Resident PGY 4
Henry Ford Hospital
Background: Perioperative Point-of-Care Ultrasound (POCUS) of the heart and lungs has increasingly become commonplace for the assessment of the cardiovascular and hemodynamic status in the operating room theatre. The body of literature citing the benefits of the use of perioperative POCUS is vast, although most authors agree that the implementation of this skill has been hindered mostly by lack of formal training among anesthesiologists. The purposes of this study were to establish whether implementing a curriculum of perioperative POCUS of heart and lungs for current in-training anesthesia residents during their required month of cardiac anesthesia was feasible, and whether an evaluation tool would show improvement in the residents’ baseline knowledge of POCUS.
Methods: We performed a prospective, cohort, observational, single-center study involving anesthesia residents during their third post-graduate training year, undergoing their required cardiac anesthesia rotation, from July 2017 to November 2018. The main intervention of our study was to implement a curriculum to educate anesthesia residents in perioperative POCUS of the heart and lungs on patients undergoing elective cardiothoracic procedures for a four-week period. Data collected from the subjects recruited, included assessing prior training on TTE and level of expertise, and prior rotations in the intensive care unit. A 21-question, multiple-choice, electronic-generated test was developed to gauge performance improvement before (“pre-test”) and after (“post-test”) the four-week period. This exam was validated by emergency room physicians with a fellowship in ultrasound, that took the exam. The primary outcome of our study was to demonstrate improvement in baseline knowledge in perioperative POCUS of the heart and lungs between both tests. The authors qualified improvement if the subject was able to demonstrate score enhancement between the pre-test and the post-test. Additionally, the authors qualified as significant improvement those subjects who were able to obtain more than 60% score in the post-test and an increase of 25% when compared with the pre-test. Official approval from our Institutional Board Review committee was obtained prior initiation of this study.
Results: Out of the 16 residents, 13 of them (81.3%), showed improved score between the pre-test and post-test, after the four-week period of the rotation. The difference between pre-test and post-test mean score was 5 (P = 0.001). Ten of the residents that enhanced their score between the pre-test and the post-test (n=10 out of 13, 77%), showed significant improvement in our study. This suggests that the application of the curriculum was successful, and the examination was able to accurately discriminate knowledge improvement among the subjects.
Conclusion: In summary, this study demonstrates that integrating a curriculum dedicated to perioperative POCUS, as part of the goals and objectives during the rotation of cardiac anesthesia is achievable, and that anesthesia residents who received the training proposed by the authors improved their cognitive and technical POCUS skills, although further research with larger study population is required to substantiate these findings. Ultimately, the aim would be to empower the future anesthesiologists to utilize TTE into their routine practice in order to improve patient outcomes.
Navas-Blanco, Jose R. and Sanders, Joseph A, "Incorporating Perioperative POCUS as part of the Anesthesia Residency Curriculum" (2019). Teaching and Education. 9.