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Education, Teaching, and Quality Improvement |

Implementation and Results of a Critical Care Ultrasound Program for Fellows Using Cloud-Based Image Review Software

Daniel Fein, MD; Peter Lee, MD; Charles Peng, MD; Hayley Gershengorn, MD; Pierre Kory, MD
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Beth Israel Medical Center, New York, NY


Chest. 2013;144(4_MeetingAbstracts):583A. doi:10.1378/chest.1704656
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Abstract

SESSION TITLE: Use of Technology in Training

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PM

PURPOSE: Training in General Critical Care Ultrasound (GCCUS) skills is increasingly provided during Pulmonary/Critical Care (PCCM) fellowship despite reports of multiple teaching barriers. Studies demonstrate competence in aspects of GCCUS shortly after focused training interventions, but no intra or post-fellowship skill assessments have been done. We describe the implementation of an ultrasound program (USP) to facilitate the teaching and assessment of GCCUS skills during fellowship.

METHODS: A multi-component USP for first year fellows was devised as follows: 1) Required attendance at a 3-day intensive, hands-on course at start of fellowship; 2) Mandated saving of protocolized image sets with immediate interpretation using a structured GCCUS report form; 3) Use of software to allow wireless uploading of studies to a centralized database (Qpath™, Telexy Healthcare); 4) Daily over-reading and feedback on uploaded studies by an attending trained in GCCUS; and 5) Monthly conferences to review problem areas, illustrative cases, and deliver focused lectures. Fellow interpretations of Basic Critical Care Echocardiography (BCE) and Lung Ultrasound (LUS) exams were compared to the attending interpretation using kappa analysis.

RESULTS: 4 first year fellows participated in the USP. From training month 4 through 8, 53 BCE studies were over-read. 88% of fellow interpreted left ventricular function (kappa .69, p <.01), 92% of right ventricular function (kappa .62, p<.01), and 81% of inferior vena cava analysis (kappa .70, p<.01) agreed with the attending. 64% of LUS interpretations agreed with the attending (kappa .28, p<.02).

CONCLUSIONS: Implementation of a USP which includes a three-day intensive course and software that allows routine over-reading and feedback by trained faculty facilitates the teaching and assessment of GCCUS skills and ensures proficiency in BCE and LUS interpretation.

CLINICAL IMPLICATIONS: Fellowship programs with GCCUS trained faculty should adopt a USP that allows for over-reading of all fellow ultrasound activity to ensure the proficiency of fellows in GCCUS skills.

DISCLOSURE: The following authors have nothing to disclose: Daniel Fein, Peter Lee, Charles Peng, Hayley Gershengorn, Pierre Kory

Qpath online ultrasound database tool used in this case for trainee teaching.


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