ECHOCARDIOGRAPHIC INTERPRETATION SKILLS OF GRADUATING CARDIOLOGY TRAINEES: ARE THEY COMPETENT?

Abstract

Echocardiography (echo) is an important diagnostic and prognostic tool for managing patients with cardiac disease. Accurate interpretation of echo images is essential to provide high quality patient care. For decades, competence in echo has been conferred by the attainment of a predefined: (1) number of months of training, and (2) number of echo studies performed and interpreted. There is no information regarding the adequacy of a cardiology resident’s echo interpretation skills at the time of cardiology training program completion. The purpose of this study was to assess the proficiency of graduating cardiology trainees at echo interpretation. Sixty-six trainees within 2.5 months of completing a Canadian cardiology training program participated in voluntary testing. The mean number of months of training was 6.3 (range 5-12) months. 65% of trainees had completed the requisite 6 months of echo training to be eligible for Level 2 certification. Trainees were asked to interpret 14 echocardiographic studies that demonstrated important findings in the following categories: left ventricular (LV) size/function, right ventricular (RV) size/function, valvular abnormalities, pericardial disease, hypertrophic cardiomyopathy (HCM), and congenital heart disease. Images were chosen to be representative of those typically encountered in a community cardiology practice. Trainees were asked to: (1) identify any abnormalities, and (2) provide a corresponding interpretation. Evaluation criteria were pre-determined through the consensus of two experienced echocardiographers, who assembled a list of important and critical abnormalities and interpretations for each set of images. Scoring of trainees responses was blinded to identity and performed independently. The average scores for the accurate identification for each category of echo pathology were: LV size/function 45%; RV size/function 85%; valvular abnormalities 57%; pericardial disease 56%, HCM 17%; and congenital heart disease 52%. The average score for the identification of the predefined critical diagnoses was 68%. The average overall score for the cohort was 57.45% (+/−11.8%). 18.2% of trainees achieved the predefined passing grade of 70%. The ability of trainees trained at and graduating from Canadian cardiology training programs to accurately identify and interpret important abnormalities on echo is suboptimal despite having completed the necessary months of echo training required. These findings demonstrate an urgent need to re-evaluate the current approaches to echo training.