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Goudelin M, Evrard B, Donisanu R, Gonzalez C, Truffy C, Orabona M, Galy A, Lapébie FX, Jamilloux Y, Vandeix E, Belcour D, Hodler C, Ramirez L, Gagnoud R, Chapellas C, Vignon P. Therapeutic impact of basic critical care echocardiography performed by residents after limited training. Ann Intensive Care 2024; 14:119. [PMID: 39073505 PMCID: PMC11286607 DOI: 10.1186/s13613-024-01354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The objective was to assess the agreement between therapeutic proposals derived from basic critical care echocardiography performed by novice operators in ultrasonography after a limited training (residents) and by experts considered as reference. Secondary objectives were to assess the agreement between operators' answers to simple clinical questions and the concordance between basic two-dimensional measurements. METHODS This observational, prospective, single-center study was conducted over a 3-year period in a medical-surgical intensive care unit. Adult patients with acute circulatory and/or respiratory failure requiring a transthoracic echocardiography (TTE) examination were studied. In each patient, a TTE was performed by a resident novice in ultrasonography after a short training program and by an expert, independently but within 1 h and in random order. Each operator addressed standardized simple clinical questions and subsequently proposed a therapeutic strategy based on a predefined algorithm. RESULTS Residents performed an average of 33 TTE studies in 244 patients (156 men; age: 63 years [52-74]; SAPS2: 45 [34-59]; 182 (75%) mechanically ventilated). Agreement between the therapeutic proposals of residents and experienced operators was good-to-excellent. The concordance was excellent for suggesting fluid loading, inotrope or vasopressor support (all Kappa values > 0.80). Inter-observer agreement was only moderate when considering the indication of negative fluid balance (Kappa: 0.65; 95% CI 0.50-0.80), since residents proposed diuretics in 23 patients (9.5%) while their counterparts had the same suggestion in 35 patients (14.4%). Overall agreement of responses to simple clinical questions was also good-to-excellent. Intraclass correlation coefficient exceeded 0.75 for measurement of ventricular and inferior vena cava size. CONCLUSIONS A limited training program aiming at acquiring the basic level in critical care echocardiography enables ICU residents novice in ultrasonography to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.
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Affiliation(s)
- Marine Goudelin
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
- Inserm CIC1435, 87000, Limoges, France
| | - Bruno Evrard
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
- Inserm CIC1435, 87000, Limoges, France
| | - Roxana Donisanu
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Céline Gonzalez
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Christophe Truffy
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Marie Orabona
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Antoine Galy
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | | | - Yvan Jamilloux
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Elodie Vandeix
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Dominique Belcour
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Charles Hodler
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Lucie Ramirez
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Rémi Gagnoud
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Catherine Chapellas
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren University Hospital, 87000, Limoges, France.
- Inserm CIC1435, 87000, Limoges, France.
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Lorke DE, Rock JA, Hernandez R, Graham D, Keough N, van Tonder DJ. Creation of 21st century anatomy facilities: designing facilities for integrated preclinical education in the Middle East. BMC MEDICAL EDUCATION 2023; 23:388. [PMID: 37237263 DOI: 10.1186/s12909-023-04361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The establishment of new anatomy facilities needs to accommodate a combination of modern teaching modalities that best align with evidence-based best teaching practices. This article describes the process in which our state-of-the-art anatomy laboratories were designed and implemented, and how these facilities support aspects of modern anatomy education. METHODS A list of best practices for anatomy education in a modern medical curriculum was summarized from the literature. To assess student satisfaction, a survey related to student perception of the anatomy facilities (5-point Likert scale) was conducted. RESULTS Our educational modalities include a broad range of teaching approaches. The Instructional Studio houses prosected and plastinated specimens, and cadaveric dissections are performed. Each of our three Dry Laboratories allow for active learning and interaction between small student groups. The Webinar Room acts as a conference room for departmental and online meetings, discussions with students, and dialogues with affiliated hospitals via the internet. The Imaging Center is equipped with a Sectra® medical educational platform, CAE Vimedix® Virtual Medical Imaging Ultrasound Training System, and Philipps Lumify® Ultrasound devices to train students to conduct and interpret sonographic images. Moreover, the Complete Anatomy® program is made available to all our students. CONCLUSION The layout of our newly created Anatomy Facilities allows for all aspects of modern medical education mentioned in the literature. These educational modalities and teaching approaches are highly appreciated by our faculty and students. Moreover, these technologies allowed for a smooth transition from on-site anatomy teaching to online education during the COVID pandemic.
