emergency Medicine
- Diagnostic Ultrasound
Background:
- Current Emergency Medicine (EM) residency training mandates a minimum of 25 Extended Focused Assessment with Sonography in Trauma (eFAST) scans.
- Limited evidence supports the existing 25-scan benchmark for achieving initial eFAST competency.
- This study investigated whether EM interns attain competency with fewer than 25 eFAST scans.
Purpose of the Study:
- To determine the actual number of eFAST scans required for Emergency Medicine interns to achieve initial competency.
- To challenge the existing 25-scan benchmark for eFAST proficiency in residency training.
Main Methods:
- A multicenter retrospective review of prospectively collected quality assurance (QA) data from EM interns' eFAST scans.
- Utilized Cumulative Summation (CUSUM) analysis to calculate the mean number of scans needed for initial competency.
- Assessed inter-rater reliability (IRR) of the QA rubric and surveyed interns on prior point-of-care ultrasound (POCUS) experience.
Main Results:
- A median of 8 eFAST scans (IQR [5, 10], range 5-15) were required for interns to achieve initial competency.
- No significant difference in the number of scans required was found between interns with and without prior eFAST experience (p=0.85).
- High inter-rater reliability (IRR) was achieved for the eFAST QA rubric.
Conclusions:
- Emergency Medicine interns achieve initial eFAST competency after a median of 8 scans, suggesting the current 25-scan benchmark may be excessive.
- CUSUM analysis offers a valuable method for assessing initial eFAST competency and can inform competency-based medical education strategies.
- Findings support the development of a more nuanced, data-driven approach to evaluating procedural competency in residency training.
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