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The Feasibility of Training Internal Medicine Residents in Bedside Echocardiography Image Acquisition and Interpretation FREE TO VIEW

Branden Luna; Anas Mansour; Kim Jordan; Karanvir Grewal; John Elliot; James Davidson
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Riverside Methodist Hospital, Columbus, OH

Chest. 2014;146(4_MeetingAbstracts):686A. doi:10.1378/chest.1993138
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SESSION TITLE: End-of-Life Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To determine if internal medicine residents can acquire and interpret a focused bedside echocardiography exam after a short training course involving on-line and hands-on training.

METHODS: Residents volunteered to participate in an IRB-approved study aimed at learning bedside echocardiography. The program consisted of 3 components: 1) online training modules constructed by CAE healthcare entitled “Focused Thoracic Echocardiography”, 2) hands-on training to learn image acquisition with sonographers trained in echocardiography, and 3) training in image interpretation under supervision of a board certified cardiologist. On completion of training, the resident physician performed bedside echocardiography on consented patients aged 18 years or older admitted to a 32-bed CICU. Images were evaluated independently by the performing resident and a board-certified cardiologist. Both commented on interpretability (quality of image) and assessment of LV function, presence of pericardial effusion, RV dilation, and volume status. Correlational statistics were used to assess agreement.

RESULTS: Seven residents completed the training program. All residents completed the assigned modules and averaged 15 hours of combined training time. Residents performed an average of 15-16 echocardiography studies. A total of 111 echoes were performed; 110 were interpreted by both resident and cardiologist. Agreement on “interpretability” of the images was fair (Kappa = 0.27, p<0.001); however, there was moderate agreement on LV function (0.47, p<.001, presence of pericardial effusion (0.40, p<.001), RV dilation (0.44, p < 0.001), and volume status (0.44, p = 0.002).

CONCLUSIONS: The training program outlined in this study shows that internal medicine residents (PGY 1-3) can be taught in a short period of time to acquire echocardiographic images and interpret those images with fair and moderate correlation compared to experienced sonographers and cardiologists, respectively. Some of the limitations of this study are that residents volunteered to participate showing interest in learning bedside echocardiography prior to enrollment, the importance of each individual component of training was difficult to assess, and the on-line modules' cost may prevent widespread implementation.

CLINICAL IMPLICATIONS: The addition of a bedside echocardiography exam to the traditional physical exam of acutely ill patients could greatly increase speed and accuracy of diagnosis, and in turn, expedite decision making and improve patient treatment(s).

DISCLOSURE: The following authors have nothing to disclose: Branden Luna, Anas Mansour, Kim Jordan, Karanvir Grewal, John Elliot, James Davidson

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