Evaluation of an advanced critical care echocardiography program: a mixed methods study

Area of Science:

• Medical Education
• Critical Care Medicine
• Diagnostic Imaging

Background:

• Advanced critical care echocardiography (CCE) training programs for intensivists are under-documented.
• Understanding factors influencing CCE training program success is crucial for improving intensivist skills.

Purpose of the Study:

• To describe a longitudinal echocardiography training program for critical care fellows and faculty.
• To investigate the impact of supervision models (distributed conditional vs. predefined en-bloc) and an optional echocardiography laboratory rotation on learner engagement and progress.

Main Methods:

• A mixed-methods study involving critical care fellows and faculty from five ICUs (July 2015-July 2018).
• The program included theoretical lectures and practical sessions, with modifications to supervision and the addition of an echo lab rotation after the first year.
• Semistructured interviews were conducted, and progress toward portfolio completion (150 transthoracic echocardiograms) was analyzed using a Bayesian framework.

Main Results:

• Sixty-five learners enrolled; 18 were interviewed. Only 9% completed the required echocardiogram portfolio.
• Key barriers identified by learners included lack of time, insufficient supervision, and skill complexity.
• Conditional supervision was linked to a higher rate of unsupervised echocardiogram submission (rate ratio, 1.11) compared to unconditional supervision. An echo lab rotation led to a decrease in unsupervised echocardiogram submissions.

Conclusions:

• Trainees identified lack of time and supervision access as significant barriers to completing the CCE training program.
• Portfolio completion success was not solely dependent on protected time in the echo lab or unconditional direct supervision.
• Further investigation is required to elucidate the specific factors that promote the success of advanced critical care echocardiography training programs.