Yan Bryan P, Fok Jacquelyn Chi-Ying, Wong Teddy Hong-Yee, Tse Gary, Lee Alex P W, Yang Xing-Sheng, Sun Jing-Ping
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Int J Cardiol Heart Vasc. 2018 May 2;19:41-45. doi: 10.1016/j.ijcha.2018.03.007. eCollection 2018 Jun.
Focused cardiac ultrasound (FOCUS) examination using a portable device is increasingly used for bedside diagnosis of cardiovascular diseases. This is a 4-week pilot project aiming to teach medical students to perform FOCUS to detect valvular heart lesions.
Patients undergoing routine transthoracic echocardiography (TTE) were recruited by third year medical students who performed physical examination (PE) and FOCUS after 6-hour training to detect significant (moderate-to-severe) valvular lesions. Performance of FOCUS and PE was compared to TTE as reference using kappa statistics.
10 medical students performed 212 PE and FOCUS on 107 patients with mean age 63.7 ± 14.9 years. TTE detected 126 significant valvular lesions of which FOCUS correctly identified 54 lesions (κ = 0.45) compared to 32 lesions by PE (κ = 0.28, p < 0.01). FOCUS was better than PE in identifying mitral stenosis (κ = 0.51 vs. 0.17), aortic stenosis (κ = 0.45 vs. 0.16) and tricuspid regurgitation (κ = 0.39 vs. 0.09, all p < 0.01). Students became more proficient in performing FOCUS examination with time.
Teaching junior medical students to perform and interpret FOCUS was feasible after brief training and better than PE in detecting significant valvular lesions. Further studies are warranted to determine the utility of incorporating this new technology into mainstream medical training.
使用便携式设备进行的心脏聚焦超声（FOCUS）检查越来越多地用于心血管疾病的床旁诊断。这是一个为期4周的试点项目，旨在教授医学生进行FOCUS检查以检测心脏瓣膜病变。
三年级医学生招募接受常规经胸超声心动图（TTE）检查的患者，这些医学生在经过6小时培训后进行体格检查（PE）和FOCUS检查，以检测显著（中至重度）瓣膜病变。使用kappa统计量将FOCUS和PE的表现与作为参考的TTE进行比较。
10名医学生对107例平均年龄为63.7±14.9岁的患者进行了212次PE和FOCUS检查。TTE检测到126处显著瓣膜病变，其中FOCUS正确识别出54处病变（κ=0.45），而PE识别出32处病变（κ=0.28，p<0.01）。在识别二尖瓣狭窄（κ=0.51对0.17）、主动脉狭窄（κ=0.45对0.16）和三尖瓣反流（κ=0.39对0.09，所有p<0.01）方面，FOCUS优于PE。随着时间的推移，学生们在进行FOCUS检查方面变得更加熟练。
对低年级医学生进行FOCUS检查的操作和解读培训在经过简短训练后是可行的，并且在检测显著瓣膜病变方面优于PE。有必要进行进一步研究以确定将这项新技术纳入主流医学培训的效用。
