Assessment of cardiopulmonary point-of-care ultrasound objective structured clinical examinations in graduating anesthesiology residents across multiple residency programs

Jay Shen; Mandeep Singh; Timothy T Tran; Nibras F Bughrara; Christine Vo; Matthew Sigakis; Sara Nikravan; Ryan Tone; Charandip K Sandhu; Clinton Kakazu; Vikas Kumar; Archit Sharma; Radwan Safa; Melissa Byrne; Sudhakar Subramani; Nick Pham; Davinder Ramsingh

doi:10.1016/j.jclinane.2023.111260

Assessment of cardiopulmonary point-of-care ultrasound objective structured clinical examinations in graduating anesthesiology residents across multiple residency programs

J Clin Anesth. 2023 Dec:91:111260. doi: 10.1016/j.jclinane.2023.111260. Epub 2023 Sep 19.

Authors

Jay Shen¹, Mandeep Singh², Timothy T Tran³, Nibras F Bughrara⁴, Christine Vo⁵, Matthew Sigakis⁶, Sara Nikravan⁷, Ryan Tone⁸, Charandip K Sandhu⁹, Clinton Kakazu¹⁰, Vikas Kumar¹¹, Archit Sharma¹², Radwan Safa⁴, Melissa Byrne⁶, Sudhakar Subramani¹², Nick Pham¹³, Davinder Ramsingh⁸

Affiliations

¹ UC Irvine School of Medicine, Irvine, CA, USA. Electronic address: jayys@hs.uci.edu.
² Keck Hospital of USC, Los Angeles, CA, USA.
³ University of Colorado, Aurora, CO, USA.
⁴ Albany Medical College, Albany, NY, USA.
⁵ University of Oklahoma, Oklahoma City, OK, USA.
⁶ University of Michigan Health System, Ann Arbor, MI, USA.
⁷ University of Washington, Seattle, WA, USA.
⁸ Loma Linda University, Loma Linda, CA, USA.
⁹ UC Davis Medical Center, Sacramento, CA, USA.
¹⁰ Harbor-UCLA Medical Center, Torrance, CA, USA.
¹¹ Augusta University, Augusta, GA, USA.
¹² University of Iowa, Iowa City, IA, USA.
¹³ UC Irvine School of Medicine, Irvine, CA, USA.

PMID: 37734197
DOI: 10.1016/j.jclinane.2023.111260

Abstract

Study objective: To implement and assess a cardiopulmonary point-of-care ultrasound (POCUS) objective structured clinical examination (OSCE) in a large cohort of graduating anesthesia residents.

Design: Observational cohort study.

Setting: University-affiliated hospitals.

Subjects: 150 graduating anesthesia residents in their last nine months of training.

Interventions: A standardized cardiopulmonary OSCE was administered to each resident.

Measurements: The cardiac views evaluated were parasternal long axis (PLAX), apical 4 chamber (A4C), and parasternal short axis (PSAX). The pulmonary views evaluated were pleural effusion (PLE) and pneumothorax (PTX). In addition, a pre- and post-exam survey scored on a 5-point Likert scale was administered to each resident.

Main results: A4C view (mean 0.7 ± 0.3) scored a lower mean, compared to PSAX (mean 0.8 ± 0.3) and PLAX (mean 0.8 ± 0.4). Residents performed well on the PTX exam (mean 0.9 ± 0.3) but more poorly on the PLE exam (mean 0.6 ± 0.4). Structural identification across cardiac and pulmonary views were mostly high (means >0.7), but advanced interpretive skills and maneuvers had lower mean scores. Pre- and post- OSCE survey results were positive with almost all questions scoring >4 on the Likert scale.

Conclusion: Our study demonstrates that a cardiopulmonary POCUS OSCE can be successfully implemented across multiple anesthesia training programs. While most residents were able to perform basic ultrasound views and identify structures, advanced interpretive skills and maneuvers performed lower.

Keywords: Cardiac ultrasound; Objective structured clinical examinations; Point-of-care ultrasound; Pulmonary ultrasound; Resident education.