The Assessment of Technical and Interpretative Proficiency in Echocardiography

Nair, Parvathy; Siu, Samuel C.; Sloggett, Cairrine; Biclar, Lizette; Sidhu, Ravindar S.; Yu, Eric

doi:10.1016/j.echo.2006.01.015

Cited by 41 publications

(36 citation statements)

References 29 publications

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“…A study examining cardiologists found no association between experience and proficiency. 5 One final possibility relates to the fact that FAST and cardiac examinations demonstrated proportionally more educational US during the earlier learning phases. These would be more likely to be obtained during nonclinical times when the sonographer has more time to obtain and interpret images, thus artificially enhancing performance.…”

Section: Discussionmentioning

confidence: 99%

Learning Curves in Emergency Ultrasound Education

Blehar

Barton

Gaspari

2015

Academic Emergency Medicine

159

144

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Objectives: Proficiency in the use of bedside ultrasound (US) has become standard in emergency medicine residency training. While milestones have been established for this training, supporting data for minimum standard experience are lacking. The objective of this study was to characterize US learning curves to identify performance plateaus for both image acquisition and interpretation, as well as compare performance characteristics of learners to those of expert sonographers.Methods: A retrospective review of an US database was conducted at a single academic institution. Each examination was scored for agreement between the learner and expert reviewer interpretation and given a score for image quality. A locally weighted scatterplot smoothing method was used to generate a model of predicted performance for each individual examination type. Performance characteristics for expert sonographers at the site were also tracked and used in addition to performance plateaus as benchmarks for learning curve analysis.Results: There were 52,408 US examinations performed between May 2007 and January 2013 and included for analysis. Performance plateaus occurred at different points for different US protocols, from 18 examinations for soft tissue image quality to 90 examinations for right upper quadrant image interpretation. For the majority of examination types, a range of 50 to 75 examinations resulted in both excellent interpretation (sensitivity > 84% and specificity > 90%) and good image quality (90% the image quality benchmark of expert sonographers).Conclusions: Educational performance benchmarks occur at variable points for image interpretation and image quality for different examination types. These data should be considered when developing training standards for US education as well as experience requirements for US credentialing. The initial ACEP guidelines focused on the number of US examinations that were required to be performed by a physician prior to being considered competent. In the most recent ACEP guidelines, it is recommended that 25 to 50 examinations be performed for each of the core applications. While the ACEP guidelines note that other metrics may be used to determine competency, the absolute number of US examinations performed remains the most common (and easiest to obtain) metric. Likewise, while the ACGME milestone competencies focus on a variety of metrics, they do include a cutoff of 150 total examinations as minimum experience to complete residency training. Choosing a specific number as a benchmark for competency remains a theme for national guidelines in EM and other specialties.

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Section: Discussionmentioning

confidence: 99%

Learning Curves in Emergency Ultrasound Education

Blehar

Barton

Gaspari

2015

Academic Emergency Medicine

159

144

View full text Add to dashboard Cite

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“…6,22,23 Hybrid simulations, in which two or more simulation modalities are combined, have been used in cardiology, anesthesiology, and obstetrics-gynecology. [24][25][26] Noeller et al 27 used a hybrid simulation model to train EM residents in cardiac, pediatric, toxicology, and trauma resuscitations. They used different simulation modalities at separate training stations within a theme-based workshop and found a high level of resident satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Simulation Combining a High Fidelity Scenario with a Pelvic Ultrasound Task Trainer Enhances the Training and Evaluation of Endovaginal Ultrasound Skills

Girzadas¹,

Antonis²,

Zerth³

et al. 2009

Academic Emergency Medicine

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Objectives: In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills.Methods: A total of 45 EM residents at two institutions were randomized into two groups. Each group was assigned to one of two formats involving an ectopic pregnancy scenario. One format incorporated the new hybrid model, in which residents had to manipulate an endovaginal US probe in a task trainer; the other used the standard high-fidelity simulation mannequin together with static photo images. After finishing the scenario, residents self-rated their overall learning experience and how well the scenario evaluated their ability to interpret endovaginal US images. Faculty members reviewed video recordings of the other institution's residents and rated their own ability to evaluate residents' skills in interpreting endovaginal US images and diagnosing and managing the case scenario. Visual analog scales (VAS) were used for the self-ratings.Results: Compared to the residents assigned to the standard simulation scenario, residents assigned to the hybrid model reported an increase in their overall educational experience (D VAS = 10, 95% confidence interval [CI] = 4 to 18) and felt the hybrid model was a better measure of their ability to interpret endovaginal US images (D VAS = 17, 95% CI = 7 to 28). Faculty members found the hybrid model to be better than the standard simulation for evaluating residents' skills in interpreting endovaginal US images (D VAS = 13, 95% CI = 6 to 20) and diagnosing and managing the case (D VAS = 10, 95% CI = 2 to 18). Time to reach a diagnosis was similar in both groups (p = 0.053).Conclusions: Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents. The use of endovaginal US by emergency physicians (EPs) has demonstrated potential to decrease emergency department (ED) length of stay and to facilitate rapid assessment of patients with ruptured ectopic pregnancy.2,3 During the past 10 years, acquiring and interpreting US images has become an accepted part of the training of emergency medicine (EM) residents. The

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“…Interestingly a recently published study evaluating proficiency of cardiology trainees showed that time of training and number of examinations performed are not as well correlated with ability as was expected [6 ]. The disparity could be explained by the differences between TEE and TTE, and by the motivation of the trainees; it could also be explained by the differences in initial PTEeXAM candidates and the cardiology residents in the study.…”

Section: Training and Certification In Perioperative Echocardiographymentioning

confidence: 66%