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