A Pilot Feasibility Study of teaching focused cardiac ultrasound to Australian medical students in a structured program

A Pilot Feasibility Study of teaching focused cardiac ultrasound to Australian medical students in a structured program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Pilot Feasibility Study of teaching focused cardiac ultrasound to Australian medical students in a structured program Kyle Shapcott Brooks, Jonathan Barrett, Dean Mckenzie, David Canty This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6771448/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background Focused Cardiac Ultrasound (FCU) has become integrated into undergraduate medicine curricula but has not yet occurred in Australia. The aim of this study was to assess the feasibility of an FCU training program for Australian medical students. Methods Fifteen echo-naïve 2nd year medical students were invited to complete an optional 20-week FCU curriculum consisting of 10 hours of online material and weekly scanning practice on a simulator and hospitalised patients that was not included in their University assessments. Student attendance and course satisfaction were recorded. Assessment of performance and interpretation of FCU on hospitalized patients was performed using agreement of FCU with formal transthoracic echocardiography. Students assessed Left ventricular (LV) function using visual estimation method (VEM), Right ventricular (RV) size by RV: LV size ratio (> 1.0) and presence of pericardial effusion (> 5mm). Results Of the 15 eligible participants 15 enrolled in the course and 14 completed the course. Attendance at weekly tutorials was 71% (range 40–100%) and mean student satisfaction score 84% (range 60–100%) were high. Nine (60%) students performed and reported a mean of 4.2 (range 1–15) FCU scans on patients. Agreement of FCU with TTE for left ventricular systolic function was good (Ƙ 0.74, 0.4–0.90). Low prevalence of other pathologies hindered assessment of agreement. Conclusion An FCU curriculum of 10 hours of on-line learning and 20 weeks of supervised scanning by sonographers was well attended by students who reported good satisfaction and showed good agreement in separating reduced from normal left ventricular systolic function. Echocardiography Education Medical Student Cardiology Ventricular function Figures Figure 1 Figure 2 Figure 3 Background Although there has been a rapid expansion in integration of focused cardiac ultrasound (FCU) into undergraduate medicine curricula, [ 1 – 8 ] uptake has been slow in Australia. At the time of writing there are no available publications of teaching FCU in Australian medical schools. We developed an FCU curriculum for 2nd year medical students that minimises trainer time by providing all theoretical knowledge via an online educational platform (Google Drive). This is supplemented by weekly supervised image acquisition training on an echocardiography simulator (Vimedix™, CAE Healthcare, Montreal, Canada), peer student volunteers and hospitalised patients in small groups. The primary aim of this study is to determine the feasibility of delivering our course. We defined feasibility as > 70% completion rate of online learning materials and attendance at practical sessions and mean student satisfaction score from a self-reported survey. The secondary aim was to assess the ability of students to perform and interpret FCU for discrimination of normal from abnormal left ventricular systolic function, right ventricular dilatation and pericardial effusion. Method Design This prospective observational pilot feasibility study was approved by The Epworth HealthCare Human Research Ethics Committee (EH2017-264) and was performed in accordance with the declaration of Helsinki and the National Statement on Ehtical Conduct in Human Research. Written consent was obtained from all participants and patients. Participants and setting Fifteen 2nd year medical students from the University of Melbourne who attended a full-time clinical rotation at Epworth Hospital (The entire cohort at our clinical school) were offered training in FCU. The course was voluntary, did not contribute to the student’s academic assessment, and students attended in their own time. For pilot data on accuracy, we approached in-patients on the coronary care unit who had received a formal transthoracic echocardiogram within one month. No students had prior training in ultrasound. Curriculum The FCU teaching program was developed by a consultant intensivist (KB) with recognized training and expertise in TTE. Course structure, online videos and student report proformas are made available as appendix 1, 2 and 3 to allow dissemination of the teaching materials at other centres. The curriculum outlined in appendix 1 is aimed at initial learning to both perform and interpret FCU. Our FCU protocol teaches categorical assessment to identify clinically important cardiac pathology. For LV function we teach the Visual Estimation Method (VEM) with categories of normal or mild/moderate/severe pathology. For RV dysfunction we measure the RV:LV size ratio and for valvular pathology we dichotomise assessment grouping normal or mild pathology in contrast to moderate to severe pathology. The dichotomous assessment to identify valvular pathology greater than mild is shown in Table 1 . Table 1 Classification of Valvular Lesions Grading Guide For Students. Valve Grading Guide Mitral Valve Regurgitation Jet area % of LA > 20% or Vena contracta Width > 3mm Stenosis Mean Gradient > 5mmHg or Pressure ½ time > 140mSec Aortic Valve Regurgitation Jet height % of LVOT >25% or Vena Contracta > 3mm Stenosis Peak Velocity > 3m/sec or Valve replacement in situ Pulmonary Valve Regurgitation Obvious Colour flow Doppler regurgitation Stenosis Clear aliasing through valve Tricuspid valve Regurgitation Jet area > 5cm or Vena contracta Width > 7mm Stenosis Impaired valve opening with clear aliasing The knowledge