nach oben

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Erschienen in:

12.07.2022 | Reports of Original Investigations

Evaluation of an advanced critical care echocardiography program: a mixed methods study

verfasst von: MD, MME Ghislaine Douflé, MD Martin Urner, MD Laura Dragoi, MD Aditi Jain, MD, PhD Ryan Brydges, MD, PhD Dominique Piquette

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 10/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Limited data exist on advanced critical care echocardiography (CCE) training programs for intensivists. We sought to describe a longitudinal echocardiography program and investigate the effect of distributed conditional supervision vs predefined en-bloc supervision, as well as the effect of an optional echocardiography laboratory rotation, on learners’ engagement.

Methods

In this mixed methods study, we enrolled critical care fellows and faculty from five University of Toronto-affiliated intensive care units (ICU) between July 2015 and July 2018 in an advanced training program, comprising theoretical lectures and practical sessions. After the first year, the program was modified with changes to supervision model and inclusion of a rotation in the echo laboratory. We conducted semistructured interviews and investigated the effects of curricular changes on progress toward portfolio completion (150 transthoracic echocardiograms) using a Bayesian framework.

Results

Sixty-five learners were enrolled and 18 were interviewed. Four (9%) learners completed the portfolio. Learners reported lack of time and supervision, and skill complexity as the main barriers to practicing independently. Conditional supervision was associated with a higher rate of submitting unsupervised echocardiograms than unconditional supervision (rate ratio, 1.11, 95% credible interval, 1.08 to 1.14). After rotation in the echocardiography laboratory, submission of unsupervised echocardiograms decreased.

Conclusion

Trainees perceived lack of time and limited access to supervision as major barriers to course completion. Nevertheless, successful portfolio completion was related to factors other than protected time in the echocardiography laboratory or unconditional direct supervision in ICU. Further research is needed to better understand the factors promoting success of CCE training programs.

Nur mit Berechtigung zugänglich

Vieillard-Baron A, Slama M, Cholley B, Janvier G, Vignon P. Echocardiography in the intensive care unit: from evolution to revolution? Intensive Care Med 2008; 34: 243–249. https://doi.org/10.1007/s00134-007-0923-5 CrossRefPubMed

Royse CF, Canty DJ, Faris J, Haji DL, Veltman M, Royse A. Core review: physician-performed ultrasound: the time has come for routine use in acute care medicine. Anesth Analg 2012; 115: 1007–28. https://doi.org/10.1213/ane.0b013e31826a79c1 CrossRefPubMed

Price S, Via G, Sloth E, et al. Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS). Cardiovasc Ultrasound 2008; 6: 49. https://doi.org/10.1186/1476-7120-6-49 CrossRefPubMedPubMedCentral

Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr 2014; 27: e1–33. https://doi.org/10.1016/j.echo.2014.05.001 CrossRef

Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 2010; 23: 1225–30. https://doi.org/10.1016/j.echo.2010.10.005 CrossRefPubMed

Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26: 567–81. https://doi.org/10.1016/j.echo.2013.04.001 CrossRefPubMed

Moore CL, Copel JA. Point–of–care ultrasonography. New Engl J Med 2011; 364: 749–57. https://doi.org/10.1056/nejmra0909487 CrossRefPubMed

Vignon P, Mücke F, Bellec F, et al. Basic critical care echocardiography: validation of a curriculum dedicated to noncardiologist residents. Crit Care Med 2011; 39: 636–42. https://doi.org/10.1097/ccm.0b013e318206c1e4 CrossRefPubMed

Wiegers SE. The point of care. J Am Soc Echocardiogr 2016; 29: A19. https://doi.org/10.1016/j.echo.2016.02.007 CrossRefPubMed

10.

European Society of Intensive Care Medicine. European diploma in advanced critical care echocardiography. Available from URL: https://www.esicm.org/education/edec-2/ (accessed May 2022).

11.

National Board of Echocardiography, Inc. Application for Certification in Critical Care Echocardiography (CCEeXAM): certifcation requirements and online certification instructions 2021. Available from URL: https://echoboards.org/docs/CCEeXAM-Cert_App-2021.pdf (accessed April 2022).

12.

Mayo PH, Koenig S. Advanced critical care echocardiography certification: an update. Chest 2020; 158: 48–9. https://doi.org/10.1016/j.chest.2020.02.037 CrossRefPubMed

13.

