Cloud-based supervision of training in focused cardiac ultrasound - A scalable solution?

Increasing demand for training in focused cardiac ultrasound (FCU) is constrained by availability of supervisors to supervise training on patients. We designed and tested the feasibility of a cloud-based (internet) system that enables remote supervision and monitoring of the learning curve of image quality and interpretative accuracy for one novice learner.

After initial training in FCU (iHeartScan and FCU TTE Course, University of Melbourne), a novice submitted the images and interpretation of 30 practice FCU examinations on hospitalised patients to a supervisor via a cloud-based portal. Electronic feedback was provided by the supervisor prior to the novice performing each FCU examination, which included image quality score (for each view) and interpretation errors. The primary outcome of the study was the number of FCU scans required for two consecutive scans to score: (i) above the lower limit of acceptable total image quality score (64%), and (ii) below the upper limit of acceptable interpretive errors (15%).

The number of FCU practice examinations required to meet adequate image quality and interpretation error standard was 10 and 13, respectively. Improvement in image acquisition continued, remaining within limits of acceptable image quality. Conversely, interpretive in-accuracy (error > 15%) continued.

This electronic FCU mentoring system circumvents (but should not replace) the requirement for bed-side supervision, which may increase the capacity of supervision of physicians learning FCU. The system also allows real-time tracking of their progress and identifies weaknesses that may assist in guiding further training.