Criteria, Processes, and Determination of Competence in Basic Critical Care Echocardiography Training: A Delphi Process Consensus Statement by the Learning Ultrasound in Critical Care (LUCC) Initiative


Arvind Rajamani, University of Sydney Nepean Clinical School, Intensive Care Medicine, Kingswood, NSW, Australia; Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia. Electronic address:
Laura Galarza, Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain.
Filippo Sanfilippo, Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco," Catania, Italy.
Adrian Wong, Department of Critical Care, King's College Hospital, London, UK.
Alberto Goffi, Department of Critical Care Medicine and Li Ka Shing Knowledge Institute, St. Michael's Hospital Toronto, Toronto, ON, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Pieter Tuinman, Department of Intensive Care Medicine, Amsterdam University Medical Centers VUmc, Amsterdam, The Netherlands; Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Paul Mayo, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY; Department of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center, New Hyde Park, NY.
Robert Arntfield, Division of Critical Care, Department of Medicine, Western University, London, ON, Canada.
Richard Fisher, Department of Critical Care, King's College Hospital, London, UK.
Michelle Chew, Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Michel Slama, Medical Intensive Care, DRIME Department, University Hospital of Amiens, Amiens, France.
David Mackenzie, Department of Emergency Medicine, Maine Medical Center, Portland, ME.
Eunise Ho, Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China.
Louise Smith, Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia.
Markus Renner, Department of Intensive Care Medicine, Dunedin Hospital, Dunedin, New Zealand; Otago University, New Zealand.
Miguel Tavares, Department of Anesthesiology and Critical Care, Hospital Geral de Santo António, Porto, Portugal.
Natesh Prabu R, Department of Critical Care Medicine, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
Kollengode Ramanathan, Cardiothoracic Intensive Care Unit, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Sebastian Knudsen, Royal Perth Hospital, Perth, WA, Australia.
Vijeth Bhat, John Hunter Hospital, Intensive Care Unit, New Lambton Heights, NSW, Australia.
Hemamalini Arvind, University of Sydney.
Stephen Huang, University of Sydney Nepean Clinical School, Intensive Care Medicine, Kingswood, NSW, Australia.

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Clinical Competence; Critical Care (standards); Curriculum; Delphi Technique; Echocardiography (standards); Education, Medical, Graduate; Evidence-Based Medicine; Guidelines as Topic; Humans


BACKGROUND: With the paucity of high-quality studies on longitudinal basic critical care echocardiography (BCCE) training, expert opinion guidelines have guided BCCE competence educational standards and processes. However, existing guidelines lack precise detail due to methodological flaws during guideline development. RESEARCH QUESTIONS: To formulate methodologically robust guidelines on BCCE training using evidence and expert opinion, detailing specific criteria for every step, we conducted a modified Delphi process using the principles of the validated AGREE-II tool. Based on systematic reviews, the following domains were chosen: components of a longitudinal BCCE curriculum; pass-grade criteria for image-acquisition and image-interpretation; and formative/summative assessment and final competence processes. STUDY DESIGN AND METHODS: Between April 2020 and May 2021, a total of 21 BCCE experts participated in four rounds. Rounds 1 and 2 used five web-based questionnaires, including branching-logic software for directed questions to individual panelists. In round 3 (videoconference), the panel finalized the recommendations by vote. During the journal peer-review process, Round 4 was conducted as Web-based questionnaires. Following each round, the agreement threshold for each item was determined as ≥ 80% for item inclusion and ≤ 30% for item exclusion. RESULTS: Following rounds 1 and 2, agreement was reached on 62 of 114 items. To the 49 unresolved items, 12 additional items were added in round 3, with 56 reaching agreement and five items remaining unresolved. There was agreement that longitudinal BCCE training must include introductory training, mentored formative training, summative assessment for competence, and final cognitive assessment. Items requiring multiple rounds included two-dimensional views, Doppler, cardiac output, M-mode measurement, minimum scan numbers, and pass-grade criteria. Regarding objective criteria for image-acquisition and image-interpretation quality, the panel agreed on maintaining the same criteria for formative and summative assessment, to categorize BCCE findings as major vs minor and a standardized approach to errors, criteria for readiness for summative assessment, and supervisory options. INTERPRETATION: In conclusion, this expert consensus statement presents comprehensive evidence-based recommendations on longitudinal BCCE training. However, these recommendations require prospective validation.

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