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Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact

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Waweru-Siika, Wangari ; Barasa, Anders ; Wachira, Benjamin ; Nekyon, David ; Karau, Barbara ; Juma, Fatimah ; Wanjiku, Grace ; Otieno, Harun ; Bloomfield, Gerald S ; Sloth, Erik. / Building focused cardiac ultrasound capacity in a lower middle-income country : A single centre study to assess training impact. I: International Journal of Emergency Medicine. 2020 ; Bind 10, Nr. 3. s. 136-143.

Bibtex

@article{e2ea3cf18bec4adb9ec392b5b5c0fe71,
title = "Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact",
abstract = "Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally.Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa >0.6 indicative of good inter-rater agreement.Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties.Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives.",
keywords = "Capacity building, Focused cardiac ultrasound, Low and middle-income, Training",
author = "Wangari Waweru-Siika and Anders Barasa and Benjamin Wachira and David Nekyon and Barbara Karau and Fatimah Juma and Grace Wanjiku and Harun Otieno and Bloomfield, {Gerald S} and Erik Sloth",
note = "{\textcopyright} 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.",
year = "2020",
month = sep,
day = "10",
doi = "10.1016/j.afjem.2020.04.011",
language = "English",
volume = "10",
pages = "136--143",
journal = "International Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B./Saunders Co",
number = "3",

}

RIS

TY - JOUR

T1 - Building focused cardiac ultrasound capacity in a lower middle-income country

T2 - A single centre study to assess training impact

AU - Waweru-Siika, Wangari

AU - Barasa, Anders

AU - Wachira, Benjamin

AU - Nekyon, David

AU - Karau, Barbara

AU - Juma, Fatimah

AU - Wanjiku, Grace

AU - Otieno, Harun

AU - Bloomfield, Gerald S

AU - Sloth, Erik

N1 - © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.

PY - 2020/9/10

Y1 - 2020/9/10

N2 - Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally.Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa >0.6 indicative of good inter-rater agreement.Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties.Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives.

AB - Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally.Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa >0.6 indicative of good inter-rater agreement.Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties.Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives.

KW - Capacity building

KW - Focused cardiac ultrasound

KW - Low and middle-income

KW - Training

UR - http://www.scopus.com/inward/record.url?scp=85086658354&partnerID=8YFLogxK

U2 - 10.1016/j.afjem.2020.04.011

DO - 10.1016/j.afjem.2020.04.011

M3 - Journal article

C2 - 32923324

VL - 10

SP - 136

EP - 143

JO - International Journal of Emergency Medicine

JF - International Journal of Emergency Medicine

SN - 0735-6757

IS - 3

ER -

ID: 60881824