Feasibility and Reliability of Nonexpert POCUS for Cardiovascular Preparticipation Screening of Varsity Athletes: The SHARP Protocol.

BACKGROUND: Point of care ultrasound (POCUS) is a potential adjunctive cardiovascular preparticipation screening modality for young competitive athletes. A novel cardiac POCUS screening protocol, Screening the Heart of the Athlete Research Program (SHARP), was developed for nonexpert examiners to assess common structural etiologies associated with sudden cardiac arrest/death (SCA/D). METHODS: Assessment of primary outcomes of feasibility, and reliability of obtained measurements, performed by comparison to formal transthoracic echocardiogram was undertaken. Inter-rater reliability was based on Intraclass correlation coefficients (ICC) defined as moderate for 0.40 to 0.59, good for 0.60 to 0.79, and excellent for 0.80 or greater. Electrocardiograms (ECGs) were also obtained. Identification of disease or other abnormalities was a secondary outcome. RESULTS: Fifty varsity athletes at our institution underwent the SHARP protocol, with 19 undergoing formal transthoracic echocardiogram and ECG for comparison. POCUS image quality was good to excellent. Feasibility of assessing for hypertrophic cardiomyopathy, aortic root dilatation, and left-ventricular function was deemed highly possible but limited in 20% for right-ventricular assessment. Reliability was good for measurements of interventricular septal thickness (0.67), end diastolic left-ventricular diameter (0.61), aortic root diameter (0.63), and moderate for left-ventricular posterior wall thickness (0.42). No cardiovascular abnormalities were detected. CONCLUSIONS: A novel, comprehensive SHARP POCUS protocol performed by nonexpert practitioners demonstrated feasibility and reliability to assess varsity level athletes for common structural etiologies associated with SCA/D. Further large athlete screening cohort studies are required to validate the SHARP protocol and the role of cardiac POCUS as a screening modality.

Effect of a review course on emergency medicine residents' self-confidence.

OBJECTIVES: Several organizations offer review courses designed to guide final-year (postgraduate year five) residents' study for their certification examination. The effect of these courses on residents' confidence is unknown. Self-confidence has been positively linked with examination performance. The present study measures the impact of a review course on fifth-year emergency medicine residents' overall confidence and confidence in their: (i) knowledge and its application; (ii) planned study strategies to master the knowledge/application; and (iii) recognition that mastery of knowledge/application had been achieved. METHODS: Before/after study. Over the initial 2 years, 46 postgraduate year five residents from all 12 Canadian emergency medicine programmes attended the course. They prospectively completed a pre-/post-course questionnaire on the above-listed aspects of self-confidence, for each of 22 clinical domains. A 5-point Likert-type scale was used for each question. Pre-/post-course means were compared using t-tests for matched pairs. RESULTS: Data were complete for 36 participants (78%). The course significantly increased residents' overall self-confidence (mean difference 0.38, standard error of the mean [SEM] 0.06, P < 0.001), confidence in knowledge/application (mean difference 0.28, SEM 0.06, P < 0.001), in their study strategies to master knowledge/application (mean difference 0.48, SEM 0.08, P < 0.001) and in their recognition of knowledge/application mastery (mean difference 0.45, SEM 0.11, P < 0.001). Domains showing increased self-confidence did not match domains specifically addressed in the course, suggesting that the course effects extend beyond the selected topics. CONCLUSIONS: A review course increased emergency medicine residents' self-assessed confidence in their knowledge/application, in their study strategies and in their recognition of mastery, beyond the course specifics.