Wu Andrew H, Chowdhary Harshika, Fischer Matthew, Salehi Ali, Grogan Tristan, Saddic Louis, Neelankavil Jacques, Harvey Reed
The authors are at the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA in Los Angeles, CA. is a cardiothoracic anesthesiologist; is a medical student; is a cardiac anesthesiologist; is a cardiac anesthesiologist; is a clinical statistician; is a cardiac anesthesiologist; is a cardiac anetshesiologist; is a cardiac anesthesiologist.
J Educ Perioper Med. 2022 Apr 1;24(2):1-6. doi: 10.46374/volxxiv_issue2_harvey. eCollection 2022 Apr-Jun.
The use of echocardiography to assess left ventricular ejection fraction (LVEF) is an important component of anesthesiology resident education; however, there is no consensus on the most effective method for teaching this skill set. This study investigates the impact and feasibility of teaching a quantitative LVEF assessment method to anesthesiology residents, compared with teaching visual estimation techniques.
We included all anesthesiology residents rotating through cardiac anesthesia at our institution from August 2020 through March 2021. Participants completed a pretest to assess baseline ability to accurately estimate LVEF. All tests consisted of transthoracic echocardiography images with standard views from 10 patients. Participants were assigned to either a control group that received teaching on visual estimation of LVEF or an intervention group that was taught quantitative LVEF assessment with the Simpson biplane method of discs. After 4 weeks, all participants were administered a postteaching exam. A retention exam was administered an additional 4 weeks later. LVEF accuracy was measured as the absolute difference between their LVEF estimation and the reference value.
Control and intervention groups performed similarly on the preteaching exam of LVEF estimation accuracy. Intervention-group residents demonstrated significantly improved accuracy in LVEF assessment on the postteaching exam (3.6% improvement in accuracy, confidence interval [CI], 1.23-5.97; = .03) compared with the control group (0.60% improvement inaccuracy, CI, -1.77-2.97; = .62). The observed improvement was not maintained through the retention exam. Addition of quantitative LVEF assessment to traditional teaching of visual LVEF estimation methods significantly improved the diagnostic accuracy of anesthesiology residents' left ventricular systolic function assessment.
使用超声心动图评估左心室射血分数（LVEF）是麻醉学住院医师培训的重要组成部分；然而，对于教授这项技能的最有效方法尚无共识。本研究调查了与教授视觉估计技术相比，向麻醉学住院医师教授定量LVEF评估方法的影响和可行性。
我们纳入了2020年8月至2021年3月在我们机构轮转心脏麻醉的所有麻醉学住院医师。参与者完成了一项预测试，以评估准确估计LVEF的基线能力。所有测试均包括来自10名患者的标准视图的经胸超声心动图图像。参与者被分配到接受LVEF视觉估计教学的对照组或接受辛普森双平面圆盘法定量LVEF评估教学的干预组。4周后，所有参与者都进行了教学后考试。再过4周后进行了一次留存考试。LVEF准确性以他们的LVEF估计值与参考值之间的绝对差值来衡量。
在LVEF估计准确性的教学前考试中，对照组和干预组表现相似。与对照组（准确性提高0.60%，置信区间[CI]，-1.77-2.97；P = 0.62）相比，干预组住院医师在教学后考试中的LVEF评估准确性有显著提高（准确性提高3.6%，置信区间，1.23-5.97；P = 0.03）。通过留存考试，观察到的改善未能持续。在传统的视觉LVEF估计方法教学中增加定量LVEF评估，显著提高了麻醉学住院医师左心室收缩功能评估的诊断准确性。