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Affiliation(s)
- Dietrich E Lorke
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, P O Box 127788, Abu Dhabi, United Arab Emirates.
| | - John A Rock
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Robert Hernandez
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Medicine, Kerkorian School of Medicine, University of Nevada, Las Vegas, United States of America
| | - David Graham
- Department of Medical Imaging and Radiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- College of Medicine, American University of Antigua, Antigua, Antigua and Barbuda
| | - Natalie Keough
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, P O Box 127788, Abu Dhabi, United Arab Emirates
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Daniël J van Tonder
- Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, P O Box 127788, Abu Dhabi, United Arab Emirates
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Rajamani A, Galarza L, Sanfilippo F, Wong A, Goffi A, Tuinman P, Mayo P, Arntfield R, Fisher R, Chew M, Slama M, Mackenzie D, Ho E, Smith L, Renner M, Tavares M, Prabu R N, Ramanathan K, Knudsen S, Bhat V, Arvind H, Huang S. Criteria, Processes, and Determination of Competence in Basic Critical Care Echocardiography Training: A Delphi Process Consensus Statement by the Learning Ultrasound in Critical Care (LUCC) Initiative. Chest 2022; 161:492-503. [PMID: 34508739 DOI: 10.1016/j.chest.2021.08.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the paucity of high-quality studies on longitudinal basic critical care echocardiography (BCCE) training, expert opinion guidelines have guided BCCE competence educational standards and processes. However, existing guidelines lack precise detail due to methodological flaws during guideline development. RESEARCH QUESTIONS To formulate methodologically robust guidelines on BCCE training using evidence and expert opinion, detailing specific criteria for every step, we conducted a modified Delphi process using the principles of the validated AGREE-II tool. Based on systematic reviews, the following domains were chosen: components of a longitudinal BCCE curriculum; pass-grade criteria for image-acquisition and image-interpretation; and formative/summative assessment and final competence processes. STUDY DESIGN AND METHODS Between April 2020 and May 2021, a total of 21 BCCE experts participated in four rounds. Rounds 1 and 2 used five web-based questionnaires, including branching-logic software for directed questions to individual panelists. In round 3 (videoconference), the panel finalized the recommendations by vote. During the journal peer-review process, Round 4 was conducted as Web-based questionnaires. Following each round, the agreement threshold for each item was determined as ≥ 80% for item inclusion and ≤ 30% for item exclusion. RESULTS Following rounds 1 and 2, agreement was reached on 62 of 114 items. To the 49 unresolved items, 12 additional items were added in round 3, with 56 reaching agreement and five items remaining unresolved. There was agreement that longitudinal BCCE training must include introductory training, mentored formative training, summative assessment for competence, and final cognitive assessment. Items requiring multiple rounds included two-dimensional views, Doppler, cardiac output, M-mode measurement, minimum scan numbers, and pass-grade criteria. Regarding objective criteria for image-acquisition and image-interpretation quality, the panel agreed on maintaining the same criteria for formative and summative assessment, to categorize BCCE findings as major vs minor and a standardized approach to errors, criteria for readiness for summative assessment, and supervisory options. INTERPRETATION In conclusion, this expert consensus statement presents comprehensive evidence-based recommendations on longitudinal BCCE training. However, these recommendations require prospective validation.
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Affiliation(s)
- Arvind Rajamani
- University of Sydney Nepean Clinical School, Intensive Care Medicine, Kingswood, NSW, Australia; Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia.
