Tool to Improve Qualitative Assessment of Left Ventricular Systolic Function

Abstract

Interactive online learning tools have revolutionized graduate medical education and can impart echocardiographic image interpretive skills. We created self-paced, interactive online training modules using a repository of echocardiography videos of normal and various degrees of abnormal left ventricles. In this study, we tested the feasibility of this learning tool. Thirteen anesthesia interns took a pre-test and then had 3 weeks to complete the training modules on their own time before taking a post-test. The average score on the post-test (74.6% ± 11.08%) was higher than the average score on the pre-test (57.7% ± 9.27%) (P < 0.001). Scores did not differ between extreme function (severe dysfunction or hyperdynamic function) and non-extreme function (normal function or mild or moderate dysfunction) questions on both the pre-test (P = 0.278) and post-test (P = 0.093). The interns scored higher on the post-test than the pre-test on both extreme (P = 0.0062) and non-extreme (P = 0.0083) questions. After using an online educational tool that allowed learning on their own time and pace, trainees improved their ability to correctly categorize left ventricular systolic function. Left ventricular systolic function is often a key echocardiographic question that can be difficult to master. The promising performance of this educational resource may lead to more time- and cost-effective methods for improving diagnostic accuracy among learners.

Cardiogenic Shock Induced by Anterior Pituitary Hypofunction and Thyrotoxicosis

“…In 2019, Mosebach et al reported a case of acute myocarditis presenting as an acute coronary syndrome [ 7 ]. In 2020, Tran et al studied a case of idiopathic eosinophilic myocarditis presenting with features of an acute coronary syndrome [ 8 ]. Viral myocarditis is regarded as a precursor of cardiomyopathy, which results from common viral infections and post-viral immune-mediated responses [ 9 ].…”

Quantitative Echocardiography Improves Resident Assessment of Left Ventricular Systolic Function

“…Current training environments typically incorporate some combination of hands-on perioperative instruction, self-guided didactics, or simulator-based education with a focus on qualitative visual estimation techniques. [10][11][12][13] Visual estimation techniques, however, suffer from significant interobserver variability and may yield agreement as low as 50% even in the hands of experienced echocardiographers. 6 The addition of quantitative LVEF assessment with the Simpson biplane method of discs was shown to improve diagnostic accuracy in a cohort of critical care physicians, 14 but the positive impact of incorporating this technique into an anesthesiology residency curriculum has never been studied.…”

“…As part of a focused cardiac ultrasound exam, simulation-based curricula have been successfully used to teach visual approximation of LVEF. [10][11][12][13] Structured teaching interventions in visual estimation techniques led to improvement in resident ability to qualitatively categorize LVEF with improved image quality and structure identification and a decrease in interobserver variability. [10][11][12][13] The improvement in image interpretation was most pronounced in images representing extremes of systolic function.…”

“…[10][11][12][13] Structured teaching interventions in visual estimation techniques led to improvement in resident ability to qualitatively categorize LVEF with improved image quality and structure identification and a decrease in interobserver variability. [10][11][12][13] The improvement in image interpretation was most pronounced in images representing extremes of systolic function. 10,14 Although it is the cornerstone of current cardiac ultrasound education, qualitative assessment of LVEF has been shown to be less accurate and less reproducible than quantitative assessment by the biplane method of discs or modified Simpson's rule.…”

“…[10][11][12][13] The improvement in image interpretation was most pronounced in images representing extremes of systolic function. 10,14 Although it is the cornerstone of current cardiac ultrasound education, qualitative assessment of LVEF has been shown to be less accurate and less reproducible than quantitative assessment by the biplane method of discs or modified Simpson's rule. 15 The efficacy of teaching quantitative methods of LVEF and the incorporation of these techniques into a curriculum has not been explored in studies of anesthesiology resident education.…”