Almaani M, Alabdrab Alnabi M, Bainbridge D, Taneja R. Transthoracic echocardiography performed by intensive care fellows: Is minimal focused training enough? Crit Care 2011; 15: S9. https://doi.org/10.1186/cc9445 CrossRef

14.

Charron C, Templier F, Goddet NS, Baer M, Vieillard-Baron A, Group of Investigators of SAMU 92. Difficulties encountered by physicians in interpreting focused echocardiography using a pocket ultrasound machine in prehospital emergencies. Eur J Emerg Med 2015; 22: 17–22. https://doi.org/10.1097/mej.0000000000000153

15.

Manasia AR, Nagaraj HM, Kodali RB, et al. Feasibility and potential clinical utility of goal-directed transthoracic echocardiography performed by noncardiologist intensivists using a small hand-carried device (SonoHeart) in critically ill patients. J Cardiothorac Vasc Anesth 2005; 19: 155–9. https://doi.org/10.1053/j.jvca.2005.01.023 CrossRefPubMed

16.

Gillon S, Walker D, Jones N. Barriers to focused echocardiography education. Eur J Emerg Med 2016; 23: 75–6. https://doi.org/10.1097/mej.0000000000000309 CrossRefPubMed

17.

Eisen LA, Leung S, Gallagher AE, Kvetan V. Barriers to ultrasound training in critical care medicine fellowships: a survey of program directors. Crit Care Med 2010; 38: 1978–83. https://doi.org/10.1097/ccm.0b013e3181eeda53 CrossRefPubMed

18.

Kirkpatrick JN, Grimm R, Johri AM, et al. Recommendations for Echocardiography Laboratories Participating in Cardiac Point of Care Cardiac Ultrasound (POCUS) and critical care echocardiography training: report from the American Society of Echocardiography. J Am Soc Echocardiogr 2020; 33: 409–22. https://doi.org/10.1016/j.echo.2020.01.008 CrossRefPubMed

19.

Noritomi DT, Vieira ML, Pesaro AE, et al. Validation of an echochardiography training program for intensivists. Crit Care 2009; 13: P3. https://doi.org/10.1186/cc7805 CrossRefPubMedCentral

20.

Ahern M, Mallin MP, Weitzel S, Madsen T, Hunt P. Variability in ultrasound education among emergency medicine residencies. West J Emerg Med. 2010; 11: 314–8. PubMedPubMedCentral

21.

Colebourn CL, Jones L. Preventing too little too late: a novel process of continuous curriculum evaluation. JPD 2014; 4: 3–14.

22.

Ali A, Korzick K, Miller A, Urrutia L, Strony R. Toward echocardiography and critical care ultrasound integration into critical care fellowship. Crit Care Med 2014; 42: A1436. CrossRef

23.

Kanji HD, McCallum JL, Bhagirath KM, Neitzel AS. Curriculum development and evaluation of a hemodynamic critical care ultrasound: a systematic review of the literature. Crit Care Med 2016; 44: e742–50. https://doi.org/10.1097/ccm.0000000000001661 CrossRefPubMed

24.

Greenstein YY, Littauer R, Narasimhan M, Mayo PH, Koenig SJ. Effectiveness of a critical care ultrasonography course. Chest 2017; 151: 34–40. https://doi.org/10.1016/j.chest.2016.08.1465 CrossRefPubMed

25.

Blackstock A, Morton S, Powell-Tuck J, Aron J. Development of an intensive care advanced echo course. Intensive Care Med Exp 2018; 6: 246.

26.

Beraud AS, Rizk NW, Pearl RG, Liang DH, Patterson AJ. Focused transthoracic echocardiography during critical care medicine training: Curriculum implementation and evaluation of proficiency. Crit Care Med 2013; 41: e179–81. https://doi.org/10.1097/ccm.0b013e31828e9240 CrossRefPubMed

27.

Yamamoto R, Clanton D, Willis RE, Jonas RB, Cestero RF. Rapid decay of transthoracic echocardiography skills at 1 month: a prospective observational study. J Surg Educ 2018; 75: 503–9. https://doi.org/10.1016/j.jsurg.2017.07.011 CrossRefPubMed

28.

Kimura BJ, Sliman SM, Waalen J, Amundson SA, Shaw DJ. Retention of ultrasound skills and training in "point-of-care" cardiac ultrasound. J Am Soc Echocardiogr 2016; 29: 992–7. https://doi.org/10.1016/j.echo.2016.05.013 CrossRefPubMed

29.