base teaching included approximately 10 hours of online video lectures and supplementary reading material (Appendix 2) that were completed prior to practical teaching. The practical teaching occurred over a period of 6 months. To be adaptable to the students’ busy schedules, weekly practical sessions were offered via an online booking system (Google Calendar). Initially image acquisition was taught under supervision by the intensivist or qualified cardiac sonographer on an ultrasound simulator (Vimedix,TM CAE Healthcare, Montreal, Canada) and this was followed by supervised scanning of fellow students followed by patients once students had gained confidence with obtaining basic views. Students were encouraged to attend weekly. Outcome Measures The primary end-point, feasibility of delivering the course and all associated educational content, was assessed by completion of online learning materials and attendance at weekly practical tutorials. Attendance was recorded by the research staff. At the completion of the teaching students were asked to complete a mixed methods satisfaction survey (Appendix 4). The efficacy of the course was assessed as a secondary end-point of this study. We assessed the ability of participants to identify reduced LV systolic function using VEM, abnormal RV size by RV: LV size ratio (> 1.0) and presence of pericardial effusion (> 5mm) using FCU on hospital in-patients who had received a conventional TTE within one week. The assessment was performed 6 months after course commencement. Patients were identified by the researchers during weekdays using convenience sampling and were excluded if they had subcostal or intercostal drains, pneumothorax, known pregnancy or a cardiac procedure such as open cardiac surgery or pacemaker insertion performed after the recent TTE. The participants were not provided with any medical information about the patient or TTE result. Supervisors facilitated the process but did not provide any assistance in image acquisition or interpretation. Participants completed a structured FCU report (Appendix 3), which was compared to the conventional TTE. Agreement between the participant’s FCU report and conventional TTE was assessed by the primary researcher. Statistical methods Statistical analyses were supervised by a statistician (DM) and according to the STARD statement [ 9 ]. The sample size was fixed at 15 students (maximum) as this represented the entire cohort at our clinical school. To assess estimates of agreement between FCU and TTE beyond that expected by chance, Cohen’s kappa (Ƙ) statistic [ 10 ] was used for binary data such as valve function and the Fleiss-Cohen weighted kappa coefficient [ 11 ] for ordinal data such as normal, mild, moderate, severe LV function. Descriptive data were stored in Microsoft Excel 2016 (Microsoft Corp., Redmond, CA) and for statistical analyses we used Stata/IC 15 (Stata Corp., College Station, TX). For LV function a heat map [ 12 ] comprising a rectangular matrix, with each cell shaded so as to represent, in this case the strength of the agreement between trainees and experts, was generated using R.3.4.2 (R Foundation for Statistical Computing, Vienna, 2017). Results All 15 students participated in the course but one student dropped out after four weeks to defer the entire year of university study. Fourteen students completed the online learning materials and attendance at the supervised practical training sessions averaged 71% (range 40–100%). Participant flow is detailed in Fig. 1. Mean student satisfaction was high (82%, range 60–100%) as summarized in Fig. 2. An example of feedback included “Seeing pathology on the screen has helped me learn and understand the physiology”. Unfortunately, the data collection period of the study coincided with end-of-year examinations and annual leave and 5 students refused to complete the end of course assessment. The remaining 9 participants performed 38 scans (mean 4.2, range 1–15) on 38 patients. The characteristics of the patients and their TTE findings are summarised in Tables 2 and 3 . Table 2 Patient Characteristics at Time of Focused Cardiac Ultrasound by Student Patient Characteristic Mean Range (n = 38) Age 70.7 56–84 Height 171.4 152–185 Weight 87.1 47–130 BMI 29.6 17.3–39.8 Number Percentage Male Gender 31 (81.6) Admitting unit Cardiology 24 (63.1) Orthopaedics 3 (7.9) Oncology 3 (7.9) Cardiothoracic 2 (5.2) Renal 2 (5.2) Other 4 (10.5) Table 3 Agreement indices and prevalence of abnormalities for each cardiac feature assessed by medical students. Feature assessed Abnormal (%) Overall agreement (%) (95% CI) Sensitivity (Positive agreement) % (95%CI) Specificity (Negative agreement) % (95%CI) Positive predictive value % (95% CI) Negative predictive value % (95% CI) Chance Corrected Agreement Ƙ (95%CI) LV Function 1,2 34.2 94.6 (81.8 to 99.3) 60.0 (14.7 to 94.7) 100.0 (89.1 to 100.0) 100.0 (29.2 to 100.0) 94.1 (80.3 to 99.3) 0.722 (0.362 to 1.0) Mitral Valve 5.3 97.4 (86.2 to 99.9) 50.0 (1.3 to 98.7) 100.0 (90.3 to 100.0) 100.0 (2.5 to 100.0) 97.3 (85.8 to 99.9) 0.655 (0.028–1.0) Tricuspid Valve 7.9 100.0 (90.3 to 100.0) 100.0 (29.2 to 100.0) 100.0 (89.4 to 100.0) 100.0 (29.2 to 100.0) 100.0 (89.4 to 100.0) 1.0 (1.0 to 1.0) Aortic Valve 0.0 100.0 (90.7 to 100.0) N/A 100.0 (90.7 to 100.0) N/A 100.0 (90.7 to 100/0) N/A Any valve abnormal 13.2 97.4 (86.2 to 99.9) 75.0 (19.4 to 99.4) 100.0 (89.7 to 100.0) 100.0 (29.2 to 100.0) 97.1 (85.1 to 99.9) 0.843 (0.543 to 1.0) RV:LV size 3 5.3 94.6 (81.8 to 99.3) 0.0 (0.0 to 84.2) 100.0 (90.0 to 100.0) N/A 94.6 (81.8 to 99.3) N/A Pericardial effusion 0.0 100.0 (90.7 to 100.0) N/A 100.0 (90.7 to 100.0) N/A 100.0 (90.7 to 100/0) N/A 1 LV function Binary analysis performed on normal and mild impairment vs. moderate or severe. 