Ensuring Competency in Focused Cardiac Ultrasound: a Systematic Review of Training Programs

Overview

Journal J Intensive Care

Publisher Biomed Central

Specialty Critical Care

Date 2020 Dec 14

PMID 33308314

Citations 10

Authors

Lauren E Gibson

Gabrielle A White-Dzuro

Patrick J Lindsay

Sheri M Berg

Edward A Bittner

Marvin G Chang

Affiliations

Soon will be listed here.

Abstract

Background: Focused cardiac ultrasound (FoCUS) is a valuable skill for rapid assessment of cardiac function and volume status. Despite recent widespread adoption among physicians, there is limited data on the optimal training methods for teaching FoCUS and metrics for determining competency. We conducted a systematic review to gain insight on the optimal training strategies, including type and duration, that would allow physicians to achieve basic competency in FoCUS.

Methods: Embase, PubMed, and Cochrane Library databases were searched from inception to June 2020. Included studies described standardized training programs for at least 5 medical students or physicians on adult FoCUS, followed by an assessment of competency relative to an expert. Data were extracted, and bias was assessed for each study.

Results: Data were extracted from 23 studies on 292 learners. Existing FoCUS training programs remain varied in duration and type of training. Learners achieved near perfect agreement (κ > 0.8) with expert echocardiographers on detecting left ventricular systolic dysfunction and pericardial effusion with 6 h each of didactics and hands-on training. Substantial agreement (κ > 0.6) on could be achieved in half this time.

Conclusion: A short training program will allow most learners to achieve competency in detecting left ventricular systolic dysfunction and pericardial effusion by FoCUS. Additional training is necessary to ensure skill retention, improve efficiency in image acquisition, and detect other pathologies.

Citing Articles

Advocating for an Advanced Cardiac POCUS Curriculum Among Internal Medicine Residents.

Eromosele O, Pipilas A, Sherer J, Schwartz M J Med Educ Curric Dev. 2024; 11:23821205241296957.

PMID: 39712651 PMC: 11662376. DOI: 10.1177/23821205241296957.

Therapeutic impact of basic critical care echocardiography performed by residents after limited training.

Goudelin M, Evrard B, Donisanu R, Gonzalez C, Truffy C, Orabona M Ann Intensive Care. 2024; 14(1):119.

PMID: 39073505 PMC: 11286607. DOI: 10.1186/s13613-024-01354-7.

Utility of focused cardiac ultrasonography training in veterinary students to differentiate stages of subclinical myxomatous mitral valve disease in dogs.

Huh T, Achilles E, Massey L, Loughran K, Larouche-Lebel E, Convey V J Vet Intern Med. 2024; 38(3):1325-1333.

PMID: 38532734 PMC: 11099716. DOI: 10.1111/jvim.17056.

Exploring Brain and Heart Interactions during Electroconvulsive Therapy with Point-of-Care Ultrasound.

Chang M, Barbour T, Bittner E Med Sci (Basel). 2024; 12(2).

PMID: 38525771 PMC: 11024754. DOI: 10.3390/medsci12020017.

Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis.

Haji-Hassan M, Capras R, Bolboaca S Diagnostics (Basel). 2023; 13(24).

PMID: 38132248 PMC: 10742630. DOI: 10.3390/diagnostics13243665.

References

Croft L, Duvall W, Goldman M . A pilot study of the clinical impact of hand-carried cardiac ultrasound in the medical clinic. Echocardiography. 2006; 23(6):439-46. DOI: 10.1111/j.1540-8175.2006.00240.x. View

Pontone G, Moharem-Elgamal S, Maurovich-Horvat P, Gaemperli O, Pugliese F, Westwood M . Training in cardiac computed tomography: EACVI certification process. Eur Heart J Cardiovasc Imaging. 2017; 19(2):123-126. DOI: 10.1093/ehjci/jex310. View

. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011; 37(7):1077-83. DOI: 10.1007/s00134-011-2246-9. View

See K, Ong V, Ng J, Tan R, Phua J . Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model*. Crit Care Med. 2014; 42(10):2169-77. DOI: 10.1097/CCM.0000000000000413. View

Gaudet J, Waechter J, McLaughlin K, Ferland A, Godinez T, Bands C . Focused Critical Care Echocardiography: Development and Evaluation of an Image Acquisition Assessment Tool. Crit Care Med. 2016; 44(6):e329-35. DOI: 10.1097/CCM.0000000000001620. View

