Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Can J Anaesth. 2022 Oct;69(10):1260-1271. doi: 10.1007/s12630-022-02281-6. Epub 2022 Jul 12.
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.
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.
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.
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.
针对重症监护超声心动图（CCE）的高级培训课程，目前相关数据有限。本研究旨在描述一个纵向超声心动图培训计划，并调查分布式条件监督与预定义整体监督的效果，以及可选超声心动图实验室轮转对学习者参与度的影响。
本混合方法研究纳入了 2015 年 7 月至 2018 年 7 月期间来自多伦多大学 5 家附属医院重症监护病房（ICU）的重症监护医师和教员，他们参加了一个高级培训计划，包括理论讲座和实践课程。第一年结束后，改变了监督模式，并增加了在超声心动图实验室轮转，对该计划进行了修改。我们进行了半结构化访谈，并使用贝叶斯框架调查课程变化对完成作品集（150 份经胸超声心动图）进度的影响。
共纳入 65 名学习者，其中 18 名接受了访谈。4 名（9%）学习者完成了作品集。学习者报告缺乏时间和监督，以及技能复杂性是独立实践的主要障碍。条件监督与未监督超声心动图的提交率高于无条件监督（比率比，1.11，95%可信区间，1.08 至 1.14）。在超声心动图实验室轮转后，未监督超声心动图的提交量减少。
学员认为缺乏时间和有限的监督是完成课程的主要障碍。然而，成功完成作品集与保护在超声心动图实验室的时间或 ICU 中的无条件直接监督以外的其他因素有关。需要进一步研究以更好地了解促进 CCE 培训计划成功的因素。
