title: Prospective assessment of a score for assessing basic critical-care transthoracic echocardiography skills in ventilated critically ill patients.
abstract: BACKGROUND
  We studied a score for assessing basic transthoracic echocardiography (TTE) skills exhibited by residents who examined critically ill patients receiving mechanical ventilation.
  
  
  METHODS
  We conducted a prospective study in the 16 residents who worked in our medical-surgical ICU between 1 May 2008 and 1 November 2009. The residents received theoretical teaching (two hours) then performed supervised TTEs during their six-month rotation. Their basic TTE skills in mechanically ventilated patients were evaluated after one (M1), three (M3), and six (M6) months by two experts, who used a scoring system devised for the study. After scoring, residents gave their hemodynamic diagnosis and suggested a treatment.
  
  
  RESULTS
  The 4 residents with previous TTE skills obtained a significantly higher total score than did the 12 novices at M1 (18 (16 to 19) versus 13 (10 to 15), respectively, P = 0.03). In the novices, the total score increased significantly during training (M1, 13 (10 to 14); M3, 15 (12 to 16); and M6, 17 (15 to 18); P < 0.001) and correlated significantly with the number of supervised TTEs (r = 0.68, P < 0.0001). In the overall population, agreement with experts regarding the diagnosis and treatment was associated with a significantly higher total score (17 (16 to 18) versus 13 (12 to 16), P = 0.002). A total score ≥ 19/20 points had 100% specificity (95% confidence interval, 79 to 100%) for full agreement with the experts regarding the diagnosis and treatment.
  
  
  CONCLUSIONS
  Our results validate the scoring system developed for our study of the assessment of basic critical-care TTE skills in residents.
authors.affiliation: Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Jozwiak
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre F-94270, France ; Faculté de Médecine Paris-Sud, Université Paris-Sud, EA4533, Le Kremlin-Bicêtre F-94270, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.affiliation: Centre Hospitalo-Universitaire Guillaume et René Laennec, service de réanimation chirurgicale, Nantes F-44000, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Cinotti
authors.affiliation: Centre Hospitalier Côte de Lumière, service de médecine polyvalente, Les Sables d'Olonne F-85100, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Bontemps
authors.affiliation: Centre Hospitalier Départemental de la Vendée, service de réanimation, La Roche-sur-Yon F-85000, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
authors.affiliation: Centre Hospitalier Bretagne Sud Lorient, service de réanimation médicale, Lorient F-56100, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Belliard
keywords: Basic critical-care echocardiography skills; Goal-oriented bedside echocardiography; Hemodynamic assessment; Intensive care unit; Non-cardiologist intensivists
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