Ensuring competency in focused cardiac ultrasound: a systematic review of training programs

Abstract

Background Focused cardiac ultrasound (FoCUS) is a valuable skill for rapid assessment of cardiac function and volume status. Despite recent widespread adoption among physicians, there is limited data on the optimal training methods for teaching FoCUS and metrics for determining competency. We conducted a systematic review to gain insight on the optimal training strategies, including type and duration, that would allow physicians to achieve basic competency in FoCUS. Methods Embase, PubMed, and Cochrane Library databases were searched from inception to June 2020. Included studies described standardized training programs for at least 5 medical students or physicians on adult FoCUS, followed by an assessment of competency relative to an expert. Data were extracted, and bias was assessed for each study. Results Data were extracted from 23 studies on 292 learners. Existing FoCUS training programs remain varied in duration and type of training. Learners achieved near perfect agreement (κ > 0.8) with expert echocardiographers on detecting left ventricular systolic dysfunction and pericardial effusion with 6 h each of didactics and hands-on training. Substantial agreement (κ > 0.6) on could be achieved in half this time. Conclusion A short training program will allow most learners to achieve competency in detecting left ventricular systolic dysfunction and pericardial effusion by FoCUS. Additional training is necessary to ensure skill retention, improve efficiency in image acquisition, and detect other pathologies.

Maximum inferior vena cava diameter predicts post-induction hypotension in hypertensive patients undergoing non-cardiac surgery under general anesthesia: A prospective cohort study

“…Similar to ultrasound-based IVC parameters ( 22 ), the mechanism of ΔVTI-PLR in predicting PIH is based on fluid responsiveness assessment ( 23 ). ΔVTI-PLR was not selected in the current study due to technical difficulty ( 24 ).…”

Point-of-Care Ultrasound: A Case Series of Potential Pitfalls

“…28 Importantly, given the lack of consistent standards and the significant variability in POCUS protocols (number of views obtained, optional assessment of gross valvular pathologies, and use of Doppler), POCUS practitioners should be explicit about their scanning protocol, specify which structures were assessed, and mention structures that were not evaluated. 8 , 29 , 30 For example, in our first and third cases, a statement such as “valves not assessed” may have been helpful and prompted the team to request a comprehensive echocardiogram for specific valvular assessment.…”

“…Given the absence of the POCUS images and specific information on the training undergone by the POCUS users in our cases, one can only speculate that insufficient training and experience may have contributed to the failure to identify and integrate critical findings in our patients. 17 , 29 …”

Focused cardiac ultrasound in pregnancy

“…48,50 Acquiring competence in FOCUS Numerous reports have attested to the attainment of competency in FOCUS in disparate clinical groups. [51][52][53][54] Generally, training includes didactic lectures and proctored imaging experience. Skill acquisition can be achieved in a relatively short timeframe with multiple studies showing that 6 h of didactic lectures and 6-10 h of proctored imaging are sufficient for competence in imaging and interpretation.…”