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Volume 30 2014
fit comfortably into a physician’s lab coat. Recently, studies to
educate both medical students and internal medicine residents
have shown promising results. The optimal duration and
methodology for teaching HHCU skills has not been estab-
lished. Our objective was to assess the effectiveness of two
condensed educational programs occurring over a single
clinical rotation to teach internal medicine residents diagnostic
and technical skills of HHCU.
METHODS: Over a one-year period, internal medicine residents
were recruited during their cardiology ward rotation into a
single-centre, non-blinded, randomized trial. The two
condensed teaching strategies were: a conventional ward-based
program and a technology driven (simulation-based) strategy.
In the conventional group, residents were given one hour of
ward-based teaching for a total of 4 sessions. Residents in the
technology arm of the study also completed 4 teaching ses-
sions, but used only an online module-based education pro-
gram and a virtual trainer (CAE Healthcare, Québec).
Outcomes were evaluated using both a). An OSCE to evaluate
interpretation ability (assessing both Type I and Type II error
rates) and b). Demonstration of HHCU acquisition skills
graded by two Level-III echocardiographers.
RESULTS: Twenty-four internal medicine residents were
recruited (13 in the conventional and 11 in the technology
arm). Characteristics and baseline ability to interpret
HHCU images were similar. After teaching, the conven-
tional group had a significant relative increase in the ability
to make a singular correct diagnosis (156%, p<0.001). In
the technology arm, making a singular correct diagnosis
increased 169% from baseline (p¼0.001). Interpretation
skill was not significantly different between groups (Table
1). Both groups, however, significantly increased their false-
positive rate (type II error), from 30% to 44% (p¼0.079)
and from 29% to 45% (p¼0.008). Lastly, diagnostic
quality ultrasound images were more likely to be acquired
from participants in the conventional ward-based program
(53.8%) than in the technology-driven group (13.6%,
p¼0.006).
CONCLUSION: Our findings suggest that HHCU interpreta-
tion and acquisition skills improve following both a con-
ventional ward-based and technology-driven approach.
However, our study emphasizes the important limitations
of simulation-based teaching of HHCU skills since acqui-
sition skill was superior following conventional ward-based
teaching. Lastly, we detected a significant increase in the
false positive rate following both teaching programs. This
suggests that a short duration of training may not be suf-
ficient for HHCU to be performed in a safe and appropriate
manner.
Canadian Journal of Cardiology
503
COMPETENCY-BASED EDUCATION IN CARDIOLOGY: IS IT TIME?
E Yu, P Nair, M Sibbald, P Dorian
Toronto, Ontario
BACKGROUND: Mastering the basic skills required to
practice cardiology is becoming harder as the curriculum
expands with more emphasis on non-medical expert
roles, increasing work hour restrictions and technologic
growth in the field with the advent of newer modalities
for investigation of cardiac disease. Recent observations
from formal assessments at end of training have sug-
gested that competency and proficiency in skills such as
ECG and echocardiographic interpretation may be
suboptimal.
The purpose of this study is to identify whether residents
perceive gaps in training, and whether current training models
provide residents with the requisite tools to function as an
independent consultant.
METHODS: We surveyed current and recent graduates of
adult cardiology training programs in Canada, between
academic years 2010-2014, using a survey administered by
the Canadian Cardiovascular Society. A total of 425 sur-
veys were sent via email, and 110 responses were received.
Demographics of respondents were as follows: male gender
73%; training program located in Eastern Canada 67%;
training program size: small (1-9 residents): 10%; medium
(10-19 residents) 56%; and large (>20 residents) 34%.
Procedural and diagnostic test interpretation and perfor-
mance by residents were recorded; as well as the optimum
number residents believed were important in their
training. The resident’s self rated level of competency and
proficiency in performance and interpretation were also
recorded.
RESULTS: The residents’ self-report of procedural and diag-
nostic testing volumes as well as their perceived minimum
exposure to achieve competency and proficiency are presented
in the following table.
Graduating residents and recent graduates rated their level
of competency and proficiency high or extremely high for:
cardioversion (71%); pericardiocentesis (62%); right heart
catheterization (57%); temporary transvenous pacemaker
(58%); echocardiographic interpretation (52%); ECG
interpretation (47%) and exercise stress test interpretation
(42%). Areas where the greatest percentage of graduating
residents and recent graduates rated their competency and
proficiency as poor to low included: pacemakers and de-
vices interpretation (24%); myocardial perfusion image
interpretation (31%); and holter monitor interpretation
(24%).
CONCLUSION: Areas that received low ratings of perceived
competency and proficiency in performance directly correlates
with the amount of dedicated time allocated for training in
these domains. Given the identification of such potential gaps
in knowledge, current traditional Methods of cardiology
training should be reassessed.
