Impact of Deliberate Practice on Interpretation of Right Ventricular Pathology on Point-of-Care Echocardiography

SESSION TITLE: Rapid Session: Bedside Imaging SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 07:30 AM - 08:30 AM PURPOSE: Point-of-care (POC) echocardiography performed and interpreted by non-cardiologist clinicians is increasingly used to evaluate the right ventricle (RV) of patients presenting with an acute pulmonary embolism, however few studies have evaluated training methods for skill development. Learning curves have previously been used to demonstrate improvements in skill and knowledge with deliberate practice. We used learning curves to describe the impact of deliberate practice in POC RV assessment on learners with varying experience. METHODS: A 50-question quiz on RV size and function was developed with a minimum of 3 standard POC echo views from patients with acute pulmonary embolism. Learners were given 30 seconds per question to select “normal” or “abnormal” for RV size and function. Deliberate practice was structured as immediate feedback to learners with the correct answer after each case. Learners also completed a survey on attitudes, confidence and experience pre- and post-quiz. Data was analyzed by cumulative accuracy and comparisons were made across confidence and experience levels. RESULTS: Of thirty-six participants, 78% were trainees (residents and fellows), 22% were attendings with a mean post-training experience of 7.4 years. 94% reported prior ultrasound training, including courses (national or regional) and self-directed learning. Median pre- and post-test confidence was 4 on a 5-point Likert scale. Maximum mean cumulative accuracy was 78% for all learners, 77% for trainees and 80% for attendings. Low (score 3 or less) pre-test confidence correlated with a maximum mean cumulative accuracy of 75% compared to 81% in learners with a high pre-test confidence (score of 5). Specific accuracy thresholds were achieved earlier in learners with greater experience. CONCLUSIONS: Our study showed learners with varying experience levels attained a competency level of 78% for RV ultrasound assessment after 50 deliberate practice cases. Learners with higher confidence level and experience achieved accuracy thresholds after fewer practice cases. A competency threshold in this skill is unknown, however prior data has shown that experts in POC RV assessment reach a maximum accuracy of 87-90% when compared to cardiologist-interpreted studies. Our results show that learners at various skill levels for RV interpretation continue to improve with deliberate practice after 50 cases. CLINICAL IMPLICATIONS: This study adds to our understanding of the amount of practice needed to develop competency in POC ultrasound. DISCLOSURE: The following authors have nothing to disclose: Angela Love, Eric Bondarsky, Jason Filopei, Madeline Ehrlich, Samuel Acquah, Paru Patrawalla No Product/Research Disclosure Information