Echocardiography Training for Cardiac Surgery Residents

Transcription

Echocardiography Training for
Cardiac Surgery Residents
Mazin Fatani, MD
25 October, 2014
Echocardiography Training for
Cardiac Surgery Residents
Kevin Lachapelle, FRCPSC, FACS,
Farhan Bhanji, MD, M.Sc. (Ed), FRCPC, FAHA,
Peter McLeod FRCP, FACP
I do not have an affiliation (financial or otherwise)
with a pharmaceutical, medical device or
communications organization.
Je n’ai aucune affiliation (financière ou autre)
avec une entreprise pharmaceutique, un fabricant
d’appareils médicaux ou un cabinet de communication.
Mazin Fatani, MD
25 October, 2014
Echocardiography Training for Cardiac Surgery Residents | M Fatani
Echocardiography
• Non-invasive diagnostic tool
• Provides rapid and detailed information about anatomy
and function of the cardiovascular system
• Conventional vs. Focused Echocardiography
• Useful in the management of critically ill patients
• Mostly done by cardiologists
•
Beaulieu Y, Critical Care Medicine. 2007
The International Conference on Residency Education
|
La Conférence internationale sur la formation des résidents
4
Study Rational
• Provision of 24 hour echocardiography by a Cardiologist is
not feasible
• There is a questionable need for involvement of cardiac
surgeons in performing focused echocardiographic studies
• Lack of studies in addressing echocardiography training for
cardiac surgery residents
* Jones A, Academic Emergency Medicine. 2003
** Manasia A, Journal of Cardiothoracic and Vascular Anesthesia. 2005
|
5
Study Purpose
• Conduct a Canadian national survey to acquire
informed opinions about training objectives for
echocardiography training for cardiac surgery
residents
|
6
Research Questions
• Should cardiac surgery residents be trained in echo?
• What are the objectives of echo training for cardiac
surgery residents?
|
7
Study Design & Methodology
• Cross-sectional, stratified national survey of:
 Cardiac surgery residents
 Cardiac surgeons
 Cardiologists
 Cardiac surgery program directors
• Online questionnaire
• Anonymous
• April-May 2013
|
8
Population & Recruitment
• All cardiac surgery program directors
• CSCS provided the list for all cardiac surgery residents in
Canada
• Cardiology program directors were asked to provide a list
of 5 echocardiographers
• Cardiac surgery program directors were asked to provide
a list of 5 cardiac surgeons
|
9
Survey rate of response by group of participants
Sent
Returned
Response rate (%)
Overall
201
89
44.3
Cardiac surgery resident
73
38
52.1
Cardiac surgeon
65
30
46.2
Cardiologist
51
15
29.4
Cardiac surgery program
director
12
6
50.0
|
10
Questionnaire
- Level 1: At least 40 limited or focused studies and a
minimum of 4 weeks in the echocardiography laboratory
•
Do cardiac surgery residents require training in Echocardiography?
•
To which level should cardiac surgery residents be trained?
•
Transthoracic
or Transesophageal
Echo and
or both?
- Level 3:Echo
A minimum
of twelve months
performance of
- Level 2: A minimum of six training blocks and at least 150
complete transthoracic studies (Proficiency in the
Independent Practice of Transthoracic Echocardiography)
at least a cumulative total of 300 transthoracic studies and
the interpretation of at least 550 additional studies
• Grade
the importance
of 18 training objectives
(Fellowship
in Echocardiography)
|
11
Do cardiac surgery residents require training
in echocardiography?
120%
100%
100%
97%
92%
97%
80%
67%
60%
40%
33%
20%
8%
3%
0%
0%
Overall (N=89)
Cardiac surgeon (N=30)
Cardiac surgery
program director (N=6)
