title: Efficacy of a Standardized Computer-Based Training Curriculum to Teach Echocardiographic Identification of Rheumatic Heart Disease to Nonexpert Users.
abstract: The ability to integrate echocardiographic for rheumatic heart disease (RHD) into RHD prevention programs is limited because of lack of financial and expert human resources in endemic areas. Task shifting to nonexperts is promising; but investigations into workforce composition and training schemes are needed. The objective of this study was to test nonexperts' ability to interpret RHD screening echocardiograms after a brief, standardized, computer-based training course. Six nonexperts completed a 3-week curriculum on image interpretation. Participant performance was tested in a school-screening environment in comparison to the reference approach (cardiologists, standard portable echocardiography machines, and 2012 World Heart Federation criteria). All participants successfully completed the curriculum, and feedback was universally positive. Screening was performed in 1,381 children (5 to 18 years, 60% female), with 397 (47 borderline RHD, 6 definite RHD, 336 normal, and 8 other) referred for handheld echo. Overall sensitivity of the simplified approach was 83% (95% CI 76% to 89%), with an overall specificity of 85% (95% CI 82% to 87%). The most common reasons for false-negative screens (n = 16) were missed mitral regurgitation (MR; 44%) and MR ≤1.5 cm (29%). The most common reasons for false-positive screens (n = 179) included identification of erroneous color jets (25%), incorrect MR measurement (24%), and appropriate application of simplified guidelines (39.4%). In conclusion, a short, independent computer-based curriculum can be successfully used to train a heterogeneous group of nonexperts to interpret RHD screening echocardiograms. This approach helps address prohibitive financial and workforce barriers to widespread RHD screening.
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, D.C.. Electronic address: abeaton@cnmc.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Beaton
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil; Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Nascimento
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Diamantino
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Gabriel T R
authors.initials: GT
authors.lastname: Pereira
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Eduardo L V
authors.initials: EL
authors.lastname: Lopes
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Cassio O
authors.initials: CO
authors.lastname: Miri
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Kaciane K O
authors.initials: KK
authors.lastname: Bruno
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil; Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Graziela
authors.initials: G
authors.lastname: Chequer
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Camila G
authors.initials: CG
authors.lastname: Ferreira
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Luciana C X
authors.initials: LC
authors.lastname: Lafeta
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, D.C.
authors.forename: Hedda
authors.initials: H
authors.lastname: Richards
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, D.C.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Perlman
authors.affiliation: Department of Cardiology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Webb
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil; Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Antonio L P
authors.initials: AL
authors.lastname: Ribeiro
authors.affiliation: Department of Cardiology, Children's National Health System, Washington, D.C.
authors.forename: Craig
authors.initials: C
authors.lastname: Sable
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil; Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil.
authors.forename: Maria do Carmo P
authors.initials: Mdo C
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D001938:Brazil; D002309:Cardiology / Q000193:education*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003479:Curriculum; D004452:Echocardiography; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D012214:Rheumatic Heart Disease / Q000175:diagnosis*; D013647:Task Performance and Analysis