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Brief Group Training of Medical Students in Focused Cardiac Ultrasound May Improve Diagnostic Accuracy of Physical Examination - 04/11/14

Doi : 10.1016/j.echo.2014.08.001 
Thomas M. Stokke a, b, c, d, Vidar Ruddox, MD a, e, Sebastian I. Sarvari, MD, PhD b, c, d, Jan E. Otterstad, MD, PhD e, Erlend Aune, MD, PhD e, Thor Edvardsen, MD, PhD, FESC a, b, c, d,
a Faculty of Medicine, University of Oslo, Oslo, Norway 
b Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway 
c Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway 
d Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway 
e Division of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway 

Reprint requests: Thor Edvardsen, MD, PhD, FESC, Oslo University Hospital, Rikshospitalet, Department of Cardiology, Postbox 4950 Nydalen, 0424 Oslo, Norway.

Abstract

Background

Physical examination and auscultation can be challenging for medical students. The aim of this study was to investigate whether a brief session of group training in focused cardiac ultrasound (FCU) with a pocket-sized device would allow medical students to improve their ability to detect clinically relevant cardiac lesions at the bedside.

Methods

Twenty-one medical students in their clinical curriculum completed 4 hours of FCU training in groups. The students examined patients referred for echocardiography with emphasis on auscultation, followed by FCU. Findings from physical examination and FCU were compared with those from standard echocardiography performed and analyzed by cardiologists.

Results

In total, 72 patients were included in the study, and 110 examinations were performed. With a stethoscope, sensitivity to detect clinically relevant (moderate or greater) valvular disease was 29% for mitral regurgitation, 33% for aortic regurgitation, and 67% for aortic stenosis. FCU improved sensitivity to detect mitral regurgitation (69%, P < .001). However, sensitivity to detect aortic regurgitation (43%) and aortic stenosis (70%) did not improve significantly. Specificity was ≥89% for all valvular diagnoses by both methods. For nonvalvular diagnoses, FCU’s sensitivity to detect moderate or greater left ventricular dysfunction (90%) was excellent, detection of right ventricular dysfunction (79%) was good, while detection of dilated left atrium (53%), dilated right atrium (49%), pericardial effusion (40%), and dilated aortic root (25%) was less accurate. Specificity varied from 57% to 94%.

Conclusions

After brief group training in FCU, medical students could detect mitral regurgitation significantly better compared with physical examination, whereas detection of aortic regurgitation and aortic stenosis did not improve. Left ventricular dysfunction was detected with high sensitivity. More extensive training is advised.

Le texte complet de cet article est disponible en PDF.

Highlights

We trained 21 medical students in FCU using a group model.
We examined whether the students improved at bedside diagnosis after 4 hours of training.
LV dysfunction and MR were identified with high sensitivity.
Detection of aortic valve pathology did not improve compared with physical examination.
The group model limited individual scanning time. More extensive training is advised.

Le texte complet de cet article est disponible en PDF.

Keywords : Focused cardiac ultrasound, Pocket sized, Physical examination, Diagnostic accuracy, Medical students

Abbreviations : AR, AS, FCU, LV, MR


Plan


 The study was supported by Centre for Cardiological Innovation, funded by the Research Council of Norway. T.M.S. received a grant from the Medical Student Research Program at the Faculty of Medicine, University of Oslo.


© 2014  American Society of Echocardiography. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 27 - N° 11

P. 1238-1246 - novembre 2014 Retour au numéro
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