MD London Health Sciences Centre University of Western Ontario London, Ontario, Canada
Background: Current widely used tools for assessment of competency of transthoracic echocardiogram (TTE) interpretations rely on multiple-choice questions and case logs demonstrating achievement of minimum numerical benchmarks. These tools have limited capacity to assess how trainees formulate clinically relevant summary statements. There is an increasing emphasis on utilizing free-text summary statements as a more accurate method of assessing competency in TTE interpretation. However, the inherent variability in free-text summaries composed by trainees and experts creates challenges for developing marking schemes. This study aims to develop a consensus-based marking scheme for TTE summary statements and to determine which items are critical for competency.
METHODS AND RESULTS: A Modified Delphi approach with two rounds of surveys and a consensus finalizing meeting was conducted to establish items that should be included in the summary statement and items critical to fulfill competency. Items related to cardiac structures in general, and those required in specific indications (e.g. hypertrophic cardiomyopathy). We used >80% agreement to define consensus.
Twenty-seven Canadian echocardiography experts provided ratings on the surveys. Eleven experts participated in the consensus finalizing meeting. Through this process, it was established that 79 items should be included in the summary statement (Table 1). Five general items should be included in all summary statements: left ventricular (LV) size, LV systolic function, right ventricular (RV) size and RV function, and a statement about valves. The remaining 74 items should be included in specific indications or if there is an abnormality related to the item. Sixteen items were deemed critical for competency (Table 2). Only LV systolic function was deemed critical to fulfill competency in all summary statements and the remaining 15 items were critical only in specific indications. For example, aortic dimensions were critical for competency only if abnormal. Consensus was also established on 7 items on reporting style.
Conclusion: These findings inform robust, consensus-based marking schemes for TTE summary statements. When integrated into assessments, our findings can improve training and competency in TTE interpretation among cardiology residents.