Yes
|
3%
Cardiac surgery
resident (N=38)
Cardiologist (N=15)*
No
12
To which level should cardiac surgery
residents be trained?
80%
67%
70%
60%
50%
40%
30%
20%
37%
35%
30%
29%
10%
13%
13%
7%
18%
16% 17%
0%
Cardiac surgeons (N=30)
An echo training course
Echo course and rotation
|
3%
0%
directors (N=6)
Level 1 Training
20%
16%
7%
0%
Overall (N=89)
33%
26%
18%
11%
40%
37%
(N=38)
Level 2 Training
7%
0%
Cardiologist (N=15)
No need for training
13
To which level should cardiac surgery
residents be trained?
90%
83%
80%
70%
60%
50%
40%
47%
37%
35%
47%
45%
43%
37%
33%
30%
20%
11%
10%
17%
13%
7%
7%
0%
0%
Overall (N=89)
Echo course ± rotation
|
3%
0%
director (N=6)
Level 1 Training
20%
16%
(N=38)
Level 2 Training
0%
Cardiologist (N=15)
No need for training
14
In which of the following do cardiac surgery residents need training?
120%
100%
100%
80%
87%
83%
79%
60%
40% 40%
40%
20%
0%
20%
13%
1%
6%
Overall (N=89)
7%
1%
11%
3%
3%
3%
Both
Transthoracic Echo
|
0%
0%
0%
0%
director (N=6)
Transesophageal Echo
0%
3%
0%
(N=38)
Neither
0%
0%
Cardiologist (N=15)
Unspecified
15
Training Objectives
Percent (%) voting 'must or should be included'
100
Distribution of votes for 18 objectives
90
80
70
60
50
40
Series1
30
20
10
0
|
16
Objectives rated as important by 80% and more
in all participants
|
17
Objectives rated as important by 80% and more
of all participants but not cardiologists
Professional Role
Training objectives
Overall
Cardiac surgery
residents (N=38)
Cardiologists
(N=15)
Cardiac surgery
directors and
surgeons (N=36)
N
%
N
%
N
%
N
%
Assessment of gross wall motion abnormalities
82
92.1
35
92.1
11
73.3
36
100.0
Understanding of standard ultrasound windows/planes
necessary to perform focused echocardiography
80
89.9
37
97.4
11
73.3
32
88.9
Recognition of presence of acute valvular regurgitation
78
87.6
36
94.7
11
73.3
31
86.1
Recognition of presence of an aortic dissection
75
84.3
32
84.2
11
73.3
32
88.9
Recognition of presence of mediastinal clots
71
79.7
31
81.6
9
60
31
86.1
Knowledge of ultrasound/echo basics
70
78.6
32
84.2
7
46.67
31
86.1
|
18
Discussion
• 92% of all respondents think that cardiac surgery residents needs
training in echocardiography
• Fewer cardiologists (66%) agreed that cardiac surgery residents
needs training in echo compared to all other groups (p<0.01)
• 7 training objectives were identified as either must or should be
included by > 80% of each groups
• An echo course with or without a rotation in echo lab was considered
in training residents in echo in most groups
|
19
Limitations
• Online survey
• Response rates
• Underrepresentation of cardiologists in the survey
• FOCUS echo should not replace a full echo study
|
20
Conclusion
• There is a perceived learning needs in echocardiography
training for cardiac surgery residents
|
21
Course: Bedside Ultrasound for Cardiac Surgery Residents
|
22
Course: Bedside Ultrasound for Cardiac Surgery Residents
90.00
Resident
.
1
2
3
4
5
6
7
8
9
Group
mean
Pre-test
score
Post-test
score
Pre-eval
score
Post-eval
score
53
61
61
61
46
69
30
23
38
92
100
92
92
61
84
65
69
92
66
33
72
16
61
11
22
33
44
100
94
100
66
100
77
77
88
100
49.11
83.00
39.78
89.11
83.00
80.00
70.00
60.00
50.00
49.11
40.00
30.00
20.00
10.00
0.00
Test results
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
89.11
39.78
Test results
|
Future work
• This survey may aid development of a focused echo
course designed for cardiac surgery residents
|
24
QUISTIONS ?
THANK YOU!
25

Echocardiography Training for Cardiac Surgery Residents

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