Gaudet Jonathan, Waechter Jason, McLaughlin Kevin, Ferland André, Godinez Tomás, Bands Colin, Boucher Paul, Lockyer Jocelyn
1Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2Department of Anesthesia, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 4Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Crit Care Med. 2016 Jun;44(6):e329-35. doi: 10.1097/CCM.0000000000001620.
Little attention has been placed on assessment tools to evaluate image acquisition quality for focused critical care echocardiography. We designed a novel assessment tool to objectively evaluate the image acquisition skills of critical care trainees learning focused critical care echocardiography and examined the tool for evidence of validity.
Prospective observational study.
Medical-surgical ICUs at a tertiary care teaching hospital.
Trainees in our critical care medicine fellowship program.
Six trainees completed a focused critical care echocardiography training curriculum followed by performing 20 transthoracic echocardiograms on patients receiving invasive mechanical ventilation. At three assessment intervals (the 1st and 2nd examinations, 10th and 11th examinations, and 19th and 20th examinations), echocardiograms performed by trainees were compared with those of critical care physicians certified in echocardiography and scored according to the focused critical care echocardiography assessment tool. The primary outcome was an efficiency score (overall assessment tool score divided by examination time). Differences in mean efficiency scores between echocardiographers of differing skill levels and changes in trainees' mean efficiency scores with increasing focused critical care echocardiography experience were compared by using t tests.
On the initial assessment, mean efficiency scores (SD) for trainees and experienced physicians were 1.55 (0.95) versus 2.78 (1.38), respectively (p = 0.02), and for the second and third assessments, the corresponding efficiency ratings for trainees and experienced physicians were 2.48 (0.97) versus 4.55 (1.32) (p < 0.01) and 2.61 (1.37) versus 4.17 (2.12) (p = 0.04), respectively.
Trainees' efficiency in focused critical care echocardiography image acquisition improved quickly in the first 10 studies, yet, it could not match with the performance of experienced physicians after 20 focused critical care echocardiography studies. The focused critical care echocardiography assessment tool demonstrated evidence of validity and could discern changes in trainees' image acquisition performance with increasing experience.
对于评估重点危重症超声心动图检查的图像采集质量的评估工具，关注较少。我们设计了一种新型评估工具，以客观评估学习重点危重症超声心动图的危重症实习医生的图像采集技能，并检验该工具的有效性证据。
前瞻性观察性研究。
一所三级护理教学医院的内科-外科重症监护病房。
我们危重症医学 fellowship 项目的实习医生。
6 名实习医生完成了重点危重症超声心动图培训课程，随后对接受有创机械通气的患者进行 20 次经胸超声心动图检查。在三个评估时间点（第 1 次和第 2 次检查、第 10 次和第 11 次检查、第 19 次和第 20 次检查），将实习医生进行的超声心动图检查与获得超声心动图认证的危重症医生的检查进行比较，并根据重点危重症超声心动图评估工具进行评分。主要结局是效率得分（总体评估工具得分除以检查时间）。使用 t 检验比较不同技能水平的超声心动图医生之间平均效率得分的差异，以及实习医生平均效率得分随重点危重症超声心动图经验增加的变化。
在初次评估时，实习医生和经验丰富的医生的平均效率得分（标准差）分别为 1.55（0.95）和 2.78（1.38）（p = 0.02），在第二次和第三次评估时，实习医生和经验丰富的医生相应的效率评分分别为 2.48（0.97）和 4.55（1.32）（p < 0.01）以及 2.61（1.37）和 4.17（2.12）（p = 0.04）。
在最初的 10 项研究中，实习医生在重点危重症超声心动图图像采集方面的效率迅速提高，但在 20 项重点危重症超声心动图研究后，其表现仍无法与经验丰富的医生相匹配。重点危重症超声心动图评估工具显示出有效性证据，并且能够识别实习医生随着经验增加在图像采集表现上的变化。