2 Only 37 cases available for Expert 3 Only 37 cases available for Students CI = Confidence Interval N/A = Not Applicable The agreement between TTE and FCU for the outcome of LV function on categorical analysis was good (Ƙ 0.74, 95% CI 0.40 to 0.90). A heat map for agreement on the categorical analysis of LV function is shown in Fig. 3. The overall agreement between students and formal TTE was high ranging from 94.6% (95%CI 81.8 to 99.3) for RV:LV size ratio to 100% (95% CI 90.3 to 100.0) for Tricuspid valve assessment. Apart from LV function the prevalence of abnormal results was low and there were no abnormal Aortic valves or pericardial effusions in our sample. Discussion This study has demonstrated good feasibility for our pilot FCU training program, with 100% of all students who completed the clinical year volunteering, completing the course and reporting high satisfaction with it. There was a high attendance rate at the bedside teaching sessions and although the completion rate of the end-of-course assessment was lower, this was still acceptable given the course was optional and the assessment from the course not counted towards the student’s university assessment. It should be noted that the students have a busy schedule and no student is able to attend all the available learning opportunities available in our hospital. The participants who performed the end-of-course assessment were able to successfully grade global left ventricular systolic function as either normal, mild, moderately or severely impaired as previously reported by critical care doctors [ 13 , 14 ]. Our teaching program draws on other research in this field which has shown the efficacy of teaching (VEM) using an online library of echo loops [ 14 – 17 ]. It should be noted that whilst the results of the students compare favourably with formal diagnostic echocardiography the assessments students have made are a significant simplification of the gold standard [ 18 ]. Dichotomising the valvular assessment into normal or abnormal may have made assessment easier for students but the low number of studies performed precludes certainty around the true skill level obtained by students and this is pilot data only. Another limitation includes the low prevalence of most pathologies. This problem of low prevalence for particular pathologies has important implications for future research in this area. Conclusions An FCU curriculum of 10 hours of on-line learning and 20 weeks of supervised scanning by sonographers was well attended by students who reported good satisfaction with the course. Students showed good agreement when assessing left ventricular systolic function. By utilizing the flipped classroom model, an echo simulator, peer scanning and a flexible booking system for hands on practice we have demonstrated successful integration of FCU course into the existing curriculum. Further research will be required to determine the true diagnostic accuracy of students who receive this teaching program. Declarations Ethics Approval: Epworth HealthCare Human Research Ethics Committee (EH2017-264) Conflicts of Interest and Source of Funding: The primary author study received a grant from the Epworth Foundation to conduct the study. The remaining authors have disclosed that they do not have any conflicts of interest. This work was performed at Epworth Richmond 89 Bridge Rd Richmond 3121 Victoria Australia Author Contribution KB - Responsible for the initial concept and design of the manuscript as well as writing the initial draft and editing subsequent drafts. KB also helped perform data analysis and interpretation.JB - Assisted wth Concept design, data acquisition, interpretation of data, and final manuscript drafting and editing.DM - Responsible for data analysis and assisted with developing statistical methods and final manuscript draftingDC- Assisted with concept and design formulation as well as data interpretation and all drafts of the manuscript. Acknowledgement Karen Scholz Epworth Healthcare sonographer assisted in data collection and student education. Katrina Timmins (PhD) Epworth Healthcare sonographer assisted in data collection and student education. Data Availability Data is provided within the manuscript and supplementary information files References Andersen GN, Graven T, Skjetneb K, et al.: Diagnostic Influence of Routine Point-of-Care Pocket-size Ultrasound Examinations Performed byMedical Residents . J Ultrasound Med . 2015, 34:627-636. 10.7863/ultra.34.4.627. Arger PH, Schultz SM, Sehgal CM, et al.: Teaching Medical Students Diagnostic Sonography J Ultrasound Med . J Ultrasound Med . 2015, 24:1365-1369. 10.7863/jum.2005.24.10.1365. Bahner DP, Adkins EJ, Hughes D, et al.: Integratedmedical school ultrasound: development of an ultrasound vertical curriculum . Critical Ultrasound Journal . 2013, 5:6-15. 10.1186/2036-7902-5-6 Chiem AT, Soucy Z, Dinh VA, et al.: MD Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools A Discussion of Common Challenges and Strategies From the UMeCali Experience . J Ultrasound Med . 2016, 35:221-223. 10.7863/ultra.15.05006 Cawthorn TR, Nickel C, Oreilly M, et al.: Development and Evaluation of Methodologies for Teaching Focused Cardiac Ultrasound Skills to Medical Students. J Am Soc Echocardiogr . 2014, 27:302-309. 10.1016/j.echo.2013.12.006 Richard A. Hoppmann Victor V. Rao, Floyd Bell, Mary Beth Poston, et al.: The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience . Crit Ultrasound J . 2015, 17:18. 10.1186/s13089-015-0035-3 Bahner DP, Goldman E, Way D, et al.: The State of Ultrasound Education in U.S. Medical Schools: Results of a National Survey Academic Medicine. Crit Ultrasound J . 2014, 89:1681-86. 10.1097/ACM.0000000000000414 Rao S, van Holsbeeck BA, Musial JL, et al.: Comprehensive Ultrasound Education at the WayneState University School of Medicine A Pioneer Year Review. J Ultrasound Med . 2008, 27:745-749. 10.7863/jum.2008.27.5.745 Zoghbi WA, Adams D, Bonow R, Enriquez-Sarano M : Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation . Journal of the American Society of Echocardiography . 2017, 30:303-370. 