Jones Alan E, Tayal Vivek S, Kline Jeffrey A
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA.
Acad Emerg Med. 2003 Oct;10(10):1054-8. doi: 10.1111/j.1553-2712.2003.tb00574.x.
To determine if a focused transthoracic echocardiography (TTE) training course would improve the accuracy of completion and interpretation of a goal-directed TTE by emergency medicine residents.
This was a prospective, observational, educational study of the impact of a focused training course on the change in physician performance on pre- and postcourse examinations testing competency in goal-directed TTE defined by five criteria: 1). image orientation, 2). anatomy identification, 3). chamber size grading, 4). ventricular function estimation, and 5). pericardial effusion identification. Subjects included were emergency medicine residents with between ten and 20 hours of noncardiac ultrasound didactics and between 20 and >150 proctored noncardiac ultrasound examinations. All underwent five hours of focused echocardiography didactics and one hour of proctored practical echocardiography training designed and implemented by an emergency physician ultrasound director and a cardiologist. Before the start of the training course, participants completed two examinations: 1) written 23-question test on the above concepts and 2) performance of a TTE on a healthy subject testing 16 elements that define a properly performed examination. After the training course, participants again completed both examinations.
A total of 21 emergency medicine residents qualified for and underwent standardized testing and training. The percentage correct on the precourse written examination was 54% (95% CI = 50% to 59%), and the postcourse examination score was 76% (95% CI = 71% to 80%) (p < 0.005, paired t-test). The percentage correct on the precourse practical examination was 56% (95% CI = 51% to 60%), and the postcourse examination score was 94% (95% CI = 91% to 96%) (p < 0.005).
A focused six-hour echocardiography training course significantly improved emergency medicine residents' percentage scores on both written and practical examinations testing essential components required for correct goal-directed TTE performance and interpretation.
确定一门聚焦式经胸超声心动图（TTE）培训课程是否能提高急诊医学住院医师完成并解读目标导向性TTE的准确性。
这是一项前瞻性、观察性教育研究，旨在探讨聚焦式培训课程对医师在课程前后考试中表现变化的影响，这些考试测试了由五个标准定义的目标导向性TTE能力：1）图像方位；2）解剖结构识别；3）腔室大小分级；4）心室功能评估；5）心包积液识别。纳入的受试者为急诊医学住院医师，他们接受过10至20小时的非心脏超声教学以及20至超过150次有监督的非心脏超声检查。所有受试者均接受了由一名急诊医师超声主任和一名心脏病专家设计并实施的5小时聚焦式超声心动图教学以及1小时有监督的实践超声心动图培训。在培训课程开始前，参与者完成两项考试：1）关于上述概念的23道书面测试题；2）在一名健康受试者身上进行TTE检查，测试16项定义正确检查的要素。培训课程结束后，参与者再次完成这两项考试。
共有21名急诊医学住院医师符合标准并接受了标准化测试和培训。课程前书面考试的正确百分比为54%（95%置信区间 = 50%至59%），课程后考试成绩为76%（95%置信区间 = 71%至80%）（p < 0.005，配对t检验）。课程前实践考试的正确百分比为56%（95%置信区间 = 51%至60%），课程后考试成绩为94%（95%置信区间 = 91%至96%）（p < 0.005）。
一门6小时的聚焦式超声心动图培训课程显著提高了急诊医学住院医师在书面和实践考试中的百分比成绩，这些考试测试了正确进行目标导向性TTE操作和解读所需的关键要素。
