title: Focused Critical Care Echocardiography: Development and Evaluation of an Image Acquisition Assessment Tool.
abstract: OBJECTIVE
  Little attention has been placed on assessment tools to evaluate image acquisition quality for focused critical care echocardiography. We designed a novel assessment tool to objectively evaluate the image acquisition skills of critical care trainees learning focused critical care echocardiography and examined the tool for evidence of validity.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical-surgical ICUs at a tertiary care teaching hospital.
  
  
  METHODS
  Trainees in our critical care medicine fellowship program.
  
  
  METHODS
  Six trainees completed a focused critical care echocardiography training curriculum followed by performing 20 transthoracic echocardiograms on patients receiving invasive mechanical ventilation. At three assessment intervals (the 1st and 2nd examinations, 10th and 11th examinations, and 19th and 20th examinations), echocardiograms performed by trainees were compared with those of critical care physicians certified in echocardiography and scored according to the focused critical care echocardiography assessment tool. The primary outcome was an efficiency score (overall assessment tool score divided by examination time). Differences in mean efficiency scores between echocardiographers of differing skill levels and changes in trainees' mean efficiency scores with increasing focused critical care echocardiography experience were compared by using t tests.
  
  
  RESULTS
  On the initial assessment, mean efficiency scores (SD) for trainees and experienced physicians were 1.55 (0.95) versus 2.78 (1.38), respectively (p = 0.02), and for the second and third assessments, the corresponding efficiency ratings for trainees and experienced physicians were 2.48 (0.97) versus 4.55 (1.32) (p < 0.01) and 2.61 (1.37) versus 4.17 (2.12) (p = 0.04), respectively.
  
  
  CONCLUSIONS
  Trainees' efficiency in focused critical care echocardiography image acquisition improved quickly in the first 10 studies, yet, it could not match with the performance of experienced physicians after 20 focused critical care echocardiography studies. The focused critical care echocardiography assessment tool demonstrated evidence of validity and could discern changes in trainees' image acquisition performance with increasing experience.
authors.affiliation: 1Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2Department of Anesthesia, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 4Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gaudet
authors.forename: Jason
authors.initials: J
authors.lastname: Waechter
authors.forename: Kevin
authors.initials: K
authors.lastname: McLaughlin
authors.forename: André
authors.initials: A
authors.lastname: Ferland
authors.forename: Tomás
authors.initials: T
authors.lastname: Godinez
authors.forename: Colin
authors.initials: C
authors.lastname: Bands
authors.forename: Paul
authors.initials: P
authors.lastname: Boucher
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Lockyer
mesh_terms: D002983:Clinical Competence; D003422:Critical Care / Q000592:standards*; D004452:Echocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D017064:Process Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods; D016526:Workload