10.1016/j.echo.2017.01.007 Bergenzaun L, Gudmundsson P, Öhlin H, Düring H, Ersson A, Ihrman L,Willenheimer R and Chew M : Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care . Critical Care . 2011, 15:R200. 10.1186/cc10368. Shahgaldi K , Gudmundsson P, ManourasA, Brodin L and Winter R: Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography. . Cardiovascular Ultrasound. 2009, 7:41. 10.1186/1476-7120-7-41 Ünlüer E, Karagöz A, Akoğlu H, Bayata S,: Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians . Western Journal of Emergency Medicine . 2014, 15:221-226. 10.5811/westjem.2013.9.16185 Hope M, la Pena E, Yang P, et al.: A visual approach for the accurate determination of echocardiographic left ventricular ejection fraction by medical students.. Journal of the American Society of Echocardiography . 2003, 16:824-831. 10.1067/S0894-7317(03)00400-0. Brooks KS, Tan LH, Rozen TH, Kelly D, McKenzie DP, Calafiore P, Barrett JA.: Validation of Epworth Richmond's Echocardiography Education Focused Year. Critical Care Medicine . 2020, 48:e34-e39. 10.1097/CCM.0000000000004076 Cohen J.: A coefficient of agreement for nominal scales . Educational and Psychological Measurement. 1960, 20:37-46. 10.1177/001316446002000104 Fleiss JL, Cohen J .: The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability . Educational and Psychological Measurement . 1973, 33:613-619. 10.1177/001316447303300309 Wilkinson L, Friendly M.: The history of the cluster heat map . The American Statistician. . 2009, 63:179-184. 10.1198/tas.2009.0033 Miner B, Purdy A, Curtis K, et al.: Feasibility study of first-year medicalstudents identifying cardiac anatomy using ultrasound in rural Panama . World J Emerg Med . 2015, 6:191-195. 10.5847/wjem.j.1920-8642.2015.03.005 Additional Declarations No competing interests reported. Supplementary Files AppendicesBEAMS.pdf Cite Share Download PDF Status: Published Journal Publication published 11 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 05 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviews received at journal 28 Jul, 2025 Reviewers agreed at journal 13 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers agreed at journal 07 Jul, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 25 Jun, 2025 Editor invited by journal 23 Jun, 2025 Submission checks completed at journal 23 Jun, 2025 First submitted to journal 23 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6771448","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476318314,"identity":"6b3485d6-83a8-4293-865b-0d3f2d0003ab","order_by":0,"name":"Kyle Shapcott 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a rapid expansion in integration of focused cardiac ultrasound (FCU) into undergraduate medicine curricula, [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] uptake has been slow in Australia. At the time of writing there are no available publications of teaching FCU in Australian medical schools.\u003c/p\u003e \u003cp\u003eWe developed an FCU curriculum for 2nd year medical students that minimises trainer time by providing all theoretical knowledge via an online educational platform (Google Drive). This is supplemented by weekly supervised image acquisition training on an echocardiography simulator (Vimedix\u0026trade;, CAE Healthcare, Montreal, Canada), peer student volunteers and hospitalised patients in small groups.\u003c/p\u003e \u003cp\u003eThe primary aim of this study is to determine the feasibility of delivering our course. We defined feasibility as \u0026gt;\u0026thinsp;70% completion rate of online learning materials and attendance at practical sessions and mean student satisfaction score from a self-reported survey. The secondary aim was to assess the ability of students to perform and interpret FCU for discrimination of normal from abnormal left ventricular systolic function, right ventricular dilatation and pericardial effusion.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003e This prospective observational pilot feasibility study was approved by The Epworth HealthCare Human Research Ethics Committee (EH2017-264) and was performed in accordance with the declaration of Helsinki and the National Statement on Ehtical Conduct in Human Research. Written consent was obtained from all participants and patients.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and setting\u003c/h3\u003e\n\u003cp\u003eFifteen 2nd year medical students from the University of Melbourne who attended a full-time clinical rotation at Epworth Hospital (The entire cohort at our clinical school) were offered training in FCU. The course was voluntary, did not contribute to the student\u0026rsquo;s academic assessment, and students attended in their own time. For pilot data on accuracy, we approached in-patients on the coronary care unit who had received a formal transthoracic echocardiogram within one month. No students had prior training in ultrasound.\u003c/p\u003e\n\u003ch3\u003eCurriculum\u003c/h3\u003e\n\u003cp\u003eThe FCU teaching program was developed by a consultant intensivist (KB) with recognized training and expertise in TTE. Course structure, online videos and student report proformas are made available as appendix 1, 2 and 3 to allow dissemination of the teaching materials at other centres. The curriculum outlined in appendix 1 is aimed at initial learning to both perform and interpret FCU. Our FCU protocol teaches categorical assessment to identify clinically important cardiac pathology. For LV function we teach the Visual Estimation Method (VEM) with categories of normal or mild/moderate/severe pathology. For RV dysfunction we measure the RV:LV size ratio and for valvular pathology we dichotomise assessment grouping normal or mild pathology in contrast to moderate to severe pathology. The dichotomous assessment to identify valvular pathology greater than mild is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification of Valvular Lesions Grading Guide For Students.