Abstracts
504
INTERIM PERFORMANCE METRICS OF AN INNOVATIVE,
WEB-BASED CANADIAN JOURNAL OF CARDIOLOGY
KNOWLEDGE DISSEMINATION PLATFORM
M McGillion, L Pilote, E Jolicoeur, H Arthur, S O’Keefe-McCarthy,
K Dallessio, S Oliver, R Kinch, J Parker, S Carroll, S Nattel
Hamilton, Ontario
BACKGROUND: As survival rates from coronary artery disease (CAD)
increase, the prevalence of persistent cardiac pain-related conditions is
on the rise. Our aim was to disseminate a web-based, multi-media
resource centre for persistent cardiac pain, CardiacPain.Net, as a
prototype for large-scale knowledge dissemination; partners included
Elsevier, the Canadian Journal of Cardiology, the Canadian Cardio-
vascular Society, the Heart and Stroke Foundation, the Canadian
Pain Coalition and Argyle Communications.
METHODS: CardiacPain.Net was based on the Canadian Institutes
of Health Research (CIHR) knowledge to action cycle as well as
the CIHR framework for citizen engagement. Substantive content
for dissemination via CardiacPain.Net was designed to tailor
specific aspects of knowledge inquiry, synthesis, and product tools
(e.g. clinical practice guidelines, diagnostic phenotype criteria).
Affected citizens were engaged across all phases of designing ar-
chitecture. Multi-media design features included open access
published resources, narrated video presentations, expert and cit-
izen roundtable discussions, downloadable fact sheets, and an
asynchronous discussion forum. Dissemination strategies included
opt-in email blasts to Elsevier subscribers (n¼ 95,000) every 3
months, online banner advertising, LinkedIn and Google adver-
tizing, and mass social media including Twitter and Facebook.
Accreditation of CardiacPain.Net for continuing medical educa-
tion in Canada and United States was secured to maximize
incentive for end-user uptake. Standard dissemination metrics
included total site visits and components visited and downloaded.
Customized metrics included unique and return visitor rates,
bounce rate, stream views, unique end-user tracking, social media
trends, and geo-targeting. All metrics were analyzed in aggregate
and distributions were examined for outliers and monthly trends.
RESULTS: Interim examination of dissemination metrics found
that in 3 months since initial launch CardiacPain.Net has had
2,549 total visits, 1,913 unique visits, and 5,418 page views.
Specific multimedia presentations and open access resources
were viewed and downloaded 414 and 413 times, respectively.
Unique and return visitor rates were 71.1% and 28.9%
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respectively with a bounce rate of 47%. Twitter constituted 75%
of all social media interactions (n¼ 124) featuring CardiacPain.
Net content. Geo-targeting analyses found that unique end-users
spanned 25 countries across 5 continents.
CONCLUSION: Our interim 3-month analyses suggest that as a
large-scale knowledge dissemination prototype, CardiacPain.Net is
capable of being far reaching and engaging to end users seeking
knowledge on persistent forms of cardiac pain. Linear and Poisson
regression analyses at 6 and 12 months follow up are required to
determine the influence of design features, region of origin, and
operating systems on customized dissemination metrics.
CIHR
505
CARDIAC SURGERY BOOT CAMP: DO NEW RESIDENTS
PROVIDE SAFE CARE?
AB Fagan
Halifax, Nova Scotia
BACKGROUND: Limited duty hours and concerns over patient safety
are forcing medical educators to rethink our current apprenticeship
based training model. “Boot camps”, offered early on in training are
designed to quickly bring trainees to a basic level deemed necessary
to safely care for patients. In an effort to best make use of this time
and ensure that we are meeting the goals of producing safe cardiac
surgery residents we surveyed medical and nursing staff.
METHODS: Surveys were distributed to staff surgeons, nurses on
the ward, residents and recent graduates. Surveys varied slightly
between groups, but questions were designed around the same
basic themes; safety, important medical issues and communica-
tion. The surveys for medical staff also contained additional
questions pertaining to technical aspects of training.
RESULTS: The survey had a 67% response rate. Sixty-seven percent
of staff surgeons felt that new residents could safely cover the ward as
the sole person on call, whereas only 31% of nursing staff felt that
junior residents provided safe coverage, even with an in house senior
on duty. Atrial fibrillation, respiratory distress, unstable hemody-
namics and delirium were consistently identified by all groups as
critical for the PGY1 to be able to manage. Nursing staff identified
delirium, pain, atrial fibrillation and respiratory distress as poorly
handled issues by new residents. Nurses identified lack of consul-
tation with senior residents and staff, failure to adequately assess
patients, poor presence on wards, poor communication/dismissive
of nursing opinions, and lack of knowledge of routine practices as
potential contributors to unsafe care.
CONCLUSION: The survey suggests important differences may
exist in what medical and nursing staff perceive as safe care.
Although all groups identified similar medical issues as
important areas for the PGY1 to master, nursing staff felt
some of these are handled poorly by junior residents. In
addition, commonly identified contributors to unsafe care
were often unrelated to medical knowledge and more related
to poor service orientation and ability to function in a large
team and as such amenable to change and should be part of
newly established “boot camps”.