Focused Cardiac Ultrasound - Competency Among Pre-internship Medical Officers in Diagnosing Cardiac Causes of Dyspnoea
Abstract
Background: Differentiating cardiovascular causes of dyspnea in resource-limited healthcare
settings can be challenging. The use of accessible, rapid point-of-care Focused Cardiac Ultrasound
(FoCUS) protocols may potentially alleviate these challenges. The Cardiac Ultrasound for
Resource-limited Settings (CURLS) protocol is a non-validated, context specific, easy to train,
easy to use Sub-Xiphoid Single Window FoCUS tool. We sought to assess trainee competence in
evaluating cardiovascular causes of dyspnea using CURLS after a brief training.
Methods: This was a quasi-experimental study conducted at the Kenyatta National Hospital over
3 weeks. We enrolled 45 graduate medical pre-interns, novices in echocardiography. Trainees
received simulated didactic and hands-on FoCUS skills training using the CURLS protocol and
2018 EACVI FoCUS training and competence assessment recommendations. Competency was
assessed in three domains: image interpretation, image acquisition, and image quality. Image
interpretation was assessed using a multiple-choice test. Image acquisition skills were assessed
using an OSCE checklist that measured their ability to obtain a Sub-xiphoid image on two healthy
living models. Image quality grading was graded by two FoCUS experts using the 2018 ACEP 5-
point image quality assurance grading scale. Data analysis involved computing trainee scores using
ranges, medians and 95% confidence intervals. Proportions of trainees who attained competence
were expressed in percentages.
Results: Aggregate image interpretation competency was attained by n=38 (84 %) of trainees with
a median score of 80%. The proportion of trainees attaining category-specific image interpretation
competency was as follows: pericardial effusion n=44 (98%), left atrial enlargement n= 40 (89%),
cardiomyopathy n=38 (84%), left ventricular hypertrophy n=37 (82%), and right ventricular
enlargement n=29 (64%). Image acquisition skills competency was attained by n=36 (80%) of
trainees with a median image acquisition skills test performance score of 82 %. Three-quarters of
trainee-obtained images were of good quality.
Conclusion: The majority of trainees in our study attained competency in FoCUS skills after
training with the CURLS protocol. The training conditions and participant selection bias limit
results generalizability
Publisher
university of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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