Lyudmila Khait, MD
Wayne State University
“Point-of-Care Echocardiography Learning Curves: Establishing Resident
Education Project Grant
Point of care ultrasound (POCUS) is an important bedside diagnostic tool that has been incorporated into emergency medicine (EM) residency education over the last decade. Point of care echocardiography (PoCE), specifically, is one of the more difficult POCUS exams to master, due to its complexity of image acquisition and interpretation. Criteria for attaining PoCE proficiency (and other POCUS exams) is poorly defined, recommended by expert consensus as the completion of 25-50 exams. In addition, the recommended grading scale (and one used at our institution) for assessing PoCE does not distinguish between image acquisition and image interpretation, two important components that complement each other and must each be mastered in order to achieve PoCE proficiency. In our proposed study, we will evaluate residents’ PoCE proficiency utilizing learning curves (LC). Generally, a LC plots a graphical relationship between the learner’s effort (x-axis) and proficiency (y-axis). We will create LCs based on both the currently recommended grading scale as well as with a novel grading scale previously developed at our institution (that independently evaluates image acquisition and interpretation) to assess PoCE educational progress and identify any deficits at our institution. We will implement a focused PoCE curriculum at the beginning of the PGY-1 (July 1, 2019) for the residency class of 2022 at Sinai-Grace Hospital and compare the LCs generated from that class to LCs generated from the class of 2022 at Detroit Receiving Hospital (no curriculum). We anticipate large variability between the residents’ psychomotor learning (image acquisition) and cognitive learning (image interpretation) without curriculum implementation, and this analysis will allow us to better focus on the PoCE educational gaps within our institution. Also, we hypothesize that focused PoCE curriculum implementation will produce less LC variability amongst the class of 2022 residents, in terms of achieving better proficiency with less effort (fewer exams performed), steeper slopes, and overall shifting of the LC to the left. Comparing the currently adopted ACEP grading scale to our novel grading scale will allow for better evaluation of the definition of PoCE proficiency, and we hope this scale can be adapted to other POCUS applications at our institution and to EM education as a whole. Current PoCE grading tools in EM education have created an atmosphere of subjectivity, and EM residents do not all achieve the same level of PoCE proficiency. LCs will allow for better evaluation of PoCE education, and allow for earlier intervention if a resident is seen “falling off the curve.” In addition, implementing a grading scale that separates image acquisition and interpretation will permit for a more objective definition of proficiency and a more targeted approach to individual education plans.
Dr. Khait is still completing the project.