Abstract
ObjectiveShock is a common emergency condition with high morbidity and mortality, and judicious fluid resuscitation can significantly affect outcomes. The use of a bedside echocardiogram and evaluation of the inferior vena cava (IVC) via ultrasound (US) for collapsibility can predict volume status. Additionally, the Association of American Medical Colleges (AAMC) Entrustable Professional Activities (EPA) 10 states that residents need to be able to address a patient with a critical illness, including hypotension, on Day 1 of residency. Existing literature revealed no published curriculum to teach medical students these skills. We aimed to determine the effectiveness of an educational intervention to teach fourth-year medical students how to utilize IVC US measurement and echocardiography to assist in volume assessment of patients presenting with shock.MethodsStudents participated in an hour session on the first day of the emergency medicine (EM) clerkship. Didactic effectiveness was evaluated by comparing results on a pre-test and post-test. The test was administered to residents and attendings during the first week of the academic year to gain evidence for content validity. Students also responded to a survey to evaluate learner satisfaction.ResultsThe average score on the validation test was 68.4% (standard deviation (SD): 21.6%, number (n) = 38) for residents and attendings, and 47.4% (SD: 19.4, n = 13) for interns. Students scored an average of 45.6% (SD: 23.6, n = 83) on the pre-test and 66.4% (SD: 22.1 n = 72) on the post-test, p < 0.01 (degrees of freedom (df) = 153, t = 5.7), Cohen's d = 0.92. The satisfaction survey showed 97.6% of students felt the session was worthwhile, 96.4% would recommend it to other students, and 83.1% felt it taught new information.ConclusionThese results show that the educational intervention provides a significant increase in knowledge regarding volume assessment and the use of echocardiogram and IVC US. Additionally, students rated the course highly and felt that it provided information not otherwise taught in medical school. This curriculum addresses the AAMC EPA 10, as it increases students’ readiness to address hypotension and could add significant value to the medical school curriculum.
Highlights
Shock is a common, high-risk emergent condition, and accurate volume assessment, informing resuscitation strategy, can significantly affect outcomes [1]
The satisfaction survey showed 97.6% of students felt the session was worthwhile, 96.4% would recommend it to other students, and 83.1% felt it taught new information. These results show that the educational intervention provides a significant increase in knowledge regarding volume assessment and the use of echocardiogram and inferior vena cava (IVC) US
High-risk emergent condition, and accurate volume assessment, informing resuscitation strategy, can significantly affect outcomes [1]. This is clearly illustrated in the case of septic shock, a leading cause of death in emergency department patients [1]
Summary
High-risk emergent condition, and accurate volume assessment, informing resuscitation strategy, can significantly affect outcomes [1]. This is clearly illustrated in the case of septic shock, a leading cause of death in emergency department patients [1]. The most recent evidence shows that early goal-directed therapy (EGDT) does not improve mortality over “usual care” but aggressive fluid resuscitation remains a mainstay of treatment [2,3,4]. A core component of EGDT, has not been shown to correlate with fluid responsiveness [6]. Dynamic inferior vena cava (IVC) measurement via ultrasound (US) has been shown to predict an increase in cardiac output in response to a fluid bolus in mechanically ventilated [7,8,9,10,11] and spontaneously breathing patients [12,13]
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