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValve\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGrading Guide\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMitral Valve\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegurgitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJet area % of LA\u0026thinsp;\u0026gt;\u0026thinsp;20% or Vena contracta Width\u0026thinsp;\u0026gt;\u0026thinsp;3mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Gradient\u0026thinsp;\u0026gt;\u0026thinsp;5mmHg or Pressure \u0026frac12; time\u0026thinsp;\u0026gt;\u0026thinsp;140mSec\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAortic Valve\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegurgitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJet height % of LVOT\u0026nbsp;\u0026nbsp; \u0026gt;25% or Vena Contracta\u0026thinsp;\u0026gt;\u0026thinsp;3mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePeak Velocity\u0026thinsp;\u0026gt;\u0026thinsp;3m/sec or Valve replacement in situ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary Valve\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegurgitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObvious Colour flow Doppler regurgitation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClear aliasing through valve\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTricuspid valve\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRegurgitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJet area\u0026thinsp;\u0026gt;\u0026thinsp;5cm or Vena contracta Width\u0026thinsp;\u0026gt;\u0026thinsp;7mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImpaired valve opening with clear aliasing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe knowledge base teaching included approximately 10 hours of online video lectures and supplementary reading material (Appendix 2) that were completed prior to practical teaching.\u003c/p\u003e \u003cp\u003eThe practical teaching occurred over a period of 6 months. To be adaptable to the students\u0026rsquo; busy schedules, weekly practical sessions were offered via an online booking system (Google Calendar). Initially image acquisition was taught under supervision by the intensivist or qualified cardiac sonographer on an ultrasound simulator (Vimedix,TM CAE Healthcare, Montreal, Canada) and this was followed by supervised scanning of fellow students followed by patients once students had gained confidence with obtaining basic views. Students were encouraged to attend weekly.\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eThe primary end-point, feasibility of delivering the course and all associated educational content, was assessed by completion of online learning materials and attendance at weekly practical tutorials. Attendance was recorded by the research staff. At the completion of the teaching students were asked to complete a mixed methods satisfaction survey (Appendix 4).\u003c/p\u003e \u003cp\u003eThe efficacy of the course was assessed as a secondary end-point of this study. We assessed the ability of participants to identify reduced LV systolic function using VEM, abnormal RV size by RV: LV size ratio (\u0026gt;\u0026thinsp;1.0) and presence of pericardial effusion (\u0026gt;\u0026thinsp;5mm) using FCU on hospital in-patients who had received a conventional TTE within one week. The assessment was performed 6 months after course commencement. Patients were identified by the researchers during weekdays using convenience sampling and were excluded if they had subcostal or intercostal drains, pneumothorax, known pregnancy or a cardiac procedure such as open cardiac surgery or pacemaker insertion performed after the recent TTE. The participants were not provided with any medical information about the patient or TTE result. Supervisors facilitated the process but did not provide any assistance in image acquisition or interpretation. Participants completed a structured FCU report (Appendix 3), which was compared to the conventional TTE. Agreement between the participant\u0026rsquo;s FCU report and conventional TTE was assessed by the primary researcher.\u003c/p\u003e\n\u003ch3\u003eStatistical methods\u003c/h3\u003e\n\u003cp\u003eStatistical analyses were supervised by a statistician (DM) and according to the STARD statement [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The sample size was fixed at 15 students (maximum) as this represented the entire cohort at our clinical school. To assess estimates of agreement between FCU and TTE beyond that expected by chance, Cohen\u0026rsquo;s kappa (Ƙ) statistic [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] was used for binary data such as valve function and the Fleiss-Cohen weighted kappa coefficient [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] for ordinal data such as normal, mild, moderate, severe LV function. Descriptive data were stored in Microsoft Excel 2016 (Microsoft Corp., Redmond, CA) and for statistical analyses we used Stata/IC 15 (Stata Corp., College Station, TX). For LV function a heat map [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] comprising a rectangular matrix, with each cell shaded so as to represent, in this case the strength of the agreement between trainees and experts, was generated using R.3.4.2 (R Foundation for Statistical Computing, Vienna, 2017).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll 15 students participated in the course but one student dropped out after four weeks to defer the entire year of university study. Fourteen students completed the online learning materials and attendance at the supervised practical training sessions averaged 71% (range 40\u0026ndash;100%). Participant flow is detailed in Fig.\u0026nbsp;1. Mean student satisfaction was high (82%, range 60\u0026ndash;100%) as summarized in Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003eAn example of feedback included \u0026ldquo;Seeing pathology on the screen has helped me learn and understand the physiology\u0026rdquo;.