title: Basic critical care echocardiography by pulmonary fellows: learning trajectory and prognostic impact using a minimally resourced training model*.
abstract: OBJECTIVE
  The spread of basic critical care echocardiography may be limited by training resources. Another barrier is the lack of information about the learning trajectory and prognostic impact of individual basic critical care echocardiography domains like acute cor pulmonale determination and left ventricular function estimation. We thus developed a minimally resourced training model and studied the latter outcomes.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Twenty-bed medical ICU.
  
  
  METHODS
  Echocardiography-naive trainees enrolled in the first year of our Pulmonary Medicine Fellowship Program from September 2012 to September 2013.
  
  
  METHODS
  We described the learning trajectory in six basic critical care echocardiography domains (adequate views, pericardial effusion, acute cor pulmonale, left ventricular ejection fraction, mitral regurgitation, and inferior vena cava variability) and correlated abnormalities in selected basic critical care echocardiography domains with clinical outcomes (mortality and length of stay).
  
  
  RESULTS
  Three-hundred forty-three basic critical care echocardiography scans were done for 318 patients by seven fellows (median of 40 scans per fellow; range, 34-105). Only one-third patients had normal basic critical care echocardiography studies. Accuracy in various basic critical care echocardiography domains was high (> 90%), especially beyond the first 30 examinations. Acute cor pulmonale was associated with ICU mortality when adjusted for Acute Physiology and Chronic Health Evaluation II score and presence of sepsis, whereas mitral regurgitation was associated with longer hospitalization only on univariate analysis.
  
  
  CONCLUSIONS
  Basic critical care echocardiography training using minimal resources is feasible. New trainees can achieve reasonable competency in most basic critical care echocardiography domains after performing about 30 examinations within the first year. The relatively high prevalence of abnormalities and the significant association of acute cor pulmonale with ICU mortality support the need for basic critical care echocardiography training.
authors.affiliation: 1Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore. 2Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Kay Choong
authors.initials: KC
authors.lastname: See
authors.forename: Venetia
authors.initials: V
authors.lastname: Ong
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ng
authors.forename: Rou An
authors.initials: RA
authors.lastname: Tan
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003422:Critical Care; D004452:Echocardiography; D004503:Education, Medical, Graduate / Q000379:methods*; D005257:Fellowships and Scholarships / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011660:Pulmonary Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality; D015272:Pulmonary Medicine / Q000193:education*