Echographiste en quelques heures ?

Limited intervention improves technical skill in focus assessed transthoracic echocardiography among novice examiners.

Frederiksen et al. BMC Med Educ. 2012 Aug 3;12:65

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La généralisation de l'échographie est une avancée majeure. Mais comment apprendre ? La pratique de l'échographie ciblée se développe notamment en médecine d'urgence. A côté des formations classiques de type DU existent de nombreuses formations de courte durée, certaines de quelques heures. Le travail présenté met en évidence qu'un tel type de formation permet une manipulation relativement fiable des équipements et l'obtention de coupes sonographiques propres à être interprétées. On notera que ceci est obtenu A CONDITION qu'au moins 10 examens supervisés soient conduits, ce qui n'est souvent pas fait avec suffisamment de rigueur dans ce que nous pouvons proposer actuellement. Par ailleurs voir et interpréter de manière fiable ne sont pas superposables (1). 

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BACKGROUNDS:

Previous studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE) and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation.

METHODS:

Twenty-one physicians with no previous training in FATE or echocardiography (Novices) participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts) was included. Novices received an initial theoretical and practical introduction (2 hours), after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation) of the same two healthy volunteers from the baseline examination was performed.

RESULTS:

At baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005). 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4) and mean global image rating after intervention was 75.0 (CI 72.9-77.0), p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9).

CONCLUSIONS:

Improvement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.