Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners

Lee, Yoonje; Shin, Hyungoo; Kim, Changsun; Lee, Inhye

doi:10.1097/md.0000000000015191

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…Akinboboye et al proposed that an acceptable learning curve of visual estimation of LVEF occurred after 20 cases had been reviewed with instant feedback [ 22 ]. In comparison, Lee et al reported a minimum of 55 case reviews with feedback to effectively train LVEF visual estimation in medical students [ 23 ]. This study used 35 cases with instant feedback because our objective was to evaluate the ability to estimate the LVEF rather than training.…”

Section: Discussionmentioning

confidence: 99%

Comparison of visual estimation and quantitative measurement of left ventricular ejection fraction in untrained perioperative echocardiographers

2023

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Background Perioperative evaluation of the left ventricular systolic function is essential information to help diagnose and manage life-threatening perioperative emergencies. Although quantifying the left ventricular ejection fraction (LVEF) is recommended to determine the left ventricular function, it may not always be feasible in emergency perioperative settings. This study compared the visual estimation of LVEF (eyeballing) by noncardiac anesthesiologists with the quantitative LVEF measured using a modified Simpson’s biplane method. Methods Transesophageal echocardiographic (TEE) studies of 35 patients were selected and 3 different echocardiographic views (the mid-esophageal four chamber view, the mid-esophageal two chamber view, and the transgastric mid-papillary short axis view) were recovered from each study and displayed in random order. Two cardiac anesthesiologists certified in perioperative echocardiography independently measured LVEF using the modified Simpson method and categorized LVEF into five grades: hyperdynamic LVEF, normal, mildly reduced LVEF, moderately reduced LVEF and severely reduced LVEF. Seven noncardiac anesthesiologists with limited experience in echocardiography also reviewed the same TEE studies and estimated the LVEF and graded LV function. The precision of the LV function classification and the correlation between visual estimation of LVEF and quantitative LVEF were calculated. The agreement of measurements between the two methods was also assessed. Results Pearson’s correlation between the LVEF estimated by the participants and the quantitative LVEF using the modified Simpson method was 0.818 (p < 0.001). Of a total of 245 responses, 120 (49.0%) responses were correct grading of the LV function. Participants were able to classify the LV function more accurately in the LV function grades 1 and 5 (65.3%). The 95% level of agreement of the Bland-Altman method was − 11.3-24.5. -21.9-22.6, − 23.1-26.5, − 20.5-22.0 and − 26.6-11.1 for LV grade 1 to 5, respectively. Conclusion Visual estimation of LVEF in perioperative TEE has acceptable accuracy in untrained echocardiographers and can be used for rescue TEE.

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Section: Discussionmentioning

confidence: 99%

Comparison of visual estimation and quantitative measurement of left ventricular ejection fraction in untrained perioperative echocardiographers

2023

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“…There appear to be no other reported uses of sequential testing being employed in FCU competence assessment in this manner. One study ( 20 ) in which novice practitioners watched cine loops of varying LV function demonstrated approximately 50 cases with feedback were required to become “proficient” at eyeballing ejection fraction. Again, using sequential analysis, variability in the numbers of cine loops that each novice practitioner required was shown, ranging from 40 to 71 cases.…”

Section: Discussionmentioning

confidence: 99%

Competency Assessment in Focused Cardiac Ultrasound—Can the Use of Sequential Testing Help Tailor Training Requirements?

Walker

McKenzie

Brooks

2022

Critical Care Explorations

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Varying numbers of scans are required by different professional bodies before focused cardiac ultrasound (FCU) competence is assumed. It has been suggested that innovation in the assessment of FCU competence is needed and that competency assessment needs to be more individualized. We report our experience of how the use of sequential testing may help personalize the assessment of FCU competence. DESIGN:This was a planned exploratory reanalysis of previously prospectively collected data. FCU was performed sequentially by an intensive care trainee and expert on the same patient. Assessment of left ventricular (LV) function by the trainee and expert was compared. Sequential testing methods were used in the analysis of this data to see if they could be used to help in the assessment of competence. Each trainee had completed a 38-hour teaching program and a logbook of 30 scans prior to enrollment. SETTING: Tertiary Australian not for profit private academic hospital. MEASUREMENTS AND MAIN RESULTS:Two hundred seventy paired echocardiograms were completed by seven trainees. For trainees to achieve greater than 90% accuracy in correctly assessing LV function when compared with an expert, a variable number of scans were required. This ranged from 13 to 25 (95% CI, 13-25) scans. Over the study period, the ability to correctly identify LV function was maintained, and it appeared there was no degradation in skill. CONCLUSIONS:Using the Sequential Probability Ratio Test demonstrates a variable number of scans were required to show greater than 90% accuracy in the assessment of LV function. As such, the use of sequential testing could help individualize competency assessments in FCU. Additionally, our data suggests that over a 6-month period, echocardiographic skill is maintained without any formal teaching or feedback. Further work assessing the utility of this method based on larger samples is required.

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“…Beside that, long-term retention was not assessed and thus the durability of the improvement in precise measurement of left ventricular ejection fraction cannot be assessed in this study. Therefore, the improvement shown in our present data may be lost over time [28].…”

Section: Discussionmentioning

confidence: 99%

Image quality to estimate ventricular ejection fraction by last year medical students improves after short courses of training

et al. 2019

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BackgroundTransthoracic echocardiography is the primary imaging modality for diagnosing cardiac conditions but medical education in this field is limited. We tested the hypothesis that a structured theoretical and supervised practical course of training in focused echocardiography in last year medical students results in a more accurate assessment and more precise calculation of left ventricular ejection fraction after ten patient examinations.MethodsAfter a theoretical introduction course 25 last year medical students performed ten transthoracic echocardiographic examination blocks in postsurgical patients. Left ventricular function was evaluated both with an eye-balling method and with the calculated ejection fraction using diameter and area of left ventricles. Each examination block was controlled by a certified and blinded tutor. Bias and precision of measurements were assessed with Bland and Altman method.ResultsUsing the eye-balling method students agreed with the tutor’s findings both at the beginning (88%) but more at the end of the course (95.7%). The variation between student and tutor for calculation of area, diameter and ejection fraction, respectively, was significantly lower in examination block 10 than in examination block 1 (each p < 0.001). Students underestimated both the length and the area of the left ventricle at the outset, as complete imaging of the left heart in the ultrasound sector was initially unsuccessful.ConclusionsA structured theoretical and practical transthoracic echocardiography course of training for last year medical students provides a clear and measurable learning experience in assessing and measuring left ventricular function. At least 14 examination blocks are necessary to achieve 90% agreement of correct determination of the ejection fraction.

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Learning curve-cumulative summation analysis of visual estimation of left ventricular function in novice practitioners

Cited by 9 publications

References 15 publications

Comparison of visual estimation and quantitative measurement of left ventricular ejection fraction in untrained perioperative echocardiographers

Comparison of visual estimation and quantitative measurement of left ventricular ejection fraction in untrained perioperative echocardiographers

Competency Assessment in Focused Cardiac Ultrasound—Can the Use of Sequential Testing Help Tailor Training Requirements?

Image quality to estimate ventricular ejection fraction by last year medical students improves after short courses of training

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