\u003c/p\u003e \u003cp\u003eUnfortunately, the data collection period of the study coincided with end-of-year examinations and annual leave and 5 students refused to complete the end of course assessment. The remaining 9 participants performed 38 scans (mean 4.2, range 1\u0026ndash;15) on 38 patients. The characteristics of the patients and their TTE findings are summarised in Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics at Time of Focused Cardiac Ultrasound by Student\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e70.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e171.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152\u0026ndash;185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e87.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u0026ndash;130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.3\u0026ndash;39.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNumber\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePercentage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitting unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(63.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopaedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiothoracic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAgreement indices and prevalence of abnormalities for each cardiac feature assessed by medical students.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeature assessed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbnormal (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverall agreement (%) (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSensitivity (Positive agreement) % (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpecificity (Negative agreement) % (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePositive predictive value % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNegative predictive value % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eChance Corrected Agreement Ƙ (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLV Function\u003csup\u003e1,2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.6\u003c/p\u003e \u003cp\u003e(81.8 to 99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003cp\u003e(14.7 to 94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(89.1 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(29.2 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94.1\u003c/p\u003e \u003cp\u003e(80.3 to 99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003cp\u003e(0.362 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMitral Valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003cp\u003e(86.2 to 99.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003cp\u003e(1.3 to 98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.3 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(2.5 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003cp\u003e(85.8 to 99.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003cp\u003e(0.028\u0026ndash;1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTricuspid Valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.3 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(29.2 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(89.4 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(29.2 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(89.4 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003cp\u003e(1.0 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic Valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.7 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.7 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.7 to 100/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny valve abnormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003cp\u003e(86.2 to 99.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003cp\u003e(19.4 to 99.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(89.7 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(29.2 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e97.1\u003c/p\u003e \u003cp\u003e(85.1 to 99.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003cp\u003e(0.543 to 1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRV:LV size\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.6\u003c/p\u003e \u003cp\u003e(81.8 to 99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003cp\u003e(0.0 to 84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.0 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94.6\u003c/p\u003e \u003cp\u003e(81.8 to 99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePericardial effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.7 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.7 to 100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003cp\u003e(90.7 to 100/0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003eLV function Binary analysis performed on normal and mild impairment vs. moderate or severe.\u003c/p\u003e \u003cp\u003e \u003csup\u003e2\u003c/sup\u003eOnly 37 cases available for Expert\u003c/p\u003e \u003cp\u003e \u003csup\u003e3\u003c/sup\u003eOnly 37 cases available for Students\u003c/p\u003e \u003cp\u003eCI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/p\u003e \u003cp\u003eN/A\u0026thinsp;=\u0026thinsp;Not Applicable\u003c/p\u003e \u003cp\u003eThe agreement between TTE and FCU for the outcome of LV function on categorical analysis was good (Ƙ 0.74, 95% CI 0.40 to 0.90). A heat map for agreement on the categorical analysis of LV function is shown in Fig.\u0026nbsp;3. The overall agreement between students and formal TTE was high ranging from 94.6% (95%CI 81.8 to 99.3) for RV:LV size ratio to 100% (95% CI 90.3 to 100.0) for Tricuspid valve assessment. Apart from LV function the prevalence of abnormal results was low and there were no abnormal Aortic valves or pericardial effusions in our sample.