Bedside cardiac ultrasound could be taught during residency

By Sarah Guy

Incorporating cardiovascular limited ultrasound exam (CLUE) training for bedside use into the internal medicine residency curriculum is feasible, report US researchers.

"Realizing the widespread potential of ultrasound-assisted physical examination requires the creation of an imaging protocol that can be successfully taught to all physicians within the confines of accredited medical education," suggest Bruce Kimura and colleagues from Scripps Mercy Hospital in San Diego, California.

They add that without such an approach, the potential exists for "excessive diversity in bedside ultrasound practice."

The program employed evidence-based techniques, set proficiency goals, and assessed residents' performance, while minimizing cost by using readily available institutional resources, says the team.

After implementation of CLUE training in their medical curriculum, including 12 monthly 1-hour lectures, once-weekly 1-hour bedside training sessions in an intensive care unit, and the requirement to image a minimum of 30 patients, residents undertook a clinical exercise (CEX) to rate them on image quality, specific knowledge, and diagnostic accuracy.

Kimura and team set a "passing threshold" of 80% and the mean image quality, knowledge, and accuracy scores were 83%, 91%, and 91%, respectively.

CLUE-CEX results did not exert a negative effect on the overall academic performance of the residency among residents, they remark, neither did they note any significant relationship between academic performance and CLUE capabilities.

Residents completed a postgraduation questionnaire that indicated they believed CLUE improved their bedside examination, and that they would use CLUE in the future if it was available.

Writing in the Journal of Hospital Medicine, Kimura et al note that this type of cardiovascular examination is likely to "expand to a more advanced version or become a component of a full-body 'ultrasound-assisted physical.' "

They conclude that despite being subject to the biases of any subjective resident skill assessment, that CLUE-CEX "was easily accomplished using a single form and faculty member, and was an efficient tool for program feedback and development."

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