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Focused Assessment Sonography for Trauma (FAST) Training: A Systematic Review

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Abstract

Background

The aim of this study was to systematically review the different methods for training Focused Assessment Sonography for Trauma (FAST), course design, and requirements for hospital credentialing.

Methods

We searched MEDLINE/PubMed, EMBASE, and the Cochrane database and performed a manual search of selected papers. All papers and abstracts written in English that studied training and education of FAST were included. Papers were critically evaluated, looking into training methods and models of FAST, their advantages and disadvantages, number and type of training hours, practice exams in the course, and number of cases advised to achieve hospital credentialing.

Results

A total of 52 studies were critically analyzed. The theoretical part of the courses lasted over a median (range) of 4 (1–16) h (n = 35 studies), while the practical part lasted over a median (range) of 4 (1–32) h (n = 34 studies). The participants performed a median (range) of 10 (3–20) FAST exams during the courses (n = 13 studies). The most commonly used model was the normal human model (65 %), followed by peritoneal dialysis patients (27 %). The least used models were animal (4 %) and cadaveric models (2 %). Each of these models had their advantages and disadvantages. The median number (range) of FAST exams needed for credentialing was 50 (10–200) (n = 19 studies).

Conclusion

Standardization of FAST training is important to improving the clinical impact of FAST. Different models used in FAST training are complementary; each has its own advantages and disadvantages. It is recommended that FAST courses be at least 2 days (16 h) long. The first day should include 4 h of theory and 4 h of training on normal human models. The second day should enforce learning using animal models, case scenarios including video clips, or simulators.

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Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Trauma Group, Department of Surgery, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates

    Alshafi Mohammad, Ashraf F. Hefny & Fikri M. Abu-Zidan

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  1. Alshafi Mohammad
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  2. Ashraf F. Hefny
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  3. Fikri M. Abu-Zidan
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Corresponding author

Correspondence to Fikri M. Abu-Zidan.

Appendices

Appendix 1

See Table 3.

Table 3 Search strategy
Full size table

Appendix 2

List of the studied articles and abstracts in alphabetical order

  • Abu-Zidan FM, Dittrich K, Czechowski JJ, Kazzam EE (2005) Establishment of a course for Focused Assessment Sonography for Trauma. Saudi Med J 26:806–811.

  • Abu-Zidan FM, Siösteen AK, Wang J, al-Ayoubi F, Lennquist S (2004) Establishment of a teaching animal model for sonographic diagnosis of trauma. J Trauma 56:99–104.

  • Adkins EJ, Nunley D, Dresbach S, Bahner DP (2012) Incorporation of focused ultrasonography into a critical care training fellowship: Validation of an educational model. Acad Emerg Med 19 Suppl 1:S249–S250.

  • Ali J, Campbell JP, Gana T, Burns PN, Ochsner MG Jr (1998) Swine and dynamic ultrasound models for trauma ultrasound testing of surgical residents. J Surg Res 76:17–21.

  • Ali J, Rozycki GS, Campbell JP, Boulanger BR, Waddell JP, Gana TJ (1996) Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid. J Surg Res 63:275–279.

  • Arafat R, Golea A, Dărămuş I, Badea R (2011) Medical education for emergency physician focused on basic competence (Focused Assessment with Sonography in Trauma). Evaluation of the Romanian national program: “Regional Emergency Medical Services Systems”. Med Ultrason 13:283–291.

  • Berg DA, Milner RE, Demangone D, Ufberg JW, McKernan E, Fisher CA, Gaughan JP, Grewal H, Dempsey DT, Goldberg AJ (2005) Successful collaborative model for trauma skills training of surgical and emergency medicine residents in a laboratory setting. Curr Surg 62:657–662.

  • Blackstock U, Munson J, Yeboah N, Szyld D (2012) Bedside ultrasonography knowledge and image interpretation gains by medical students on emergency medicine rotation. Ann Emerg Med 60:4 Suppl 1:S111–S112.

  • Bowra J, Forrest-Horder S, Caldwell E, Cox M, D’Amours SK (2010) Validation of nurse-performed FAST ultrasound. Injury 41:484–487.

  • Brenchley J, Walker A, Sloan JP, Hassan TB, Venables H (2006) Evaluation of focussed assessment with sonography in trauma (FAST) by UK emergency physicians. Emerg Med J 23:446–448.

