SESSION TITLE: Pulmonary & Critical Care Imaging
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM
PURPOSE: Focused transthoracic echocardiography (TTE) is a vital tool for anesthesiologists and critical care physicians to evaluate patients undergoing cardiac and noncardiac procedures.1 Focused Assessed Transthoracic Echocardiography (FATE) is a focused TTE exam to supplement clinical evaluation and optimize cardiopulmonary resuscitation.2 FATE is a relatively simple skill to learn3; however, without a standardized curriculum, access to this skill has been limited. We hypothesize that implementation of formal training in FATE will improve knowledge base and TTE image acquisition for resident and fellow trainees.
METHODS: After IRB approval, 22 anesthesiology residents/fellows were enrolled in a prospective cohort study. Trainees completed a didactic online module in FATE with a pre- and post-test to assess changes in knowledge with 6 hours of hands-on training. Images of FATE-protocol views were obtained before and after the course to assess image quality. Two blinded anesthesiologists graded the images; individual scores for each view were recorded and totaled.
RESULTS: Median change from the online pre-test to post-test was 40.4% (interquartile range: 22.8-56.3; p<0.001). and the total image acquisition scores from pre- to post-course improved 9.1%(2.9-15%; p=0.001), with improvement in all FATE-protocol views. The greatest increase was in the apical 4 chamber view, which was 23.9 percentage points (8.7-39.1; p=0.001). The median change for subcostal 4 chamber view was 4.3 percentage points (2.2-20.7 p=0.007), parasternal long axis view was 6.5 percentage points (-2.2-17.4; p=0.068), parasternal short axis view was 4.3 percentage points (0-10.9 p=0.124), the right pleural view was 2.2 percentage points (-6.5-10.9; p=0.572) and 4.3 percentage points (-2.2-15.2; p=0.128) for left pleural view.
CONCLUSIONS: At our institution, implementation of a formal training course in FATE improved anesthesia trainees ability to obtain TTE images. There was significant improvement in ability to perform a FATE exam from baseline. The greatest improvement was in the apical four chamber view. We will reassess this skill 6 months post-course to look for retention and factors that improve imaging. We also plan to assess efficacy of this curriculum on physicians of other subspecialties.
CLINICAL IMPLICATIONS: The ability to teach anesthesia trainees a focused TTE exam can be performed with a one day standardized course. With this training, the greatest improvement is with the ability to obtain the apical four chamber view.
DISCLOSURE: The following authors have nothing to disclose: Jemiel Nejim, Prianka Desai, Sumudu Dehipawala, Kara Fields, Sean Garvin, Christopher Tanaka, Jim Beckman, James Osorio, Stephen Haskins
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