Quantitative Feedback Facilitates Acquisition of Skills in Focused Cardiac Ultrasound

With the development of portable, affordable ultrasound machines with good image quality, many physicians have adopted focused cardiac ultrasound (FoCUS). To facilitate acquisition of these skills, we developed a simulator-based, self-taught curriculum for FoCUS that provides immediate feedback for rapid performance improvement.

Twenty-two first-year residents participated in the study. The curriculum consisted of instructive modules teaching image acquisition and interpretation of standard echocardiography views and common cardiac pathology, 7 practice cases in which participants scanned a mannequin using a mock transducer, acquired specified views with feedback provided by visual guidance technology, and interpreted these images. Trainees were tested pretraining and posttraining on different cases, without visual guidance assistance or feedback. Previously validated metrics were used to assess psychomotor skill in terms of the angle error in degrees between the planes of the optimal view, defined anatomically, and of the acquired view, as well as cognitive skill in image interpretation.

The average error in image acquisition decreased from a median of 81 degrees at the pretest to 28 degrees after training (P < 0.0001). Cognitive skill improved by 29% (21%, P < 0.0001). There was a significant correlation between cognitive and psychomotor skill (r = 0.64, P < 0.001).

A novel, simulator-based curriculum that provides immediate feedback was effective in teaching both psychomotor and cognitive skills in FoCUS without need for direct expert oversight of the learner. The curriculum's components provide a useful tool that can be applied to improve, assess, and monitor physician skill in FoCUS.