  • Brooks A, Davies B, Smethhurst M, Connolly J (2004) Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J 21:580–581.

  • Cadigan BA (2011) Accomplishing introductory training for the focused assessment with sonography for trauma: An innovative curriculum for teaching exam performance and interpretation. Ann Emerg Med 58:4 Suppl 1:S332.

  • Crouch AK, Dawson M, Long D, Allred D, Madsen T (2010) Perceived confidence in the FAST exam before and after an educational intervention in a developing country. Int J Emerg Med 3:49–52.

  • Damewood S, Jeanmonod D, Cadigan B (2011) Comparison of a multimedia simulator to a human model for teaching FAST exam image interpretation and image acquisition. Acad Emerg Med 18:413–419.

  • Favot M, Amponsah D, Manteuffel J (2012) Medical student assessment of point of care ultrasonography training as part of the emergency medicine clerkship. Ann Emerg Med 60:4 Suppl 1:S78.

  • Freeman P (1999) Ultrasound assessment of the trauma patient. Aust N Z J Surg 69:592–593.

  • Frezza EE, Solis RL, Silich RJ, Spence RK, Martin M (1999) Competency-based instruction to improve the surgical resident technique and accuracy of the trauma ultrasound. Am Surg 65:884–888.

  • Gogalniceanu P, Sheena Y, Kashef E, Purkayastha S, Darzi A, Paraskeva P (2010) Is basic emergency ultrasound training feasible as part of standard undergraduate medical education? J Surg Educ 67:152–156.

  • Gracias VH, Frankel HL, Gupta R, Malcynski J, Gandhi R, Collazzo L, Nisenbaum H, Schwab CW (2001) Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing. Am Surg 67:364–368.

  • Gracias VH, Frankel H, Gupta R, Reilly PM, Gracias F, Klein W, Nisenbaum H, Schwab CW (2002) The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination. Am Surg 68:1008–1011.

  • Han DC, Rozycki GS, Schmidt JA, Feliciano DV (1996) Ultrasound training during ATLS: an early start for surgical interns. J Trauma 41:208–213.

  • Hillingsø JG, Svendsen LB, Nielsen MB (2008) Focused bedside ultrasonography by clinicians: experiences with a basic introductory course. Scand J Gastroenterol 43:229–233.

  • Hsu JM, Joseph AP, Tarlinton LJ, Macken L, Blome S (2007) The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: experience of an Australian major trauma service. Injury 38:71–75.

  • Ingeman JE, Plewa MC, Okasinski RE, King RW, Knotts FB (1996) Emergency physician use of ultrasonography in blunt abdominal trauma. Acad Emerg Med 3:931–937.

  • Jang T, Kryder G, Sineff S, Naunheim R, Aubin C, Kaji AH (2012) The technical errors of physicians learning to perform focused assessment with sonography in trauma. Acad Emerg Med 19:98–101.

  • Jang T, Sineff S, Naunheim R, Aubin C (2004) Residents should not independently perform focused abdominal sonography for trauma after 10 training examinations. J Ultrasound Med 23:793–797.

  • Jones PG, Peak S, McClelland A, Holden A, Higginson I, Gamble G (2003) Emergency ultrasound credentialling for focused assessment sonography in trauma and abdominal aortic aneurysm: A practical approach for Australasia. Emerg Med (Fremantle) 15:54–62.

  • Kaufmann C, Liu A (2001) Trauma training: virtual reality applications. Stud Health Technol Inform 81:236–241.

  • Kern SJ, Smith RS, Fry WR, Helmer SD, Reed JA, Chang FC (1997) Sonographic examination of abdominal trauma by senior surgical residents. Am Surg 63:669–674.

  • Kirkpatrick AW, Hamilton DR, Nicolaou S, Sargsyan AE, Campbell MR, Feiveson A, Dulchavsky SA, Melton S, Beck G, Dawson DL (2003) Focused Assessment with Sonography for Trauma in weightlessness: a feasibility study. J Am Coll Surg 196:833–844.

  • Knapp B, Byars D, Stewart V, Ryszkiewicz R, Evans D (2012) Emergency medical services focused assessment with sonography in trauma and cardiac ultrasound in cardiac arrest: The training phase. Acad Emerg Med 19 Suppl 1:S189.

  • Knudson MM, Sisley AC (2000) Training residents using simulation technology: experience with ultrasound for trauma. J Trauma 48:659–665.