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco," Catania, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK
| | - Alberto Goffi
- Department of Critical Care Medicine and Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto, Toronto, ON, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Pieter Tuinman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Paul Mayo
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY; Department of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Robert Arntfield
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Richard Fisher
- Department of Critical Care, King's College Hospital, London, UK
| | - Michelle Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michel Slama
- Medical Intensive Care, DRIME Department, University Hospital of Amiens, Amiens, France
| | - David Mackenzie
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Eunise Ho
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China
| | - Louise Smith
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Markus Renner
- Department of Intensive Care Medicine, Dunedin Hospital, Dunedin, New Zealand; Otago University, New Zealand
| | - Miguel Tavares
- Department of Anesthesiology and Critical Care, Hospital Geral de Santo António, Porto, Portugal
| | - Natesh Prabu R
- Department of Critical Care Medicine, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vijeth Bhat
- John Hunter Hospital, Intensive Care Unit, New Lambton Heights, NSW, Australia
| | | | - Stephen Huang
- University of Sydney Nepean Clinical School, Intensive Care Medicine, Kingswood, NSW, Australia
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Halpern SA, Brace EJ, Hall AJ, Morrison RG, Patel DV, Yuh JY, Brolis NV. 3-D modeling applications in ultrasound education: a systematic review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:188-197. [PMID: 34711434 DOI: 10.1016/j.ultrasmedbio.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
Ultrasound offers a real-time 2-D view of structures within the human body. While many medical education programs have already dedicated a portion of their curriculum to ultrasound, others are concerned about cost, accessibility and limits to student practice. Student benefit may be affected by cognitive errors, which are in part owing to the mental heuristics required to visualize a 3-D structure by interpreting a 2-D image. A possible solution to eliminating subjectivity in ultrasound interpretation is the use of 3-D models to augment the traditional 2-D ultrasound experience. PubMed, Embase and Web of Science were searched for primary literature exploring relationships between 3-D modeling applications and their use in ultrasound education. The search and review process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Overall, 14 of the included 16 studies indicated a significant improvement in medical education of ultrasound with the intervention of 3-D modeling applications. This systematic review confirms that 3-D modeling applications benefit student learning in ultrasound education while illuminating the need for more research in this field.
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Affiliation(s)
- Sophie A Halpern
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA.
| | - Eamonn J Brace
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Arielle J Hall
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Ryan G Morrison
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Dip V Patel
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Jonathan Y Yuh
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Nils V Brolis
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
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Mayo PH, Chew M, Douflé G, Mekontso-Dessap A, Narasimhan M, Vieillard-Baron A. Machines that save lives in the intensive care unit: the ultrasonography machine. Intensive Care Med 2022; 48:1429-1438. [PMID: 35941260 PMCID: PMC9360728 DOI: 10.1007/s00134-022-06804-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.
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Affiliation(s)
- Paul H. Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- AP-HP Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010 Créteil, France ,Univ Paris Est Créteil, CARMAS, 94010 Créteil, France ,Univ Paris Est Créteil, INSERM, IMRB, 94010 Créteil, France
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France
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Nagre AS. Transthoracic echocardiography-simulator-based training versus training using human models. Ann Card Anaesth 2021; 24:503-504. [PMID: 34747767 PMCID: PMC8617381 DOI: 10.4103/aca.aca_102_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Amarja Sachin Nagre
- Consultant Cardiac Anesthesiologist, Kamalnayan Bajaj Hospital, Aurangabad, MS, India
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Duran HT, McIvor W. Simulation Training for Crisis Management: Demonstrating Impact and Value. Adv Anesth 2021; 39:241-257. [PMID: 34715977 DOI: 10.1016/j.aan.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Huong Tram Duran
- UPMC Mercy, Suite 2192, 1400 Locust Street, Pittsburgh, PA 15219, USA.
