title: The rate at which residents learn to use hand-held echocardiography at the bedside.
abstract: OBJECTIVE
  Because there is little information about the training that general internists require to perform hand-carried cardiac ultrasonography (HCU), we studied the rate of learning of a group of medical residents performing HCU after minimal formal training.
  
  
  METHODS
  Medical residents on the inpatient services at Johns Hopkins Bayview Medical Center received formal training in HCU consisting of 15-30 minutes of didactic instruction about the principles of echocardiography, followed by ongoing one-on-one instruction in performing HCU and subsequent ongoing one-on-one training from a certified echocardiography technician as they were doing scans. The residents were shown how to position the patient to obtain 2-dimensional echo images from the parasternal short and long axes and apical 4-chamber views, and how to obtain color-flow Doppler images across the mitral and aortic valves. Residents were asked to determine whether pericardial effusion was present and to assess left ventricular size, left ventricular function, and the mitral and aortic valves. The residents performed cardiac physical examination and HCU independently on patients who had a conventional transthoracic echocardiogram (CTTE) performed within 24 hours of the HCU. The residents' HCU results were compared with the CTTE results by a cardiologist specializing in echocardiography. The rates at which residents gained technical proficiency and skills in interpreting their studies were measured by linear regression to fit various outcome variables against their experience at scanning as gauged by the number of scans performed.
  
  
  RESULTS
  Thirty medical residents performed a total of 231 HCU studies. Linear regression models showed that the residents' overall technical proficiency skills improved at the rate of 0.79 (95% confidence interval [CI] 0.53-1.04) points on an overall assessment index (0-3 scale) per 10 scans completed. Interpretation accuracy improved at a rate of 1.01 (95% CI 0.69-1.39) points per 10 scans as measured by an interpretation accuracy index (0-3 scale). Because scanning efforts and instruction in HCU occurred during residents' usual rotation duties, some residents gathered experience in HCU slowly and sporadically.
  
  
  CONCLUSIONS
  This study, the first prospective, experimental effort of its kind, shows that residents as a group learned important aspects of HCU scanning and interpretation at a reasonably rapid rate.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. hellmann@jhmi.edu
authors.forename: David B
authors.initials: DB
authors.lastname: Hellmann
authors.forename: Quinn
authors.initials: Q
authors.lastname: Whiting-O'Keefe
authors.forename: Edward P
authors.initials: EP
authors.lastname: Shapiro
authors.forename: L David
authors.initials: LD
authors.lastname: Martin
authors.forename: Carol
authors.initials: C
authors.lastname: Martire
authors.forename: Roy C
authors.initials: RC
authors.lastname: Ziegelstein
mesh_terms: D000328:Adult; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D018618:Echocardiography, Doppler, Color / Q000295:instrumentation*; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007396:Internship and Residency; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors