Love Angela, Bondarsky Eric, Filopei Jason, Wang Dongliang, Patrawalla Paru
Division of Pulmonary, Critical Care and Sleep Medicine, and.
Division of Pulmonary, Critical Care and Sleep Medicine, Grossman School of Medicine, New York University, New York, New York; and.
ATS Sch. 2022 Feb 17;3(2):229-241. doi: 10.34197/ats-scholar.2021-0080OC. eCollection 2022 Jun.
Point-of-care (POC) ultrasound (POCUS) has become an essential tool in caring for critically ill patients in several specialties. Mastery in POCUS requires competency in image acquisition, image interpretation, and integration into clinical care. Deliberate practice is an effective method for performance improvement in many areas of medical education; however, it is not well described in the literature for POCUS training.
To analyze differences in the effect of deliberate practice in POCUS image interpretation on performance improvement in groups with varying skill levels.
We recruited attending physicians and trainees with varying degrees of expertise in POCUS to complete a 50-item educational instrument on the interpretation of right ventricle size and function. The instrument incorporated deliberate practice for the task of correctly identifying right ventricle size and function as either normal or abnormal. Pulmonary critical care trainees obtained and interpreted POCUS images of patients with diagnosed acute pulmonary embolism, which were compared with gold-standard, two-dimensional echocardiographic scans obtained by an expert technician and interpreted by a cardiologist board-certified in echocardiography. We mapped learners' cumulative accuracy on a learning curve to assess their performance. In addition, we compared groups on the basis of prior experience with using POC echocardiography.
Seventy-nine of 81 participants completed the survey and examination and were included in the analysis. Of the participants, 69 (87.3%) were trainees. The overall cumulative accuracy for the group was 72.9%. All groups demonstrated improvement in accuracy with repetitive practice.
Deliberate practice in POC echocardiograph interpretation is effective for improving performance in a wide range of learners. Further study is needed to define accuracy cutoffs for competency to help guide learning plans and program requirements and for application into a model for global POC echocardiography competence.
床旁超声（POCUS）已成为多个专科护理危重症患者的重要工具。掌握POCUS需要具备图像采集、图像解读以及将其整合到临床护理中的能力。刻意练习是医学教育许多领域提高表现的有效方法；然而，在POCUS培训的文献中对此描述并不充分。
分析在POCUS图像解读中刻意练习对不同技能水平组表现改善的影响差异。
我们招募了在POCUS方面具有不同专业水平的主治医师和实习生，以完成一份关于右心室大小和功能解读的50项教育工具。该工具针对正确识别右心室大小和功能正常或异常的任务纳入了刻意练习。肺部重症监护实习生获取并解读已诊断为急性肺栓塞患者的POCUS图像，并与由专业技术人员获取并由经超声心动图认证的心脏病专家解读的金标准二维超声心动图扫描结果进行比较。我们在学习曲线上绘制学习者的累积准确率，以评估他们的表现。此外，我们根据使用POC超声心动图的既往经验对各小组进行比较。
81名参与者中的79名完成了调查和检查并纳入分析。参与者中，69名（87.3%）为实习生。该组的总体累积准确率为72.9%。所有小组通过重复练习在准确率方面均有提高。
POC超声心动图解读中的刻意练习对广泛的学习者提高表现有效。需要进一步研究来确定能力的准确率临界值，以帮助指导学习计划和课程要求，并应用于全球POC超声心动图能力模型。