| | - William McIvor
- UPMC Presbyterian, Suite C222, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Comparative Early Hemodynamic Profiles in Patients Presenting to the Emergency Department with Septic and Nonseptic Acute Circulatory Failure Using Focused Echocardiography. Shock 2021; 53:695-700. [PMID: 31568225 PMCID: PMC7237072 DOI: 10.1097/shk.0000000000001449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Objective: We evaluated the early hemodynamic profile of patients presenting with acute circulatory failure to the Emergency Department (ED) using focused echocardiography performed by emergency physicians after a dedicated training program. Methods: Patients presenting to the ED with an acute circulatory failure of any origin were successively examined by a recently trained emergency physician and by an expert in critical care echocardiography. Operators independently performed and interpreted online echocardiographic examinations to determine the leading mechanism of acute circulatory failure. Results: Focused echocardiography could be performed in 100 of 114 screened patients (55 with sepsis/septic shock and 45 with shock of other origin) after a median fluid loading of 500 mL (interquartile range: 187–1,500 mL). A hypovolemic profile was predominantly observed whether the acute circulatory failure was of septic origin or not (33/55 [60%] vs. 23/45 [51%]: P = 0.37). Although a vasoplegic profile associated with a hyperkinetic left ventricle was most frequently identified in septic patients when compared with their counterparts (17/55 [31%] vs. 5/45 [11%]: P = 0.02), early left or right ventricular failure was observed in 31% of them. Hemodynamic profiles were adequately appraised by recently trained emergency physicians, as reflected by a good-to-excellent agreement with the expert's assessment (Κ: 0.61–0.85). Conclusions: Hypovolemia was predominantly identified in patients presenting to the ED with acute circulatory failure. Although vasoplegia was more frequently associated with sepsis, early ventricular dysfunction was also depicted in septic patients. Focused echocardiography seemed reliable when performed by recently trained emergency physicians without previous experience in ultrasound.
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Lautrette A, Boyer A, Gruson D, Argaud L, Schwebel C, Tardy B, Vignon P, Megarbane B, Schoeffler P, Chabrot P, Schmidt J, Boirie Y, Guerin C, Darmon M, Klouche K, Souweine B, Dellamonica J, Pereira B. Impact of take-home messages written into slide presentations delivered during lectures on the retention of messages and the residents' knowledge: a randomized controlled study. BMC MEDICAL EDUCATION 2020; 20:180. [PMID: 32493318 PMCID: PMC7271544 DOI: 10.1186/s12909-020-02092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Lectures with slide presentations are widely used to teach evidence-based medicine to large groups. Take-home messages (THMs) are poorly identified and recollected by students. We investigated whether an instruction to list THMs in written form on slides would improve the retention thereof by residents, and the residents' level of knowledge, 1 month after lectures. METHODS Prospective blinded randomized controlled study was conducted. Twelve lectures (6 control and 6 intervention lectures) were delivered to 73 residents. For the intervention lectures, the lecturers were instructed to incorporate clear written THMs into their slide presentations. The outcomes were ability of resident to recollect THMs delivered during a lecture (as assessed by accordance rate between the lecturers' and residents' THMs) and knowledge (as assessed by multiple choice questions (MCQs)). RESULTS Data for 3738 residents' THMs and 3410 MCQs were analyzed. The intervention did not significantly increase the number of THMs written on slides (77% (n = 20/26), 95% CI 56-91 vs 64% (n = 18/28), 95% CI 44-81, p = 0.31) nor THMs retention (13% (n = 238/1791), 95% CI 12-15 vs 17% (n = 326/1947), 95% 15-18, p = 0.40) nor knowledge (63.8 ± 26.2 vs 61.1 ± 31.4 /100 points, p = 0.75). In multivariable analyses performed with all THMs written on slides from the two groups, a superior knowledge was associated with notetaking during lectures (OR 1.88, 95% CI 1.41-2.51) and THMs retention (OR 2.17, 95% CI 1.54-3.04); and THMs retention was associated with written THMs (OR 2.94, 95% CI 2.20-3.93). CONCLUSIONS In lectures delivered to residents, a third of the THMs were not in written form. An intervention based on an explicit instruction to lecturers to provide THMs in written form in their slide presentations did not result in increased use of written THMs into the slide presentation or improvement of the THMs retention or level of knowledge. However, we showed that there was a strong positive association between writing THMs on a slide, retention of THMs and residents' knowledge. Further researches are needed to assess interventions to increase written THMs in lectures by faculty. TRIAL REGISTRATION ClinicalTrials.gov NCT01795651 (Fev 21, 2013).
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Affiliation(s)
- Alexandre Lautrette
- Intensive Care Medicine, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
- Intensive Care Unit, Centre Jean Perrin, Clermont-Ferrand, France.
