Pragmatic assessment of resident performed cardiac point of care ultrasound using a validated scoring metric

Stuart B Prenner; Marietta Ambrose; Dipika J Gopal; Sina Manthey; Jenna Spears; Allison Sussman; Cameron Baston

doi:10.1016/j.ijcha.2022.100993

Pragmatic assessment of resident performed cardiac point of care ultrasound using a validated scoring metric

Int J Cardiol Heart Vasc. 2022 Mar 11:39:100993. doi: 10.1016/j.ijcha.2022.100993. eCollection 2022 Apr.

Authors

Stuart B Prenner¹, Marietta Ambrose¹, Dipika J Gopal², Sina Manthey³, Jenna Spears⁴, Allison Sussman⁵, Cameron Baston⁶

Affiliations

¹ Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania and Perelman School of Medicine. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
² Kaiser Permanente South Sacramento Medical Center. Division of Cardiovascular Medicine, Department of Medicine, This author takes responsibility for study design, data collection, and a critical revision of the manuscript. 6600 Bruceville Road, Sacramento, CA 95823, USA.
³ Mayo Clinic Florida. Division of Cardiovascular Medicine, Department of Medicine, This author takes responsibility for study design, data collection, and a critical revision of the manuscript. 4500 San Pablo Rd S, Jacksonville, FL 32224, USA.
⁴ Lankenau Medical Center. Division of Cardiovascular Medicine, Department of Medicine, This author takes responsibility for study design, data collection, and a critical revision of the manuscript. 100 E Lancaster Ave., Wynnewood, PA 19096, USA.
⁵ Department of Medicine, Pennsylvania Hospital. This author takes responsibility for study design, data collection, and a critical revision of the manuscript. 800 spruce street. Philadelphia, PA 19107, USA.
⁶ Division of Pulmonary, Allergy, and Critical Care, Medicine, Department of Medicine University of Pennsylvania and Perelman School of Medicine. This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.

Abstract

Background: Cardiac point of care ultrasound (POCUS) is increasingly utilized by trainees across various specialties and can rapidly assess the cardiac status of unstable patients. However, the quality of trainee performed cardiac examinations has been reported only in controlled studies. In this study we aimed to assess the quality of all cardiac POCUS performed by internal medicine trainees at a major academic medical center over a three-year period.

Methods: 256 studies were included and were graded by experts blinded to postgraduate year (PGY) using a previously validated scoring metric.

Results: We found significant improvement in overall quality of resident performed cardiac POCUS from PGY 1 to 3 (10.8, 10.2, 13.2, p = 0.012). Assessment of left ventricular function was possible in 82% of studies and increased from PGY 1 to PGY 3 (77%, 76%, 88%, p = 0.025). Similar trends were seen in the assessment of the pericardial space (67%, 71%, 84%, p = 0.012). Images sufficient for right ventricular and volume status assessment were less commonly found (65%, 60%, 75% and 60%, 49%, 57%, respectively).

Conclusions: This study provides a real world experience of the level of diagnostic accuracy that can be expected from IM trainees with minimal hands-on supervision.

Keywords: Echocardiogram; IM, internal medicine; IVC, inferior vena cava; LV, left ventricle: RV, right ventricle; Medical education; PGY, post graduate year; POCUS; POCUS, point of care ultrasound.