Abstract
The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ). We were unable to find a published curriculum to deliver education for this at any skill level. Therefore, we developed, delivered, and evaluated a curriculum for the assessment of TRJ for novice physician sonographers. We designed an educational intervention for novice physician sonographers. The curriculum was created using a modified Delphi methodology. All novice sonographers participated in the educational intervention which consisted of a didactic lecture followed by hands-on-deliberate practice on healthy medical student volunteers with expert feedback in a simulated setting. Sonographer's knowledge was assessed at 3 time points: pre-intervention, immediately post-intervention, and 3 months post-intervention (retention assessment) by multiple choice exam. Nine novice physician sonographers participated in the intervention. Mean exam performance increased from 55.6% [standard deviation (SD) 11.3%] on the pre-intervention exam to 94.4% (SD 7.3%) on the post-intervention exam and 92.9% (SD 12.5%) on the retention exam. The mean improvement between the pre- and post- exam was +38.9% (95% CI 31.8 - 46.0), and between the pre-exam and retention exam +37.1% (95% CI 22.3 - 52.0). Sonographer knowledge of TRJ assessment improved following a brief educational intervention as measured by exam performance. Given the expanding role of POCUS it is increasingly important to provide effective resources for teaching these skills. This work establishes the basis for further study and implementation of our TRJ curriculum.
Highlights
The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ)
Tricuspid regurgitant jet velocity can serve as an estimate for RV systolic pressure by using the simplified Bernoulli equation: RV systolic pressure = 4V2 + estimated right atrial pressure, where V is the peak TRJ velocity [4]
We created a curriculum for evaluation of RV pressure by POCUS assessment of tricuspid regurgitant jet velocity (TRJV) that was delivered to a group of novice physician sonographers
Summary
The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ). We developed, delivered, and evaluated a curriculum for the assessment of TRJ for novice physician sonographers. Conclusion: Sonographer knowledge of TRJ assessment improved following a brief educational intervention as measured by exam performance. Completing a fellowship is one way to gain this knowledge, it is likely that general Emergency Medicine physicians might have interest in developing this competency In addition to these policy statements, there has been interest in emergency physicians’ ability to assess for pulmonary hypertension in the Emergency Department (ED) setting. A case series emphasizes the importance of cardiac POCUS with 8 pediatric patients who received an initial diagnosis of pulmonary hypertension by ED evaluation [6]
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