  • Ma OJ, Gaddis G, Norvell JG, Subramanian S (2008) How fast is the focused assessment with sonography for trauma examination learning curve? Emerg Med Australas 20:32–37.

  • Mahler SA, Swoboda TK, Wang H, Arnold TC (2012) Dedicated emergency department ultrasound rotation improves residents’ ultrasound knowledge and interpretation skills. J Emerg Med 43:129–133.

  • Markowitz JE, Hwang JQ, Moore CL (2011) Development and validation of a web-based assessment tool for the extended focused assessment with sonography in trauma examination. J Ultrasound Med 30:371–375.

  • McCarter FD, Luchette FA, Molloy M, Hurst JM, Davis K Jr, Johannigman JA, Frame SB, Fischer JE (2000) Institutional and individual learning curves for focused abdominal ultrasound for trauma: cumulative sum analysis. Ann Surg 231:689–700.

  • McElveen TS, Collin GR (1997) The role of ultrasonography in blunt abdominal trauma: a prospective study. Am Surg 63:184–188.

  • Pageau P, Woo MY, Stiell TG, Tashkandi M, Spacek A, Frank JR (2012) A controlled trial of traditional versus Web-based teaching of point-of-care ultrasound to medical students. Can J Emerg Med 14 Suppl 1:S26.

  • Platz E, Goldflam K, Mennicke M, Parisini E, Christ M, Hohenstein C (2010) Comparison of Web- versus classroom-based basic ultrasonographic and EFAST training in 2 European hospitals. Ann Emerg Med 56:660–667.

  • Platz E, Liteplo A, Hurwitz S, Hwang J (2011) Are live instructors replaceable? Computer vs. classroom lectures for EFAST training. J Emerg Med 40:534–538.

  • Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD (1998) Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 228:557–567.

  • Rozycki GS, Ochsner MG, Jaffin JH, Champion HR (1993) Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma 34:516–526.

  • Salen PN, Melanson SW, Heller MB (2000) The focused abdominal sonography for trauma (FAST) examination: considerations and recommendations for training physicians in the use of a new clinical tool. Acad Emerg Med 7:162–168.

  • Salen P, O’Connor R, Passarello B, Pancu D, Melanson S, Arcona S, Heller M (2001) Fast education: a comparison of teaching models for trauma sonography. J Emerg Med 20:421–425.

  • Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H (1999) Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma 46:466–472.

  • Shackford SR, Rogers FB, Osler TM, Trabulsy ME, Clauss DW, Vane DW (1999) Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma 46:553–562.

  • Sisley AC, Johnson SB, Erickson W, Fortune JB (1999) Use of an Objective Structured Clinical Examination (OSCE) for the assessment of physician performance in the ultrasound evaluation of trauma. J Trauma 47:627–631.

  • Smith RS, Kern SJ, Fry WR, Helmer SD (1998) Institutional learning curve of surgeon-performed trauma ultrasound. Arch Surg 133:530–535.

  • Thomas B, Falcone RE, Vasquez D, Santanello S, Townsend M, Hockenberry S, Innes J, Wanamaker S (1997) Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve. J Trauma 42:384–388.

  • Unlüer EE, Yavaşi O, Kara PH, Kılıç TY, Vandenberk N, Kayayurt K, Kıyançiçek S, Akoğlu H, Yılmaz C (2011) Paramedic-performed Focused Assessment with Sonography in Trauma (FAST) in the emergency department. Ulus Travma Acil Cerrahi Derg 17:113–116.

  • Walcher F, Kirschning T, Müller MP, Byhahn C, Stier M, Rüsseler M, Brenner F, Braun J, Marzi I, Breitkreutz R (2010) Accuracy of prehospital focused abdominal sonography for trauma after a 1-day hands-on training course. Emerg Med J 27:345–349.

  • Wei G, Geria RN, McCoy JV, Church AF, Kapitanyan R, Ohman Strickland PA, Wormann D, Eisenstein RM, Riggs RL (2012) A novel approach to emergency medicine ultrasonographic education during medical student clerkships and its impact on testing: A pilot program. Ann Emerge Med 60(5):S187.

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Mohammad, A., Hefny, A.F. & Abu-Zidan, F.M. Focused Assessment Sonography for Trauma (FAST) Training: A Systematic Review. World J Surg 38, 1009–1018 (2014). https://doi.org/10.1007/s00268-013-2408-8

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