Ruddox V, Stokke T, Edvardsen T, Hjelmesaeth J, Aune E, Baekkevar M . The diagnostic accuracy of pocket-size cardiac ultrasound performed by unselected residents with minimal training. Int J Cardiovasc Imaging. 2013; 29(8):1749-57. DOI: 10.1007/s10554-013-0278-7. View

Ruddox V, Norum I, Stokke T, Edvardsen T, Otterstad J . Focused cardiac ultrasound by unselected residents-the challenges. BMC Med Imaging. 2017; 17(1):22. PMC: 5336635. DOI: 10.1186/s12880-017-0191-y. View

Ryan T, Berlacher K, Lindner J, Mankad S, Rose G, Wang A . COCATS 4 Task Force 5: Training in Echocardiography. J Am Coll Cardiol. 2015; 65(17):1786-99. DOI: 10.1016/j.jacc.2015.03.035. View

Beraud A, Rizk N, Pearl R, Liang D, Patterson A . Focused transthoracic echocardiography during critical care medicine training: curriculum implementation and evaluation of proficiency*. Crit Care Med. 2013; 41(8):e179-81. DOI: 10.1097/CCM.0b013e31828e9240. View

10.

Hall D, Jordan H, Alam S, Gillies M . The impact of focused echocardiography using the Focused Intensive Care Echo protocol on the management of critically ill patients, and comparison with full echocardiographic studies by BSE-accredited sonographers. J Intensive Care Soc. 2017; 18(3):206-211. PMC: 5665138. DOI: 10.1177/1751143717700911. View

11.

Wharton G, Steeds R, Allen J, Phillips H, Jones R, Kanagala P . A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Res Pract. 2015; 2(1):G9-G24. PMC: 4676441. DOI: 10.1530/ERP-14-0079. View

12.

. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014; 40(5):654-66. DOI: 10.1007/s00134-014-3228-5. View

13.

MacDONALD M, Hawkins N, Balmain S, Dalzell J, McMurray J, Petrie M . Transthoracic echocardiography: a survey of current practice in the UK. QJM. 2008; 101(5):345-9. DOI: 10.1093/qjmed/hcm135. View

14.

Hellmann D, Whiting-OKeefe Q, Shapiro E, Martin L, Martire C, Ziegelstein R . The rate at which residents learn to use hand-held echocardiography at the bedside. Am J Med. 2005; 118(9):1010-8. DOI: 10.1016/j.amjmed.2005.05.030. View

15.

Diaz-Gomez J, Perez-Protto S, Hargrave J, Builes A, Capdeville M, Festic E . Impact of a focused transthoracic echocardiography training course for rescue applications among anesthesiology and critical care medicine practitioners: a prospective study. J Cardiothorac Vasc Anesth. 2015; 29(3):576-81. DOI: 10.1053/j.jvca.2014.10.013. View

16.

Conlin F, Connelly N, Eaton M, Broderick P, Friderici J, Adler A . Perioperative Use of Focused Transthoracic Cardiac Ultrasound: A Survey of Current Practice and Opinion. Anesth Analg. 2017; 125(6):1878-1882. DOI: 10.1213/ANE.0000000000002089. View

17.

Kanji H, McCallum J, Bhagirath K, Neitzel A . Curriculum Development and Evaluation of a Hemodynamic Critical Care Ultrasound: A Systematic Review of the Literature. Crit Care Med. 2016; 44(8):e742-50. DOI: 10.1097/CCM.0000000000001661. View

18.

Neskovic A, Edvardsen T, Galderisi M, Garbi M, Gullace G, Jurcut R . Focus cardiac ultrasound: the European Association of Cardiovascular Imaging viewpoint. Eur Heart J Cardiovasc Imaging. 2014; 15(9):956-60. DOI: 10.1093/ehjci/jeu081. View

19.

Smith C, Morad A, Balwanz C, Lyden E, Matthias T . Prospective evaluation of cardiac ultrasound performance by general internal medicine physicians during a 6-month faculty development curriculum. Crit Ultrasound J. 2018; 10(1):9. PMC: 5915984. DOI: 10.1186/s13089-018-0090-7. View

20.

Spencer K, Kimura B, Korcarz C, Pellikka P, Rahko P, Siegel R . Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2013; 26(6):567-81. DOI: 10.1016/j.echo.2013.04.001. View