title: Learning profiles for noninvasive transcutaneous Doppler ultrasound.
abstract: OBJECTIVE
  This study aimed to establish learning profiles for noninvasive transcutaneous Doppler ultrasound.
  
  
  METHODS
  Four trainees attended a 2-h lecture, followed by a 15-min demonstration on a volunteer and a 30-min hands-on workshop in a small group setting. Then, they underwent hands-on practice on 50 participants without supervision. The skill acquisitions in terms of signal magnitude, signal quality, and measurement time of the trainees were evaluated through 50 assessments, and were compared with that of a trainer with extensive experience on the use of an ultrasonic cardiac output monitor acting as a 'gold standard'. The learning profile for each individual trainee was analyzed using the cumulative sum graphical method.
  
  
  RESULTS
  Four trainees performed ultrasonic cardiac output monitor on 50 participants. All trainees attained proficiency after 18-36 assessments to achieve aortic signal magnitude and quality comparable with the trainer. It requires a minimum of nine assessments to obtain three aortic scans within 5 min with 95% success rates. Only half of the trainees achieved competence in pulmonary scans and the minimum number of assessments required was 36. A minimum of 22 assessments were required for three pulmonary scans within 10 min with 95% success rates.
  
  
  CONCLUSIONS
  A substantial period of learning needs to be undertaken to achieve proficiency on the use of noninvasive transcutaneous Doppler ultrasound. Cumulative sum analysis is a useful tool for ongoing quality assessment during medical education and training in practical procedures on an individual basis.
authors.affiliation: aAccident and Emergency Medicine Academic Unit bSchool of Public Health and Primary Care, Division of Biostatistics, Prince of Wales Hospital, The Chinese University of Hong Kong cDepartment of Chemistry, The Hong Kong University of Science and Technology, Hong Kong SAR dDepartment of Emergency, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Cangel P Y
authors.initials: CP
authors.lastname: Chan
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Li
authors.forename: Nandini
authors.initials: N
authors.lastname: Agarwal
authors.forename: King-Keung
authors.initials: KK
authors.lastname: Sin
authors.forename: Yuk-Ki
authors.initials: YK
authors.lastname: Leung
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Narain
authors.forename: Pui-Ling
authors.initials: PL
authors.lastname: Cheung
authors.forename: Mandy M
authors.initials: MM
authors.lastname: Tse
authors.forename: William B
authors.initials: WB
authors.lastname: Goggins
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
mesh_terms: D000328:Adult; D002303:Cardiac Output, Low / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D015331:Cohort Studies; D003422:Critical Care; D004503:Education, Medical, Graduate / Q000379:methods*; D004517:Education, Professional / Q000379:methods; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D018608:Ultrasonography, Doppler / Q000379:methods*