Key result
Brief mastery learning yields ~0.73 correlation between fellow and cardiologist LVOT VTI measurements.
Why the study?
Despite demand among critical care fellows to learn advanced critical care echocardiography for noninvasive cardiac output measurement, data describing skill acquisition and mastery were lacking.
Does a brief mastery learning intervention improve the accuracy of critical care fellows in measuring echocardiographic cardiac output compared to formal echocardiography?
Observational (n=32)
Single-blind
No
Does a brief mastery learning intervention improve the accuracy of critical care fellows in measuring echocardiographic cardiac output compared to formal echocardiography?
A brief mastery learning intervention enables critical care fellows to achieve strong correlations with cardiologist-measured LVOT VTI and moderate correlations for LVOT diameter, although interrater reliability indicates room for improvement.
Supports brief mastery learning for fellows' LVOT VTI assessment; leaves open validation in prospective outcome trials before clinical adoption.
Background Advanced critical care echocardiography comprises a specific set of qualitative and quantitative point-of-care echocardiography skills, including a reliable, noninvasive method to measure cardiac output. This technique requires echocardiographic measurement of left ventricular outflow tract (LVOT) diameter and LVOT velocity time integral (VTI). Although there is a demand among critical care fellows to learn these advanced techniques, there are no data describing the acquisition of mastery in these skills. Objective This pilot study aims to describe the accuracy of echocardiographic measurement of LVOT diameter and LVOT VTI obtained by critical care fellows after an educational intervention, as well as to enhance validation evidence for an image scoring assessment that is applicable to these measurements. Methods We implemented a brief mastery learning intervention to teach the measurement of LVOT diameter and VTI. Fellow measurements of these parameters, along with the corresponding echocardiographic images, were compared with a gold standard of measurements obtained by professional echocardiography technicians and interpreted by cardiologists. Results Seven fellows performed 35 echocardiograms on 32 patients. The average fellow-reported LVOT VTI was 17.0 ± 4.37 cm, whereas the average cardiologist-reported VTI was 17.3 ± 5.19 cm. The correlation (r) between fellow and cardiologist-reported VTI was 0.73 (P < 0.001), with a mean percent difference of 19.5 ± 12.0%. The average fellow-reported LVOT diameter was 2.07 ± 0.23 cm, whereas the average cardiologist-reported LVOT diameter was 2.08 ± 0.22 cm. The correlation (r) between fellow and cardiologist-reported LVOT diameter was 0.51 (P = 0.004), with a mean percent difference of 8.05 ± 7.0%. The sensitivity for fellows to detect an abnormal LVOT VTI was 91%, with a specificity of 43%. Conclusion Critical care fellow measurement of LVOT VTI and LVOT diameter demonstrated strong and moderate positive correlations with cardiologist-reported values, respectively, with acceptable clinical agreement. However, interrater reliability and percent differences showed room for improvement. Education in these advanced skills is resource intensive, and additional research is needed to determine the most effective approach to training fellows.
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Talan et al. (2024) conducted an observational in Critically ill patients (n=32). Critical care fellow point-of-care echocardiography vs. Cardiologist-interpreted formal echocardiography was evaluated on Correlation of LVOT VTI measurement between fellows and cardiologists (r 0.73, 95% CI 0.623-0.839, p=<0.001). Critical care fellows' measurements of LVOT VTI demonstrated a strong positive correlation (r = 0.73) with cardiologist-reported values after a brief mastery learning educational intervention.
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