Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.
Medical University of South Carolina, 135 Rutledge Avenue, Room 1207, Charleston, SC, 29425, USA.
BMC Cardiovasc Disord. 2021 May 12;21(1):239. doi: 10.1186/s12872-021-02045-y.
Point-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device.
Over a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard.
8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9 week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0-94.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from - 0.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement).
The 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.
床边心脏超声（心脏 POCUS）有可能成为改善坦桑尼亚心血管护理的有用工具。我们开展了一个试点项目，培训基层卫生中心的临床医生使用手持式便携式设备获取和解读重点心脏 POCUS 检查。
在为期 5 天的时间里，我们采用理论和实践相结合的方法培训临床医生，让他们按照预先规定的扫描方案进行操作，并识别关键的病理变化。在培训前后评估知识和培训后的图像采集能力。在常规临床实践中，受训者对有心血管症状/体征的患者进行扫描，为每次扫描记录一组特定的图像，并在病例报告表上记录他们对关键病理变化的解读（存在或不存在）。随后，一名心脏病专家对所有图像进行回顾，对图像质量进行评分，并对关键病理变化的解读进行盲法记录；心脏病专家的解读被视为金标准。
8 名（6 名临床医生、1 名助理医疗官和 1 名内科医生）参加并完成了培训。在接下来的 9 周内，受训者在临床实践中总共进行了 429 次心脏 POCUS 检查。按受训者分层，可解读的图像中位数比例为 76.7%（范围为 18.0-94.2%）。对于 8 名受训者中的 5 名，75%或更多的图像可解读。对于预先指定的关键病理变化的检测，受训者和心脏病专家之间的kappa 统计数据从心包积液检测的-0.03（无一致性）到三尖瓣反流检测的 0.42（中度一致性）不等。关键病理变化的平均 kappa 值在受训者之间从 0（无一致性）到 0.32（适度一致性）不等。
为期 5 天的培训计划足以培训大多数临床医生获取基本的心脏图像，但不足以准确解读这些图像。要精通图像解读，可能需要更密集的培训计划。
