Providing Transthoracic Echocardiography Training for Intensive Care Unit Trainees: An Educational Improvement Initiative

Quality Improvement Projects and Anesthesiology Graduate Medical Education: A Systematic Review

Quality improvement (QI) projects are essential components of graduate medical education and healthcare organizations to improve patient outcomes. We systematically reviewed the literature on QI projects in anesthesiology graduate medical education programs to assess whether these projects are leading to publications. A literature search was conducted in July 2023, using PubMed, Embase, and the Central Register of Controlled Trials (CENTRAL) for articles describing QI initiatives originating within the United States and applicable to anesthesiology residency training programs. The following data were collected: intervention(s), sample size (number of participants or events), outcome metric(s), result(s), and conclusion(s). One hundred and fifty publications were identified, and 31 articles met the inclusion criteria. A total of 2,259 residents and 72,889 events were included in this review. Educational modalities, such as simulation, training sessions, or online curricula, were the most prevalent interventions in the included studies. Pre-intervention and post-intervention assessments were the most common outcome metrics reported. Our review of the literature demonstrates that few QI projects performed within anesthesiology training programs lead to published manuscripts. Further research should aim at increasing the impact of required QI projects within the sponsoring institution and specialty.

Novel Three-Dimensionally Printed Ultrasound Probe Simulator and Heart Model for Transthoracic Echocardiography Education

Simulation-based training is an essential component in the education of transthoracic echocardiography (TTE). Nevertheless, current TTE teaching methods may be subject to certain limitations. Hence, the authors in this study aimed to invent a novel TTE training system employing three-dimensional (3D) printing technology to teach the basic principles and psychomotor skills of TTE imaging more intuitively and understandably. This training system comprises a 3D-printed ultrasound probe simulator and a sliceable heart model. The probe simulator incorporates a linear laser generator to enable the visualization of the projection of the ultrasound scan plane in a 3D space. By using the probe simulator in conjunction with the sliceable heart model or other commercially available anatomic models, trainees can attain a more comprehensive understanding of probe motion and related scan planes in TTE. Notably, the 3D-printed models are portable and low-cost, suggesting their potential utility in various clinical scenarios, particularly for just-in-time training.

Efficacy of a certified modular ultrasound curriculum

Background

In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated.

Objective

The main objective of this study was to determine whether there is an increase of knowledge and of psychomotor skills for the trainees in this curriculum.

Material and methods

After ethical committee approval, 41 anesthesia physicians were enrolled. To determine the increase of knowledge and of practical skills theoretical and practical tests performed were evaluated before and after two different US courses.

Results

Comparing before and after course tests, the participants showed significant improvement in theoretical multiple choice tests (p = 0.008). Regarding psychomotor skills following course 1, the trainees improved significantly in the time needed to perform the two practical tests (p = 0.03), but not in the performance of the test. Better needle visualization during simulated US-guided vessel puncture (p = 0.52) and better identification of the anatomical structures in the axillary region (p = 0.56) could not be achieved.

Conclusion

This study shows that although this US course curriculum has positively enhanced the trainees’ theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course.

Electronic supplementary material

The online version of this article (10.1007/s00101-020-00730-9) provides the two questionnaires in German. The article and additional material are available at www.springermedizin.de. Please enter the title of the article in the search field, the additional material can be found under “Ergänzende Inhalte”.

Evaluation of intensivist basic training in transthoracic echocardiography in the postoperative period of heart surgery

BACKGROUND

Transthoracic echocardiography can significantly change the management of many critical patients, and is being incorporated into many Intensive Care Units (ICU). Very few studies have examined the feasibility and impact of intensivists performing basic transthoracic echocardiography upon the management of critical patients after cardiac surgery. The present study therefore evaluates the quality of acquisition and accuracy of intensivist interpretation of basic transthoracic echocardiograms in the postoperative period of heart surgery.

METHODS

Over an 8-month period we prospectively studied 148 patients within 24h after admission to a university hospital ICU following heart surgery. We performed basic transthoracic echocardiography to evaluate ventricular function, pericardial effusion, hypovolemia and mitral regurgitation. Cohen's Kappa was used to compare transthoracic echocardiograms obtained by intensivists with basic versus advanced training. Concordance on image acquisition and interpretation was evaluated.

RESULTS

We analyzed data of adequate transthoracic echocardiograms in 148 patients (92.5%). Apical four-chamber view and advanced trainees obtained better quality images. Concordance was good for right and left ventricular function (kappa=0.7±0.14 and 0.87±0.05, respectively), and moderate for the remaining parameters. Interpretation concordance between basic and advanced training intensivists was good (kappa=0.73±0.05).

CONCLUSIONS

Intensivists with basic training in echocardiography are capable of performing and interpreting echocardiograms in most patients during the postoperative period of heart surgery.