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Assessment of Image Acquisition and Interpretation Skills in Anesthesia Residents Following Focused Cardiac Ultrasound Workshop
Abstract Number: F-48
Abstract Type: Original Research
INTRO: Focused cardiac ultrasound (FoCUS) is a safe, non-invasive method to investigate hemodynamic status in parturients. The principal competencies in developing FoCUS skills are image acquisition and interpretation. We studied the impact of an interactive workshop by measuring anesthesia trainee image acquisition quality and pre-load volume estimates on live models as compared to experts. Our hypothesis was that acquired image quality would improve with brief interactive training. A secondary hypothesis was that estimates of pre-load would demonstrate acceptable agreement with experts after training.
METHODS: After IRB approval and written consent, 33 senior trainees (CA2/3, fellow) voluntarily enrolled in a 3-hour basic FoCUS workshop. A quality of image (QOI) scoring process was developed incorporating anatomic structure inclusion, interface clarity and physiologic cycle timing. Trainees reviewed 3 videos in advance demonstrating basic FoCUS views. A 45-minute lecture highlighted FoCUS theory, practical techniques and clinical applications. 135 min hands-on sessions were conducted with live models with a 3 or 4:1 trainee:faculty ratio. Baseline testing was conducted on parasternal short axis (PSSA) and subcostal (SC) views using live models. QOI scores and measurements of left ventricular (end-diastole) [LV] and IVC (end-inspiratory) were recorded. Guided practice for PSSA and SC views was conducted. Post-workshop testing was completed on the same pre-test model with the same image quality rater. Workshop faculty conducted measurements on all models with composite average derived for expert consensus. QOI scores were compared pre- and post-workshop using the sign test. Bland Altman analysis was used to compare the LV and IVC measurements obtained by trainees to experts before and after workshop training with ±30% agreement deemed acceptable.1
RESULTS: The incidence of high QOI scores improved for IVC (pre: 61%, post: 91%, P<0.001) but not LV (pre: 58%, post: 76%], P=0.69). Agreement between trainee and expert LV and IVC measurements were acceptable and improved with training for LV but not for IVC (Figure). Magnitude of error was linearly related to the size of LV or IVC.
CONCLUSION: Anesthesia trainees can obtain high quality LV and IVC images, and estimates of preload which show acceptable agreement with experts. These observations will be used to further refine FoCUS training methodology.
1Critchley LAH: J Clin Monit Comput 1999;15:85-91