Hempel D, Stenger T, Dell' Orto MC, et al. Analysis of trainees' memory after classroom presentations of didactical ultrasound courses. Crit Ultrasound J 2014; 6: 10. https://doi.org/10.1186/2036-7902-6-10 CrossRefPubMedPubMedCentral

30.

Expert Round Table on Echocardiography in ICU. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med 2014; 40: 654–666. https://doi.org/10.1007/s00134-014-3228-5 CrossRef

31.

Harden RM. Ten questions to ask when planning a course or curriculum. Med Educ 1986; 20: 356–65. https://doi.org/10.1111/j.1365-2923.1986.tb01379.x CrossRefPubMed

32.

Prideaux D. Curriculum design. BMJ 2003; 326: 268–70. https://doi.org/10.1136/bmj.326.7383.268 CrossRefPubMedPubMedCentral

33.

Grant J. Principles of curriculum design. In: Swanwick T, Forrest K, O'Brien BC (Eds.). Understanding Medical Education: Evidence, Theory and Practice, 2nd ed. Chichester: Wiley-Blackwell; 2014: 31–46.

34.

Quiñones MA, Douglas PS, Foster E, et al. ACC/AHA clinical competence statement on echocardiography: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on clinical competence. J Am Soc Echocardiogr 2003;16:379-402. https://doi.org/10.1016/s0894-7317(03)00113-5 CrossRefPubMed

35.

Millington SJ, Arntfield RT, Hewak M, et al. The rapid assessment of competency in echocardiography scale: validation of a tool for point-of-care ultrasound. J Ultrasound Med 2016; 35: 1457–63. https://doi.org/10.7863/ultra.15.07083 CrossRefPubMed

36.

Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993; 100: 363–406. CrossRef

37.

Artino AR Jr, Brydges R, Gruppen LD. Self-regulated learning in healthcare profession education: theoretical perspectives and research methods. In: Cleland J, Dunning SJ (Eds.). Researching Medical Education. Wiley-Blackwell; 2015: 155–66.

38.

McGaghie WC, Kristopaitis T. Deliberate practice and mastery learning: origins of expert medical performance. In: Cleland J, Dunning SJ (Eds.). Researching Medical Education. Wiley-Blackwell; 2015: 219–30.

39.

Pusic MV, Pecaric M, Boutis K. How much practice is enough? Using learning curves to assess the deliberate practice of radiograph interpretation. Acad Med 2011; 86: 731–6. https://doi.org/10.1097/acm.0b013e3182178c3c CrossRefPubMed

40.

Pusic MV, Boutis K, Hatala R, Cook DA. Learning curves in health professions education. Acad Med 2015; 90: 1034–42. https://doi.org/10.1097/acm.0000000000000681 CrossRefPubMed

41.

Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med 2015; 90: 1471–86. https://doi.org/10.1097/acm.0000000000000939 CrossRefPubMed

42.

Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med 2008; 15: 988–94. https://doi.org/10.1111/j.1553-2712.2008.00227.x CrossRefPubMed

43.

Brydges R, Dubrowski A, Regehr G. A new concept of unsupervised learning: directed self-guided learning in the health professions. Acad Med 2010; 85: S49–55. https://doi.org/10.1097/acm.0b013e3181ed4c96 CrossRefPubMed

44.

Savion-Lemieux T, Penhune VB. The effects of practice and delay on motor skill learning and retention. Exp Brain Res 2005; 161: 423–31. https://doi.org/10.1007/s00221-004-2085-9 CrossRefPubMed

45.

Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg 2006; 244: 400–9. https://doi.org/10.1097/01.sla.0000234808.85789.6a CrossRefPubMedPubMedCentral

46.

Bowling A. Research Methods in Health: Investigating Health and Health Services. McGraw-Hill Education; 2009.

47.

Teddlie C, Yu F. Mixed methods sampling: a typology with examples. J Mix Methods Res 2007; 1: 77–100. https://doi.org/10.1177/1558689806292430 CrossRef

48.

Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. BMJ 2000; 320: 114–6. https://doi.org/10.1136/bmj.320.7227.114 CrossRefPubMedPubMedCentral

49.

