title: Can we improve transthoracic echocardiography training in non-cardiologist residents? Experience of two training programs in the intensive care unit.
abstract: BACKGROUND
  To evaluate the diagnostic performances of two training programs for residents with no prior ultrasound experience to reach competences in extended basic critical care transthoracic echocardiography (CCE) including Doppler capabilities.
  
  
  METHODS
  This is a prospective observational study in two intensive care units of teaching hospitals. Group I (five residents) completed a short training program (4-h theory; 3-h practical); group II (six residents) completed a longer training program (6-h theory; 12-h practical). The residents and an expert examined all patients who required a transthoracic echocardiography. Their agreement studied by Cohen's κ coefficient, concordance coefficient correlation (CCC) and Bland-Altman plots was used as an indicator of program effectiveness.
  
  
  RESULTS
  Group I performed 136 CCEs (mean/resident 27; range 22-32; 65 in ventilated patients) in 115 patients (62 men; 64 ± 18 years; Simplified Acute Physiologic Score [SAPS] II 37 ± 18). Group II performed 158 CCEs (mean/resident 26; range 21-31; 65 in ventilated patients) in 108 patients (64 men; 58 ± 17 years; SAPS II 42 ± 22). Both groups adequately assessed left ventricular (LV) systolic function (κ 0.75, 95 % confidence interval [CI] 0.64-0.86; κ 0.77, 95 % CI 0.66-0.88, respectively) and pericardial effusion (κ 0.83, 95 % CI 0.67-0.99; κ 0.76, 95 % CI 0.60-0.93, respectively). Group II appraised severe right ventricular dilatation and significant left-sided valve disease with good to very good agreement (κ 0.80, 95 % CI 0.56-0.96; κ 0.79, 95 % CI 0.66-0.93, respectively). Regarding left ventricular ejection fraction, E/A ratio, E/e' ratio and aortic peak velocity assessed by group II, CCCs were all >0.70 and the bias (mean difference) ±SD on Bland-Altman analysis was 1.3 ± 8.8 %, 0 ± 0.3, 0.4 ± 2.2 and 0.1 ± 0.4 m/s, respectively. Detection of paradoxical septum (κ 0.65, 95 % CI 0.37-0.93), of heterogeneous LV contraction (κ 0.49, 95 % CI 0.33-0.65) and of respiratory variation of the inferior vena cava (κ 0.27, 95 % CI 0.09-0.45), as well as stroke volume measurement (CCC 0.65, 95 % CI 0.54-0.74; bias ± SD -1.4 ± 4.7 cm), was appraised by group II with moderate agreement requiring probably more comprehensive training.
  
  
  CONCLUSIONS
  Although a training program blending 6-h theory and 12-h practical may be adapted to achieve some essential competences, it seems to be insufficiently to perform a complete extended basic critical care transthoracic echocardiography including Doppler capabilities.
authors.affiliation: Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies Aériennes, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France. vincent.labbe@aphp.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Labbé
authors.affiliation: Service de Cardiologie, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ederhy
authors.affiliation: Département d'épidémiologie et de recherche clinique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Pasquet
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, Assistance Publique-Hôpitaux de Paris, Paris, France.|Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Romain
authors.initials: R
authors.lastname: Miguel-Montanes
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, Assistance Publique-Hôpitaux de Paris, Paris, France.|Urgences Néphrologiques et Transplantation Rénale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rafat
authors.affiliation: Département d'épidémiologie et de recherche clinique, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.|Centre de Pharmacoépidémiologie de l'Assistance Publique-Hôpitaux de Paris (Cephepi), Paris, France.|UMR 1123 ECEVE, Sorbonne Paris Cité, Université Paris Diderot, Paris, France.|INSERM, CIC 1425-EC, Paris, France.|INSERM, UMR 1123 ECEVE, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Hajage
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, Assistance Publique-Hôpitaux de Paris, Paris, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), IAME, UMR 1137, 75018, Paris, France.|IAME 1137, Université Paris Diderot, 75018, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gaudry
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, Assistance Publique-Hôpitaux de Paris, Paris, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), IAME, UMR 1137, 75018, Paris, France.|IAME 1137, Université Paris Diderot, 75018, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Dreyfuss
authors.affiliation: Service de Cardiologie, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.|Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Paris, France.
authors.forename: Ariel
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies Aériennes, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, 75020, Paris, France.|Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
authors.affiliation: Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, Assistance Publique-Hôpitaux de Paris, Paris, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), IAME, UMR 1137, 75018, Paris, France.|IAME 1137, Université Paris Diderot, 75018, Paris, France.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
keywords: Academic training; Curriculum; Intensive care; Transthoracic echocardiography