title: Outcomes from extensive training in critical care echocardiography: Identifying the optimal number of practice studies required to achieve competency.
abstract: Optimal instruction and assessment of critical care ultrasound (CCUS) skills requires an assessment tool to measure learner competency and changes over time. In this study, a previously published tool was used to monitor the development of critical care echocardiography (CCE) competencies, the attainment of performance plateaus, and the extent to which previous experience influenced learning.
  
  
  
  A group of experts used the Rapid Assessment of Competency in Echocardiography (RACE) scale to rate a large pool of CCE studies performed by novices in a longitudinal design. A total of 380 studies performed by twelve learners were assessed; each study was independently rated by two experts.
  
  
  
  Learners demonstrated improvement in mean RACE scores over time, with peak performance occurring early in training and a performance plateau thereafter. Learners with little experience received the greatest benefit from training, with an average performance plateau reached at the twentieth study.
  
  
  
  Supporting earlier results, the RACE scale provided a straightforward means to assess learner performance with minimal requirements for evaluator training. The results of the present study suggest that novices experience the greatest gains in competency during their first twenty practice studies, a threshold which should serve to guide training initiatives.
authors.affiliation: Division of Critical Care Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: smillington@toh.on.ca.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Millington
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Hewak
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arntfield
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Yanick
authors.initials: Y
authors.lastname: Beaulieu
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Koenig
authors.affiliation: University of Wisconsin, Madison, WI, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Kory
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Mayo
authors.affiliation: Carleton University, Ottawa, Ontario, Canada.
authors.forename: Jordan R
authors.initials: JR
authors.lastname: Schoenherr
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D003162:Competency-Based Education; D003422:Critical Care; D004452:Echocardiography; D004521:Educational Measurement; D006801:Humans; D019095:Point-of-Care Systems
keywords: Critical care; Intensive care; Medical curricula; Medical education; Point-of-care; Ultrasound