- LMGE «Laboratoire Micro-organismes: Génome et Environnement», UMR CNRS 6023, Clermont-Auvergne University, Clermont-Ferrand, France.
| | - Alexandre Boyer
- Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Didier Gruson
- Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Laurent Argaud
- Intensive Care Unit, Edouard Herriot Hospital, University Hospital of Lyon, Lyon, France
| | - Carole Schwebel
- Intensive Care Unit, Albert Michallon Hospital, University Hospital of Grenoble, Grenoble, France
| | - Bernard Tardy
- Clinical Investigation Center-CIC 1408, Nord Teaching Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren Hospital, University Hospital of Limoges, Limoges, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, INSERM UMRS-1144, Paris-Diderot University, Paris, France
| | - Pierre Schoeffler
- Intensive Care Unit, Department of Anaesthesiology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Chabrot
- Department of Radiology, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Adult Emergency Department, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Yves Boirie
- Nutrition Unit, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Claude Guerin
- Intensive Care Unit, Croix Rousse Hospital, University Hospital of Lyon, Lyon, France
| | - Michaël Darmon
- Intensive Care Unit, Nord Teaching Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Kada Klouche
- Intensive Care Unit, Lapeyronie Hospital, University Hospital of Montpellier, Montpellier, France
| | - Bertrand Souweine
- LMGE «Laboratoire Micro-organismes: Génome et Environnement», UMR CNRS 6023, Clermont-Auvergne University, Clermont-Ferrand, France
- Medical Intensive Care Unit, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean Dellamonica
- Intensive Care Unit, l'Archet Hospital, Cote d'Azur University, Nice, France
| | - Bruno Pereira
- Biostatistics unit, Delegation à la Recherche Clinique (DRCI), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound. Crit Care Med 2020; 47:e948-e952. [PMID: 31569139 DOI: 10.1097/ccm.0000000000004002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners. SETTING The University of Iowa Hospitals and Clinics. SUBJECTS Twenty-four subjects (23 first-year medical students and one first-year physician assistant student). DESIGN The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills. INTERVENTIONS Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session. MEASUREMENTS AND MAIN RESULTS For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008). CONCLUSIONS Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.
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Emergency bedside ultrasound-benefits as well as caution: Part 2: Echocardiography. Curr Opin Crit Care 2020; 25:605-612. [PMID: 31567518 DOI: 10.1097/mcc.0000000000000674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Critical care echocardiography (CCE) has become an important component of general critical care ultrasonography, and a current review of its performance is presented. RECENT FINDINGS Basic CCE should be performed as a goal-directed examination to better identify specific signs and to answer important clinical questions concerning acute hemodynamic concerns. It has evolved in the ICU and also in the emergency department not only for improved diagnostic capability but also as an effective part of the triage process. It remains an efficacious procedure even in patients with respiratory failure when combined with lung ultrasonography. Numerous acronyms were proposed, but in all cases, CCE responds to the same rules as fundamental echocardiography. Basic CCE requires accessible and comprehensive training for physicians and is mandatory for all intensivists. Development of pocket echo devices may increase the use of basic CCE as has miniaturization of other medical technologies. Performance should be managed by guidelines, and the CCE training program should be standardized worldwide. More trials are welcome to evaluate its impact on patient outcomes. SUMMARY Thanks to its ability to quickly obtain a diagnostic orientation at the bedside and to implement targeted therapy, basic CCE over the past decade has become an essential tool for hemodynamic assessment of the cardiopulmonary unstable patient. Its more recent incorporation into the education of trainees in medical school and residencies/fellowships has reinforced its perceived importance in critical care management, despite the relative paucity as yet of rigorous scientific evidence demonstrating positive outcome modification from its use.
