Focused Cardiac Ultrasound Training: How Much Is Enough?

Chisholm, Christopher B.; Dodge, W. R.; Balise, Raymond R.; Williams, Sarah R.; Gharahbaghian, Laleh; Beraud, Anne Sophie

doi:10.1016/j.jemermed.2012.07.092

Cited by 50 publications

(55 citation statements)

References 5 publications

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“…While pertinent findings are optimally confirmed in at least two views, it is understood that time constraints, patient acuity, patient mobility, and patient habitus may limit views. 6,8 For images in this article, we will use an emergency medicine convention for cardiac imaging with the probe marker oriented to the patient's right, which keeps the anatomic right on the screen-left, as is the convention for other US imaging. 9 This is in contrast with image and probe orientation utilized in traditional cardiologyperformed US, but has been recognized as an accepted convention that we find to be conceptually easier, particularly when performing EP FOCUS as part of an integrated examination such as the focused assessment with sonography for trauma (FAST) or the rapid US for shock and hypotension.…”

Section: Approach To Exammentioning

confidence: 99%

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Hall

Coffey

Herbst

et al. 2015

Academic Emergency Medicine

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Emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) has been increasingly recognized as a crucial tool to help clinicians diagnose and treat potentially life-threatening conditions. The existing literature demonstrates a variety of EP FOCUS applications and protocols; however, EP FOCUS is not taught, practiced, or interpreted consistently between institutions. Drawing on over 12 years of experience in a large-volume, high-acuity academic emergency department, we have developed a protocol for teaching and performing EP FOCUS known as "The 5Es," where each E represents a specific assessment for immediately relevant clinical information. These include pericardial effusion, qualitative left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava diameter and respirophasic variation). Each of these assessments has been well described in the emergency medicine literature and is within the scope of EP-performed echocardiography. This approach provides a reliable and easily recalled framework for assessing, teaching, and communicating EP FOCUS findings that are essential in caring for the patient in the emergency setting.ACADEMIC EMERGENCY MEDICINE 2015;22:583-593 © 2015 by the Society for Academic Emergency Medicine I t has been recognized for more than 25 years that emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) is an important skill for the care of patients with potentially life-threatening presentations.1,2 A recent review detailed 16 specific protocols that included cardiac ultrasound (US) as part of the point-of-care US assessment in medical shock. 3The term "focused cardiac ultrasound" has been addressed in some detail (FOCUS, 4 FCU, 5 and FoCUS 6 ). However, this term is not specialty-specific, may include assessments that are not relevant in the acute/emergency setting, and has not included assessment of the thoracic aortic root ("exit"), which may be particularly applicable to acute and emergent presentations. We have found that the proximal thoracic aorta can be reliably assessed, providing vital information about potential aortic pathology in patients presenting with acute symptoms. 7 We thus propose the "5Es" to assess for the presence of a pericardial effusion, left ventricular ejection, ventricular equality, exit (aortic root diameter), and entrance (inferior vena cava [IVC] diameter and respirophasic variation). The 5Es protocol provides an easy-toteach, evidence-based, and standardized approach to EP FOCUS for the rapid identification and management of time-sensitive pathologic conditions. APPROACH TO EXAMTypically EP FOCUS uses one or more of three windows and five views: a parasternal long-axis (PSLA), a

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Section: Approach To Exammentioning

confidence: 99%

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Hall

Coffey

Herbst

et al. 2015

Academic Emergency Medicine

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“…Research study design varied this year with an increased representation (seven studies) of qualitative or mixed-methods methodology. 10,16,22,23,25,37,44 Fourteen studies (33%) employed rigorous experimental or quasi-experimental methodologies, 10,12,15,18,21,24,30,31,34,36,38,41,47,48 including five (71%) of the featured articles. 10,21,30,34,36 Outcome measures in all studies reviewed ranged from learner satisfaction (Kirkpatrick level I) to improved performance (Kirkpatrick level 3).…”

Section: Trends In Medical Education Research In 2013mentioning

confidence: 99%

“…The primary objective was to was to evaluate a new curriculum in 16 (37%) articles. 10,15,16,21,24,29,30,33,36,38,39,42,46,47,49,50 Learner competence continued to be a prominent research topic, which was studied in 14 (33%) articles. 13,14,17,18,22,23,25,27,32,35,[43][44][45]50 Pediatric topics continued to be studied at about the same rate as in 2012, with seven (16%) articles.…”