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study has demonstrated good feasibility for our pilot FCU training program, with 100% of all students who completed the clinical year volunteering, completing the course and reporting high satisfaction with it. There was a high attendance rate at the bedside teaching sessions and although the completion rate of the end-of-course assessment was lower, this was still acceptable given the course was optional and the assessment from the course not counted towards the student\u0026rsquo;s university assessment. It should be noted that the students have a busy schedule and no student is able to attend all the available learning opportunities available in our hospital.\u003c/p\u003e \u003cp\u003eThe participants who performed the end-of-course assessment were able to successfully grade global left ventricular systolic function as either normal, mild, moderately or severely impaired as previously reported by critical care doctors [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Our teaching program draws on other research in this field which has shown the efficacy of teaching (VEM) using an online library of echo loops [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt should be noted that whilst the results of the students compare favourably with formal diagnostic echocardiography the assessments students have made are a significant simplification of the gold standard [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Dichotomising the valvular assessment into normal or abnormal may have made assessment easier for students but the low number of studies performed precludes certainty around the true skill level obtained by students and this is pilot data only. Another limitation includes the low prevalence of most pathologies. This problem of low prevalence for particular pathologies has important implications for future research in this area.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAn FCU curriculum of 10 hours of on-line learning and 20 weeks of supervised scanning by sonographers was well attended by students who reported good satisfaction with the course. Students showed good agreement when assessing left ventricular systolic function. By utilizing the flipped classroom model, an echo simulator, peer scanning and a flexible booking system for hands on practice we have demonstrated successful integration of FCU course into the existing curriculum. Further research will be required to determine the true diagnostic accuracy of students who receive this teaching program.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics Approval:\u003c/h2\u003e \u003cp\u003eEpworth HealthCare Human Research Ethics Committee (EH2017-264)\u003c/p\u003e \u003cp\u003eConflicts of Interest and Source of Funding:\u003c/p\u003e\n\u003cp\u003eThe primary author study received a grant from the Epworth Foundation to conduct the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe remaining authors have disclosed that they do not have any conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work was performed at Epworth Richmond 89 Bridge Rd Richmond 3121 Victoria Australia\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKB - Responsible for the initial concept and design of the manuscript as well as writing the initial draft and editing subsequent drafts. KB also helped perform data analysis and interpretation.JB - Assisted wth Concept design, data acquisition, interpretation of data, and final manuscript drafting and editing.DM - Responsible for data analysis and assisted with developing statistical methods and final manuscript draftingDC- Assisted with concept and design formulation as well as data interpretation and all drafts of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eKaren Scholz Epworth Healthcare sonographer assisted in data collection and student education. Katrina Timmins (PhD) Epworth Healthcare sonographer assisted in data collection and student education.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e Data is provided within the manuscript and supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eAndersen GN, Graven T, Skjetneb K, et al.: Diagnostic Influence of Routine Point-of-Care Pocket-size Ultrasound Examinations Performed byMedical Residents . J Ultrasound Med . 2015, 34:627-636. 10.7863/ultra.34.4.627.\u003c/li\u003e\n\u003cli\u003eArger PH, Schultz SM, Sehgal CM, et al.: Teaching Medical Students Diagnostic Sonography J Ultrasound Med . J Ultrasound Med . 2015, 24:1365-1369. 10.7863/jum.2005.24.10.1365.\u003c/li\u003e\n\u003cli\u003eBahner DP, Adkins EJ, Hughes D, et al.: Integratedmedical school ultrasound: development of an ultrasound vertical curriculum . Critical Ultrasound Journal . 2013, 5:6-15. 10.1186/2036-7902-5-6\u003c/li\u003e\n\u003cli\u003eChiem AT, Soucy Z, Dinh VA, et al.: MD Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools A Discussion of Common Challenges and Strategies From the UMeCali Experience . J Ultrasound Med . 2016, 35:221-223. 10.7863/ultra.15.05006\u003c/li\u003e\n\u003cli\u003eCawthorn TR, Nickel C, Oreilly M, et al.: Development and Evaluation of Methodologies for Teaching Focused Cardiac Ultrasound Skills to Medical Students. J Am Soc Echocardiogr . 2014, 27:302-309. 10.1016/j.echo.2013.12.006\u003c/li\u003e\n\u003cli\u003eRichard A. Hoppmann Victor V. Rao, Floyd Bell, Mary Beth Poston, et al.: The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience . Crit Ultrasound J . 2015, 17:18. 10.1186/s13089-015-0035-3\u003c/li\u003e\n\u003cli\u003eBahner DP, Goldman E, Way D, et al.: The State of Ultrasound Education in U.S. Medical Schools: Results of a National Survey Academic Medicine. Crit Ultrasound J . 2014, 89:1681-86. 10.1097/ACM.0000000000000414\u003c/li\u003e\n\u003cli\u003eRao S, van Holsbeeck BA, Musial JL, et al.: Comprehensive Ultrasound Education at the WayneState University School of Medicine A Pioneer Year Review. J Ultrasound Med . 