The learning curve of sonographic inferior vena cava evaluation by novice medical students: the Pavia experience

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2 Citations (Scopus)

Abstract

Purpose: The sonographic evaluation of inferior vena cava diameters and its collapsibility—that is also defined as the caval index—has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique. Therefore, we designed this study to investigate the learning curve of inferior vena cava evaluation. Methods: We enrolled a sample of ten ultrasound-naïve medical students who received a preliminary training provided by two Junior Emergency Medicine Residents. Following training, each student performed the sonographic task on 25 different patients who were hospitalized in the internal medicine ward. The students’ performance was compared with the results obtained by a consultant in internal medicine with extensive experience in point-of-care ultrasound, who repeated the procedure on the same patients (gold standard). In detail, we evaluated the time to complete the task, the quality of the obtained images, and the ability to visually estimate and measure the caval index. Results: Although most students (9/10) reached the pre-defined level of competence, their overall performance was inferior to the one achieved by the gold standard, with little improvement over time. However, repetition was associated with progressive shortening of the time needed to achieve readable images. Conclusions: Overall, these findings suggest that, although allowing to obtain a pre-defined competence, 25 repetitions are not enough to reach a good level of proficiency for this technique, that needs a longer training to be achieved.

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalJournal of Ultrasound
Volume21
Issue number2
DOIs
Publication statusPublished - Jun 1 2018
Externally publishedYes

Fingerprint

Learning Curve
Inferior Vena Cava
Medical Students
Venae Cavae
Internal Medicine
Students
Mental Competency
Point-of-Care Systems
Central Venous Pressure
Aptitude
Emergency Medicine
Consultants
Learning
Guidelines

Keywords

  • Caval index
  • Inferior vena cava
  • Learning curve
  • Point of care ultrasound
  • Ultrasound for undergraduates

ASJC Scopus subject areas

  • Internal Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

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title = "The learning curve of sonographic inferior vena cava evaluation by novice medical students: the Pavia experience",
abstract = "Purpose: The sonographic evaluation of inferior vena cava diameters and its collapsibility—that is also defined as the caval index—has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique. Therefore, we designed this study to investigate the learning curve of inferior vena cava evaluation. Methods: We enrolled a sample of ten ultrasound-na{\"i}ve medical students who received a preliminary training provided by two Junior Emergency Medicine Residents. Following training, each student performed the sonographic task on 25 different patients who were hospitalized in the internal medicine ward. The students’ performance was compared with the results obtained by a consultant in internal medicine with extensive experience in point-of-care ultrasound, who repeated the procedure on the same patients (gold standard). In detail, we evaluated the time to complete the task, the quality of the obtained images, and the ability to visually estimate and measure the caval index. Results: Although most students (9/10) reached the pre-defined level of competence, their overall performance was inferior to the one achieved by the gold standard, with little improvement over time. However, repetition was associated with progressive shortening of the time needed to achieve readable images. Conclusions: Overall, these findings suggest that, although allowing to obtain a pre-defined competence, 25 repetitions are not enough to reach a good level of proficiency for this technique, that needs a longer training to be achieved.",
keywords = "Caval index, Inferior vena cava, Learning curve, Point of care ultrasound, Ultrasound for undergraduates",
author = "{Di Pietro}, Santi and Francesco Falaschi and Alice Bruno and Tiziano Perrone and Valeria Musella and Stefano Perlini",
year = "2018",
month = "6",
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doi = "10.1007/s40477-018-0292-7",
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T2 - the Pavia experience

AU - Di Pietro, Santi

AU - Falaschi, Francesco

AU - Bruno, Alice

AU - Perrone, Tiziano

AU - Musella, Valeria

AU - Perlini, Stefano

PY - 2018/6/1

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N2 - Purpose: The sonographic evaluation of inferior vena cava diameters and its collapsibility—that is also defined as the caval index—has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique. Therefore, we designed this study to investigate the learning curve of inferior vena cava evaluation. Methods: We enrolled a sample of ten ultrasound-naïve medical students who received a preliminary training provided by two Junior Emergency Medicine Residents. Following training, each student performed the sonographic task on 25 different patients who were hospitalized in the internal medicine ward. The students’ performance was compared with the results obtained by a consultant in internal medicine with extensive experience in point-of-care ultrasound, who repeated the procedure on the same patients (gold standard). In detail, we evaluated the time to complete the task, the quality of the obtained images, and the ability to visually estimate and measure the caval index. Results: Although most students (9/10) reached the pre-defined level of competence, their overall performance was inferior to the one achieved by the gold standard, with little improvement over time. However, repetition was associated with progressive shortening of the time needed to achieve readable images. Conclusions: Overall, these findings suggest that, although allowing to obtain a pre-defined competence, 25 repetitions are not enough to reach a good level of proficiency for this technique, that needs a longer training to be achieved.

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