Section: Trends In Medical Education Research In 2013mentioning

confidence: 99%

“…18,21,25,33,37,40,48 Eleven articles (26%) evaluated learners' procedural competency. 11,12,24,27,32,35,37,39,46,48,49 Communication strategies were studied in three articles, 22,23,25 each of which used a qualitative methodology. A new topic emerged as a trend this year in six (14%) articles, 11,19,34,37,44,52 in which clinical reasoning strategies were taught or evaluated.…”

Section: Trends In Medical Education Research In 2013mentioning

confidence: 99%

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Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2013

Farrell

Kuhn

Coates

et al. 2014

Academic Emergency Medicine

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Objectives: The objective was to critically appraise and highlight methodologically superior medical education research articles published in 2013 whose outcomes are pertinent to teaching and education in emergency medicine (EM).Methods: A search of the English-language literature in 2013 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 251 EM-related studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. Six reviewers then independently scored the remaining 43 publications using either a qualitative a or quantitative scoring system, based on the research methodology of each article. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems used parallel scoring metrics and have been used previously within this annual review.Results: Forty-three medical education research papers (37 quantitative and six qualitative studies) met the a priori criteria for inclusion and were reviewed. Six quantitative and one qualitative study were scored and ranked most highly by the reviewers as exemplary and are summarized in this article.Conclusions: This annual critical appraisal article aims to promote superior research in EM-related education, by reviewing and highlighting seven of 43 major education research studies, meeting a priori criteria, and published in 2013. Common methodologic pitfalls in the 2013 papers are noted, and current trends in medical education research in EM are discussed.ACADEMIC EMERGENCY MEDICINE 2014;21:1274-1283 by the Society for Academic Emergency Medicine Q uality, hypothesis-driven education research is necessary to promote evidence-based decisions about effective ways to teach the physicians of tomorrow. Education research has gained increasing support and prominence in emergency medicine (EM) academia, with available grant opportunities from the Society of Academic Emergency Medicine and the Council of Emergency Medicine Residency Directors. Furthermore, the 2012 Academic Emergency Medicine consensus conference focused on the theme "Education Research in Emergency Medicine: Opportunities, Challenges, and Strategies for Success" to promote a national initiative to advance the field of education research. 1 In this sixth installment of the annual critical appraisal series, the same six reviewers used previously published criteria 2 to critically analyze and rank the EM education research from 2013. The focus of this article is to review and highlight the methodologically superior studies that are pertinent to teaching and education in EM. Trends in EM education research over the past 6 years, as they can be inferred from this review, are summarized. It is METHODS Article IdentificationThe previously described methodology to search for relevant publications was used. 2 Publications...

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“…Until recently, national guidelines have focused on procedural volume as a surrogate for the amount of ''practice'' that an individual has had with a given technique [4,7,[30][31][32]37]. This is not completely unfounded.…”

Section: Introductionmentioning

confidence: 99%

Competency Testing for Pediatric Cardiology Fellows Learning Transthoracic Echocardiography: Implementation, Fellow Experience, and Lessons Learned

2015

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Evaluation consisted of a two-part exercise performed after years 1 and 2 of pediatric cardiology training. Part 1: a directly observed evaluation of technical skills as fellows imaged a normal subject (year 1) and a patient with complex heart disease (year 2). Part 2: fellows interpreted and wrote reports for two echocardiograms illustrating congenital heart disease. These were graded for accuracy and facility with communicating pertinent data. After 5 years of testing, fellows were surveyed about their experience. In 5 years, 40 fellows were tested at least once. Testing identified four fellows who underperformed on the technical portion and four on the interpretive portion. Surveys were completed by 33 fellows (83 %). Most (67 %) felt that intermittent observation by faculty was inadequate for assessing skills and that procedural volume was a poor surrogate for competency (58 %). Posttest feedback was constructive and valuable for 90, and 70 % felt the process helped them set goals for skill improvement. Overall, fellows felt this testing was fair and should continue. Fellow performance and responses identified programmatic issues that were creating barriers to learning. We describe a practical test to assess competency for cardiology fellows learning echocardiography. This paradigm is feasible, has excellent acceptance among trainees, and identifies trainees who need support. Materials developed could be easily adapted to help track upcoming ACGME-mandated metrics.

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Focused Cardiac Ultrasound Training: How Much Is Enough?

Cited by 50 publications

References 5 publications

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

The “5Es” of Emergency Physician–performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2013

Competency Testing for Pediatric Cardiology Fellows Learning Transthoracic Echocardiography: Implementation, Fellow Experience, and Lessons Learned

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