Clinical research study
The rate at which residents learn to use hand-held echocardiography at the bedside

https://doi.org/10.1016/j.amjmed.2005.05.030Get rights and content

Abstract

Purpose

Because there is little information about the training that general internists require to perform hand-carried cardiac ultrasonography (HCU), we studied the rate of learning of a group of medical residents performing HCU after minimal formal training.

Methods

Medical residents on the inpatient services at Johns Hopkins Bayview Medical Center received formal training in HCU consisting of 15-30 minutes of didactic instruction about the principles of echocardiography, followed by ongoing one-on-one instruction in performing HCU and subsequent ongoing one-on-one training from a certified echocardiography technician as they were doing scans. The residents were shown how to position the patient to obtain 2-dimensional echo images from the parasternal short and long axes and apical 4-chamber views, and how to obtain color-flow Doppler images across the mitral and aortic valves. Residents were asked to determine whether pericardial effusion was present and to assess left ventricular size, left ventricular function, and the mitral and aortic valves. The residents performed cardiac physical examination and HCU independently on patients who had a conventional transthoracic echocardiogram (CTTE) performed within 24 hours of the HCU. The residents’ HCU results were compared with the CTTE results by a cardiologist specializing in echocardiography. The rates at which residents gained technical proficiency and skills in interpreting their studies were measured by linear regression to fit various outcome variables against their experience at scanning as gauged by the number of scans performed.

Results

Thirty medical residents performed a total of 231 HCU studies. Linear regression models showed that the residents’ overall technical proficiency skills improved at the rate of 0.79 (95% confidence interval [CI] 0.53-1.04) points on an overall assessment index (0-3 scale) per 10 scans completed. Interpretation accuracy improved at a rate of 1.01 (95% CI 0.69-1.39) points per 10 scans as measured by an interpretation accuracy index (0-3 scale). Because scanning efforts and instruction in HCU occurred during residents’ usual rotation duties, some residents gathered experience in HCU slowly and sporadically.

Conclusion

This study, the first prospective, experimental effort of its kind, shows that residents as a group learned important aspects of HCU scanning and interpretation at a reasonably rapid rate.

Section snippets

Study populations

The study took place on the inpatient medical service at Johns Hopkins Bayview Medical Center, an academic medical center providing both community and tertiary services, between the dates of November 2002 and November 2004. Medical residents rotating on the inpatient services of Johns Hopkins Bayview Medical Center were asked to give informed consent to participate in this study. Those giving consent also completed Johns Hopkins Medicine’s Web-based training program on human investigation and

Characteristics of residents

Five residents who gave informed consent but performed no HCU studies were excluded from the analysis. Two of the residents who had previously spent 2 weeks training in echocardiography were also eliminated from the analysis. Thus, the analysis reported here includes 231 HCU sonographic scans performed by 30 medical residents. None of the included residents had previous training in sonography. The maximum number of studies done by any resident was 22. The residents performed an average of 7.7

Discussion

The results of this study show that, as a group, medical residents with minimal formal training can learn how to perform some of the basic functions of cardiac HCU. The rate of learning achieved by the group of residents is encouraging. Although extrapolation of the regression lines beyond the range of their defining data must be viewed with circumspection, the lines suggest that an acceptable level of skill in performing and interpreting echocardiograms might be obtainable within 20 to 40

Acknowledgment

We wish to thank Sonosite Corporation for helping to defray a small portion of the startup costs associated with this study and for providing the hand-held ultrasonography equipment used in this study.

References (18)

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