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Havaldar AA, Krishna B, Sampath S, Paramasivam SK. Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician's Performance. Indian J Crit Care Med 2020; 24:423-428. [PMID: 32863635 PMCID: PMC7435101 DOI: 10.5005/jp-journals-10071-23458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Simulation is to imitate or replicate real-life scenarios in order to improve cognitive, diagnostic and therapeutic skills. An ideal model should be good enough to output realistic clinical scenarios and respond to interventions done by trainees in real time. Use of simulation-based training has been tried in various fields of medicine. The aim of our study was to prospectively evaluate the effectiveness of simulation model “CRITICA”™ (MEDUPLAY systems) in training critical care physicians. Materials and methods The advanced intensive care unit (ICU) simulator “CRITICA”™ (MEDUPLAY systems) was developed as a joint collaboration between the Indian Institute of Science, Bengaluru and St John’s Medical College, Bengaluru. Two-day workshop was conducted. Intensive didactic and case-based scenarios were simulated to formally teach principles of advanced ICU scenarios. The physicians were tested on clinical scenarios in hemodynamic monitoring and mechanical ventilation displayed on the simulator. Assessment of the analytical thinking and pattern recognition ability was carried out before and after the display of the scenarios. Pre- and posttest scores were collected. Results The postsimulation test scores were higher than pretest scores and were statistically significant in hemodynamic monitoring and mechanical ventilation module. [Hemodynamic monitoring pre- and posttest scores 4.41 (2.06) vs 5.23 (2.22) p < 0.001] [Mechanical ventilation pre- and posttest scores 4 (2–5.5) vs 7.5 (6.5–8.5) p < 0.001]. A greater increase in posttest scores was seen in the mechanical ventilation module as compared to hemodynamic module. There was no effect of specialty or designation of a trainee on difference in pre- and posttest scores. Conclusion Simulator-based training in hemodynamic monitoring and mechanical ventilation was effective. Comparison of routine classroom teaching and simulator-based training needs to be evaluated prospectively. How to cite this article Havaldar AA, Krishna B, Sampath S, Paramasivam SK. Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician’s Performance. Indian J Crit Care Med 2020;24(6):423–428.
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Affiliation(s)
- Amarja A Havaldar
- Department of Critical Care, St. John's Medical College, Koramangala, Bengaluru, Karnataka, India
| | - Bhuvana Krishna
- Department of Critical Care, St. John's Medical College, Koramangala, Bengaluru, Karnataka, India
| | - Sriram Sampath
- Department of Critical Care, St. John's Medical College, Koramangala, Bengaluru, Karnataka, India
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Vieillard-Baron A, Millington SJ, Sanfilippo F, Chew M, Diaz-Gomez J, McLean A, Pinsky MR, Pulido J, Mayo P, Fletcher N. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45:770-788. [DOI: 10.1007/s00134-019-05604-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
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Nanjayya VB, Orde S, Hilton A, Yang Y, Costello C, Evans J, Nalos M, Yastrebov K. Levels of training in critical care echocardiography in adults. Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group. Australas J Ultrasound Med 2019; 22:73-79. [PMID: 34760542 PMCID: PMC8411793 DOI: 10.1002/ajum.12127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Critical care echocardiography (CCE) is commonly performed in many intensive care units across Australia and New Zealand (ANZ). The scope of practice ranges from Basic CCE through to Advanced CCE and includes the use of transthoracic echocardiography and transoesophageal echocardiography. Many training and qualification pathways exist with no standardisation of education goals. This document defines different levels of CCE expertise and recommends minimum training standards for each level of adult CCE in ANZ. Guidelines committee of College of Intensive Care Medicine's Ultrasound Special Interest Group held multiple face to face meetings, organised teleconferences, conducted a survey of the Fellows of the college and reviewed the international CCE training pathways prior to writing these guidelines.
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Affiliation(s)
| | - Sam Orde
- Nepean HospitalDerby StKingswoodNew South Wales2747Australia
| | - Andrew Hilton
- Austin Hospital145 Studley RdHeidelbergVictoria3084Australia
| | - Yang Yang
- Western Hospital160 Gordon StFootscrayVictoria3011Australia
| | - Cartan Costello
- Wollongong HospitalCrown StWollongongNew South Wales2500Australia
| | - John Evans
- Townsville Hospital100 Angus Smith DrDouglasQueensland4814Australia
| | - Marek Nalos
- Nepean HospitalDerby StKingswoodNew South Wales2747Australia
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