Basic critical care echocardiography: Validation of a curriculum dedicated to noncardiologist residents

Objective: To assess the efficacy of a limited, tailored training program for noncardiologist residents without experience in ultrasound to reach competence in basic critical care echocardiography. Design: Prospective descriptive clinical study. Setting: Medical-surgical intensive care unit of a teaching hospital. Patients: 201 patients (125 men; age: 61 +/- 16 yrs; Simplified Acute Physiologic Score II: 37 +/- 17; 145 ventilated patients) who required a transthoracic echocardiography were studied. Intervention and Measurements: The curriculum consisted of a 12-hr learning program blending didactics, interactive clinical cases, and tutored hands-on sessions. After completion of this tailored training program, all eligible patients subsequently underwent a transthoracic echocardiography performed in random order by a recently trained resident and an experienced intensivist with expertise in critical care echocardiography who was used as a reference. The agreement between responses to clinical questions provided by the two investigators who independently interpreted the transthoracic echocardiography study at bedside was used as an indicator of effectiveness of the tested curriculum. Main Results: Residents performed a mean of 33 transthoracic echocardiograms during the study period (range: 29-38). Experienced intensivists had significantly fewer unaddressed clinical questions than did residents (57 [5.7%] vs. 111 [11.0%] of 1,005 clinical questions: p < .0001). When compared to residents, the experienced intensivists performed shorter transthoracic echocardiography examinations (3.0 +/- 1.0 min vs. 7.0 +/- 2.5 min: p < .0001) with more acoustic windows (888 vs. 828 of 1,005 potential windows: p < .0001). Residents adequately assess global left ventricle systolic function (kappa: 0.84; 95% confidence interval: 0.76-0.92). They accurately identified dilated left ventricle (kappa : 0.90; 95% confidence interval: 0.80-1.0), dilated right ventricle (kappa: 0.76; 95% confidence interval: 0.64-0.89), dilated inferior vena cava (kappa: 0.79; 95% confidence interval: 0.63-0.94), and pericardial effusion (kappa: 0.79; 95% confidence interval: 0.58-0.99) and diagnosed two cases of tamponade. Conclusions: A 12-hr training program blending didactics, interactive clinical cases, and tutored hands-on sessions dedicated to noncardiologist residents without experience in ultrasound appears well suited for reaching competence in basic critical care echocardiography. (Crit Care Med 2011; 39:636-642)