Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact
Dublin Core
Title
Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact
African Journal of Emergency Medicine
Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact
Subject
Focused cardiac ultrasound
Training
Capacity building
Low and middle-income
Training
Capacity building
Low and middle-income
Description
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 agree-
ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro-
gramme 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 as-
sessed. 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.
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 agree-
ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro-
gramme 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 as-
sessed. 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.
Creator
Wangari Waweru-Siika, Anders Barasa, Benjamin Wachir, David Nekyon, Barbara Karau, Fatimah Juma, Grace Wanjiku, Harun Otieno, Gerald S. Bloomfield, Erik Sloth
Source
https://doi.org/10.1016/j.afjem.2020.04.011
Date
28 April 2020
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Citation
Wangari Waweru-Siika, Anders Barasa, Benjamin Wachir, David Nekyon, Barbara Karau, Fatimah Juma, Grace Wanjiku, Harun Otieno, Gerald S. Bloomfield, Erik Sloth, “Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1820.
African Journal of Emergency Medicine
Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/1820.