Baker SE, Edwards R. How many qualitative interviews is enough? Expert voices and early career reflections on sampling and cases in qualitative research. Availabe from URL: https://eprints.ncrm.ac.uk/id/eprint/2273/4/how_many_interviews.pdf (access April 2022).

50.

Creswell JW, Creswell JD. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 5th ed. Los Angeles: Sage; 2018.

51.

Depaoli S, Rus HM, Clifton JP, van de Schoot R, Tiemensma J. An introduction to Bayesian statistics in health psychology. Health Psychol Rev 2017; 11: 248–64. CrossRef

52.

Dunlosky J, Ariel R. Self-regulated learning and the allocation of study time. Psychol Learn Motiv - Adv Res Theory 2011; 54: 103–40. https://doi.org/10.1016/B978-0-12-385527-5.00004-8 CrossRef

53.

Salmoni AW, Schmdt RA, Walter CB. Knowledge of results and motor learning- a review and critical reappraisal. Psychol Bull 1984; 95: 355–86. https://doi.org/10.1037/0033-2909.95.3.355 CrossRefPubMed

54.

Deci EL. Intrinsic motivation, extrinsic reinforcement, and inequity. J Pers Soc Psychol 1972; 22: 113–20. https://doi.org/10.1037/h0032355 CrossRef

55.

Deci EL, Ryan RM, Williams GC. Need satisfaction and the self-regulation of learning. Learn Individ Diff 1996; 8: 165–83. https://doi.org/10.1016/S1041-6080(96)90013-8 CrossRef

56.

Pink DH. Drive: The Surprising Truth About What Motivates Us. Riverhead Books; 2009.

57.

Koriat A, Bjork RA. Illusions of competence in monitoring one's knowledge during study. J Exp Psychol Learn Mem Cogn 2005; 31: 187–94. https://doi.org/10.1037/0278-7393.31.2.187 CrossRefPubMed

58.

Dayan E, Cohen LG. Neuroplasticity subserving motor skill learning. Neuron 2011; 72: 443–54. https://doi.org/10.1016/j.neuron.2011.10.008 CrossRefPubMedPubMedCentral

59.

Sitzmann T, Ely K. A meta-analysis of self-regulated learning in work-related training and educational attainment: what we know and where we need to go. Psychol Bull 2011; 137: 421–42. https://doi.org/10.1037/a0022777 CrossRefPubMed

Titel: Evaluation of an advanced critical care echocardiography program: a mixed methods study
verfasst von: MD, MME Ghislaine Douflé
MD Martin Urner
MD Laura Dragoi
MD Aditi Jain
MD, PhD Ryan Brydges
MD, PhD Dominique Piquette
Publikationsdatum: 12.07.2022
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 10/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02281-6

Neu im Fachgebiet AINS

20.03.2023 | Petechien | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Hauptrubriken

Service

Fachgebiete

Themen

Sammlungen

Springer Medizin

Evaluation of an advanced critical care echocardiography program: a mixed methods study

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet AINS

Mechanische Erklärung für Petechien zum Sepsis-Ausschluss ungeeignet

Fünf „knackige“ Empfehlungen zum akuten Rückenschmerz

Anaphylaxie: Wer bekommt ein Notfall-Set, wer sogar zwei?

Gewichthebetest lässt auf Schmerzniveau im Alltag schließen

Update AINS

Update AINS

Hauptrubriken

Service

Fachgebiete

Themen

Sammlungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2022

Hemidiaphragmatic paresis associated with interscalene nerve block

White blood cell count trajectory and mortality in septic shock: a historical cohort study

Association of peripheral nerve blocks with patient-reported quality of recovery in female patients receiving breast cancer surgery: a systematic review and meta-analysis of randomized controlled studies

New approach to assessing and addressing moral distress in intensive care unit personnel: a case study

General anesthesia for Cesarean delivery in a parturient critically ill with COVID-19: a case report

The potential link between obstructive sleep apnea and postoperative neurocognitive disorders: current knowledge and possible mechanisms

Neu im Fachgebiet AINS

Mechanische Erklärung für Petechien zum Sepsis-Ausschluss ungeeignet

Fünf „knackige“ Empfehlungen zum akuten Rückenschmerz

Anaphylaxie: Wer bekommt ein Notfall-Set, wer sogar zwei?

Gewichthebetest lässt auf Schmerzniveau im Alltag schließen

Update AINS

Update AINS