Preliminary Interpretations of Transthoracic Echocardiograms by Cardiology Fellows

Carlson, Selma; Kearney, Kathleen; Li, Song; Fujioka, M; Schwaegler, B.; Kirkpatrick, James N.

doi:10.1016/j.echo.2017.07.014

Cited by 2 publications

(6 citation statements)

References 17 publications

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“…However, our fellowship echocardiography training program is similar to other large academic institutions in that fellows perform overnight emergent TTEs independently that are not always reviewed by the attending cardiologist immediately. Despite the limitation of a single-center study, the total discrepancy rate in a prior single institution study [2] is similar to our findings, making it likely that these findings may be representative of the fellowship system overall. Lastly, given that our study was not designed to measure patient outcomes, we could not estimate the effect of disagreements on misdiagnosis related patient harm.…”

Section: Discussionsupporting

confidence: 82%

“…Professional cardiovascular society recommendations [5, 8] motivate training programs to assess cardiology fellows’ competency in TTE performance and interpretation, and the American Society of Echocardiography has put forth guidelines for improvement in the quality of image acquisition and interpretation [9], however studies assessing trainees have been limited. Carlson and colleagues [2] retrospectively assessed discrepancies between cardiology fellow and attending interpretation of 292 weekend TTEs over a 1 year period and found an overall 16.8% discrepancy rate with a major discrepancy rate of 2.4%. The total discrepancy rate is similar and the major discrepancy rate is slightly lower than our findings.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to other studies [2, 10], we utilized attending TTE interpretation as the gold standard for assessing trainee performance. However, studies have shown that TTE interpretations of LV systolic function are subject to intra and inter-observer variability even among experienced cardiologists [14, 15].…”

Section: Discussionmentioning

confidence: 99%

“…Echocardiographic tamponade was determined by presence of right atrial/ventricular diastolic collapse combined with respiratory variation in mitral (≥30%) and tricuspid (≥60%) Doppler flow velocities. These criteria were selected a priori for major discordance based on whether a diagnosis that necessitated an acute change in patient management as judged by the attending cardiologist was made, consistent with prior studies [2, 6, 7]. TTE interpretation disagreements that did not meet criteria for major discordance, were graded as having minor discordance (Additional file 1).…”

Section: Methodsmentioning

confidence: 99%

“…While there is an increasing awareness of diagnostic errors as a major source of preventable patient harm [1], data evaluating accuracy of TTEs performed and interpreted by cardiology fellows are scarce. Prior work in this field is limited to retrospective studies of small sample size or fellow interpretations of sonographer-obtained TTEs [2].…”

Section: Introductionmentioning

confidence: 99%

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On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists

Spahillari

McCormick

et al. 2019

BMC Med Educ

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Background Transthoracic echocardiograms (TTE) performed and interpreted by cardiology fellows during off-duty hours are critical to patient care, however limited data exist on their interpretive accuracy. Our aims were to determine the discordance rate between TTEs performed and interpreted by cardiology fellows and National Board of Echocardiography certified attending cardiologists and to identify factors associated with discordance. Methods Consecutive on-call TTEs acquired and interpreted by 1st year cardiology fellows over 4.6 years at an academic center were prospectively evaluated by attending cardiologists. Fellow interpretations were classified as concordant or discordant with the attending interpretation. We assessed the association of patient, imaging and fellow characteristics with discordance. Results A total of 777 TTE interpretations (730 patients) were performed/interpreted by 40 first year fellows and overread by 13 attendings. The most common indications were assessment of left ventricular function (40.9%) and pericardial effusion (37.3%). There was a major or minor discordance in 4.1 and 17.4% of studies, respectively with 42.1% of disagreements occurring in assessment of left ventricular size and function. The indication to assess left ventricular function [OR 2.19, 95% CI (1.32, 3.62), P = 0.002 vs. pericardial effusion] and greater duration of echocardiographic image acquisition (OR 1.02, 95% CI 1.01, 1.03, P = 0.004) were independently associated with overall discordance. Conclusions In this large prospective study we found that attending cardiologists disagreed with 1 in 5 fellow TTE interpretations. Standardized tools for evaluation of echocardiograms performed by fellows are needed to ensure quality of training and patient safety. Electronic supplementary material The online version of this article (10.1186/s12909-019-1634-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists

Spahillari

McCormick

et al. 2019

BMC Med Educ

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<p>Cardiology Fellow Diagnostic Accuracy and Data Interpretation Outcomes: A Review of the Current Literature</p>

Zhitny

Iftekhar

Alexander

et al. 2020

VHRM

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Background: Cardiology fellows, in particular, are in a unique position to mold the new cardiovascular workforce, especially in terms of risk prevention. There is a growing need for the cardiovascular workforce. In the United States, one person dies every forty-two seconds due to a cardiovascular adverse event. Methods: A PRISMA systematic review included comprehensive search of the MED-LINE database (PubMed) from 1927 to 2020-the oldest to newest available literature on the subject available through PubMed. Results: Fifty-seven cardiology fellows together interpreted a total of 1719 EKGs with a correct rate of 52%. Sixty-four fellows completed a total of 1363 echocardiography interpretations with an accuracy rate of nearly 75%. Conclusion: Based on the studies discussed, it is evident that a cardiology fellow, particularly in their early years of training, may be limited due to a lack of experience. With continued EKG and echocardiogram interpretation, as well as other clinical skills practice, fellows can improve their diagnostic accuracy and procedural efficiency.

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Preliminary Interpretations of Transthoracic Echocardiograms by Cardiology Fellows

Cited by 2 publications

References 17 publications

On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists

On-call transthoracic echocardiographic interpretation by first year cardiology fellows: comparison with attending cardiologists

<p>Cardiology Fellow Diagnostic Accuracy and Data Interpretation Outcomes: A Review of the Current Literature</p>

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