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1.  Objective structured assessment of technical competence in transthoracic echocardiography: a validity study in a standardised setting 
BMC Medical Education  2013;13:47.
Background
Competence in transthoracic echocardiography (TTE) is unrelated to traditional measures of TTE competence, such as duration of training and number of examinations performed. This study aims to explore aspects of validity of an instrument for structured assessment of echocardiographic technical skills.
Methods
The study included 45 physicians with three different clinical levels of echocardiography competence who all scanned the same healthy male following national guidelines. An expert in echocardiography (OG) evaluated all the recorded, de-identified TTE images blindly using the developed instrument for assessment of TTE technical skills. The instrument consisted of both a global rating scale and a procedure specific checklist. Two scores were calculated for each examination: A global rating score and a total checklist score. OG rated ten examinations twice for intra-rater reliability, and another expert rated the same ten examinations for inter-rater reliability. A small pilot study was then performed with focus on content validity. This pilot study included nine physicians who scanned three patients with different pathologies as well as different technical difficulties.
Results
Validity of the TTE technical skills assessment instrument was supported by a significant correlation found between level of expertise and both the global score (Spearman 0.76, p<0.0001) and the checklist score (Spearman 0.74, p<0.001). Both scores were able to distinguish between the three levels of competence that were represented in the physician group. Reliability was supported by acceptable inter- and intra-rater values. The pilot study showed a tendency to improved scores with increasing expertise levels, suggesting that the instrument could also be used when pathologies were present.
Conclusions
We designed and developed a structured assessment instrument of echocardiographic technical skills that showed evidence of validity in terms of high correlations between test scores on a normal person and the level of physician competence, as well as acceptable inter- and intra-rater reliability scores. Further studies should, however, be performed to determine the adequate number of assessments needed to ensure high content validity and reliability in a clinical setting.
doi:10.1186/1472-6920-13-47
PMCID: PMC3621521  PMID: 23537204
Transthoracic echocardiography; Echocardiography; Assessment; Ultrasound; Global rating; Checklist
2.  Limited intervention improves technical skill in focus assessed transthoracic echocardiography among novice examiners 
BMC Medical Education  2012;12:65.
Background
Previous studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE) and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation.
Methods
Twenty-one physicians with no previous training in FATE or echocardiography (Novices) participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts) was included. Novices received an initial theoretical and practical introduction (2 hours), after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation) of the same two healthy volunteers from the baseline examination was performed.
Results
At baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005). 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4) and mean global image rating after intervention was 75.0 (CI 72.9-77.0), p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9).
Conclusions
Improvement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.
doi:10.1186/1472-6920-12-65
PMCID: PMC3477018  PMID: 22863138
Point-of-care; Bedside; Ultrasound; Echocardiography; Learning
3.  Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - A randomised, controlled simulation study of two micro-interventions 
Background
Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork.
Aim
To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio.
Methods
Participants: 46 physicians graduated within 5 years. Design: A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer.
Results
Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action".
Conclusion
Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment.
doi:10.1186/1757-7241-19-15
PMCID: PMC3061934
4.  Generalizability of a Composite Student Selection Procedure at a University-Based Chiropractic Program 
Purpose:
Non-cognitive admission criteria are typically used in chiropractic student selection to supplement grades. The reliability of non-cognitive student admission criteria in chiropractic education has not previously been examined. In addition, very few studies have examined the overall test generalizability of composites of non-cognitive admission variables in admission to health science programs. The aim of this study was to estimate the generalizability of a composite selection to a chiropractic program, consisting of: application form information, a written motivational essay, a common knowledge test, and an admission interview.
Methods:
Data from 105 Chiropractic applicants from the 2007 admission at the University of Southern Denmark were available for analysis. Each admission parameter was double scored using two random, blinded, and independent raters. Variance components for applicant, rater and residual effects were estimated for a mixed model with the restricted maximum likelihood method. The reliability of obtained applicant ranks (generalizability coefficients) was calculated for the individual admission criteria and for the composite admission procedure.
Results:
Very good generalizability was found for the common knowledge test (G=1.00) and the admission interview (G=0.88). Good generalizability was found for application form information (G=0.75) and moderate generalizability (G=0.50) for the written motivation essay. The generalizability of the final composite admission procedure, which was a weighted composite of all 4 admission variables was good (Gc = 0.80).
Conclusion:
Good generalizability for a composite admission to a chiropractic program was found. Optimal weighting and adequate sampling are important for obtaining optimal generalizability. Limitations and suggestions for future research are discussed.
PMCID: PMC2670237  PMID: 19390678
Education; Educational Measurement; College Admission Test; School Admission Criteria

Results 1-4 (4)