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Development and Validation of an Assessment Tool for Competency in Critical Care Ultrasound

Patrawalla, Paru; Eisen, Lewis Ari; Shiloh, Ariel; Shah, Brijen J; Savenkov, Oleksandr; Wise, Wendy; Evans, Laura; Mayo, Paul; Szyld, Demian
BACKGROUND: Point-of-care ultrasound is an emerging technology in critical care medicine. Despite requirements for critical care medicine fellowship programs to demonstrate knowledge and competency in point-of-care ultrasound, tools to guide competency-based training are lacking. OBJECTIVE: We describe the development and validity arguments of a competency assessment tool for critical care ultrasound. METHODS: A modified Delphi method was used to develop behaviorally anchored checklists for 2 ultrasound applications: "Perform deep venous thrombosis study (DVT)" and "Qualify left ventricular function using parasternal long axis and parasternal short axis views (Echo)." One live rater and 1 video rater evaluated performance of 28 fellows. A second video rater evaluated a subset of 10 fellows. Validity evidence for content, response process, and internal consistency was assessed. RESULTS: An expert panel finalized checklists after 2 rounds of a modified Delphi method. The DVT checklist consisted of 13 items, including 1.00 global rating step (GRS). The Echo checklist consisted of 14 items, and included 1.00 GRS for each of 2 views. Interrater reliability evaluated with a Cohen kappa between the live and video rater was 1.00 for the DVT GRS, 0.44 for the PSLA GRS, and 0.58 for the PSSA GRS. Cronbach alpha was 0.85 for DVT and 0.92 for Echo. CONCLUSIONS: The findings offer preliminary evidence for the validity of competency assessment tools for 2 applications of critical care ultrasound and data on live versus video raters.
PMID: 26692968
ISSN: 1949-8357
CID: 2041892

Critical care ultrasound skill and knowledge retention in fellows after an introductory course [Meeting Abstract]

Patrawalla, P; Evans, L; Wise, W; Szyld, D; Shiloh, A; Eisen, L; Mayo, P H
RATIONALE: To date, there is a paucity of tools developed in critical care ultrasound (CCUS) training to assess skill mastery and retention in pulmonary/critical care fellows. Regional faculty from multiple New York City-area institutions collaborate annually to teach an intensive, hands-on/didactic CCUS course to fellows. This course was previously shown to increase immediate post-course knowledge and skill1. The purpose of this study was to assess retention of skill, retention of knowledge and attitudes of fellows who have completed this course using a validated assessment tool. METHODS: A modified Delphi method was used to develop a validated assessment tool of CCUS skills. This 2-part assessment included an online multiple-choice test (cognitive skill) and behaviorally-anchored checklists on a standardized patient (technical skill) in 4 areas: safe site for internal jugular access (IJ), DVT study (DVT), pleural ultrasound, and parasternal long axis (PSLA)/parasternal short axis (PSSA) cardiac views. Between March-July 2012, 48 fellows from 4 institutions who attended the course as 1st-year fellows completed a questionnaire and the assessment in the NY Simulation Center for the Health Sciences. RESULTS: Of 48 fellows, nineteen (40%) were women, 38 (79.2%) from pulmonary/critical care and 10 (20.8%) from critical care medicine programs. Fellows were grouped according to time since attending the course: 20 (41.7%) were 6-12 months post-course, 16 (33.3%) were 16-24 months post-course, and 12 (25%) were 30-36 months post-course. Fellows reported ongoing training in ultrasound: 19 (39.6%) didactics, 18 (37.5%) simulation, 32 (66.7%) hands-on training, and 27 (56.3%) reported image review by faculty. Median (IQR) for number of IJ central lines and thoracentesis performed was 50 (40-75) and 20 (10-42), respectfully. Mean score (+/-SD) on the cognitive exam was 81.5 (+/-9.8) and did not differ across groups. The percentage of fellows achieving competency in technical skills differed for each task: 47 (97.9%) for IJ, 3 (6.3%) for DVT, 40 (83.3%) for pleural, 39 (81.3%) for PSLA, 33 (68.8%) for PSSA. These findings did not differ significantly across groups. CONCLUSIONS: This study shows high levels of competency in commonly-performed procedures (IJ and pleural) early in training with skill maintenance at 3 years. However, early skill decay was seen for DVT studies despite a range of ongoing curricular activities. Ongoing methods of formative assessment are needed to accurately assess achievement and maintenance of competency in critical care ultrasound
ISSN: 1073-449x
CID: 1769012