2008, 27:745-749. 10.7863/jum.2008.27.5.745\u003c/li\u003e\n\u003cli\u003eZoghbi WA, Adams D, Bonow R, Enriquez-Sarano M : Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation . Journal of the American Society of Echocardiography . 2017, 30:303-370. 10.1016/j.echo.2017.01.007\u003c/li\u003e\n\u003cli\u003eBergenzaun L, Gudmundsson P, \u0026Ouml;hlin H, D\u0026uuml;ring H, Ersson A, Ihrman L,Willenheimer R and Chew M : Assessing left ventricular systolic function in shock: evaluation of echocardiographic parameters in intensive care . Critical Care . 2011, 15:R200. 10.1186/cc10368.\u003c/li\u003e\n\u003cli\u003eShahgaldi K , Gudmundsson P, ManourasA, Brodin L and Winter R: Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography. . Cardiovascular Ultrasound. 2009, 7:41. 10.1186/1476-7120-7-41\u003c/li\u003e\n\u003cli\u003e\u0026Uuml;nl\u0026uuml;er E, Karag\u0026ouml;z A, Akoğlu H, Bayata S,: Visual Estimation of Bedside Echocardiographic Ejection Fraction by Emergency Physicians . Western Journal of Emergency Medicine . 2014, 15:221-226. 10.5811/westjem.2013.9.16185\u003c/li\u003e\n\u003cli\u003eHope M, la Pena E, Yang P, et al.: A visual approach for the accurate determination of echocardiographic left ventricular ejection fraction by medical students.. Journal of the American Society of Echocardiography . 2003, 16:824-831. 10.1067/S0894-7317(03)00400-0.\u003c/li\u003e\n\u003cli\u003eBrooks KS, Tan LH, Rozen TH, Kelly D, McKenzie DP, Calafiore P, Barrett JA.: Validation of Epworth Richmond\u0026apos;s Echocardiography Education Focused Year. Critical Care Medicine . 2020, 48:e34-e39. 10.1097/CCM.0000000000004076\u003c/li\u003e\n\u003cli\u003eCohen J.: A coefficient of agreement for nominal scales . Educational and Psychological Measurement. 1960, 20:37-46. 10.1177/001316446002000104\u003c/li\u003e\n\u003cli\u003eFleiss JL, Cohen J .: The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability . Educational and Psychological Measurement . 1973, 33:613-619. 10.1177/001316447303300309\u003c/li\u003e\n\u003cli\u003eWilkinson L, Friendly M.: The history of the cluster heat map . The American Statistician. . 2009, 63:179-184. 10.1198/tas.2009.0033\u003c/li\u003e\n\u003cli\u003eMiner B, Purdy A, Curtis K, et al.: Feasibility study of first-year medicalstudents identifying cardiac anatomy using ultrasound in rural Panama . World J Emerg Med . 2015, 6:191-195. 10.5847/wjem.j.1920-8642.2015.03.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Echocardiography, Education, Medical Student, Cardiology, Ventricular function","lastPublishedDoi":"10.21203/rs.3.rs-6771448/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6771448/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFocused Cardiac Ultrasound (FCU) has become integrated into undergraduate medicine curricula but has not yet occurred in Australia. The aim of this study was to assess the feasibility of an FCU training program for Australian medical students.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFifteen echo-na\u0026iuml;ve 2nd year medical students were invited to complete an optional 20-week FCU curriculum consisting of 10 hours of online material and weekly scanning practice on a simulator and hospitalised patients that was not included in their University assessments. Student attendance and course satisfaction were recorded. Assessment of performance and interpretation of FCU on hospitalized patients was performed using agreement of FCU with formal transthoracic echocardiography. Students assessed Left ventricular (LV) function using visual estimation method (VEM), Right ventricular (RV) size by RV: LV size ratio (\u0026gt;\u0026thinsp;1.0) and presence of pericardial effusion (\u0026gt;\u0026thinsp;5mm).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOf the 15 eligible participants 15 enrolled in the course and 14 completed the course. Attendance at weekly tutorials was 71% (range 40\u0026ndash;100%) and mean student satisfaction score 84% (range 60\u0026ndash;100%) were high. Nine (60%) students performed and reported a mean of 4.2 (range 1\u0026ndash;15) FCU scans on patients. Agreement of FCU with TTE for left ventricular systolic function was good (Ƙ 0.74, 0.4\u0026ndash;0.90). Low prevalence of other pathologies hindered assessment of agreement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAn FCU curriculum of 10 hours of on-line learning and 20 weeks of supervised scanning by sonographers was well attended by students who reported good satisfaction and showed good agreement in separating reduced from normal left ventricular systolic function.\u003c/p\u003e","manuscriptTitle":"A Pilot Feasibility Study of teaching focused cardiac ultrasound to Australian medical students in a structured program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 10:42:57","doi":"10.21203/rs.3.rs-6771448/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-05T05:02:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-05T02:35:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T08:43:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233752991581294691972810355213788187869","date":"2025-07-13T06:29:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"240874212539509816668817263560025778577","date":"2025-07-08T04:18:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"219766356569573560779140332265933301045","date":"2025-07-07T21:45:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T12:17:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-25T12:15:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T11:58:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-23T11:34:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-06-23T11:31:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"612bbf1a-1144-4765-8c4b-d39e4fbf4ac8","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:07:40+00:00","versionOfRecord":{"articleIdentity":"rs-6771448","link":"https://doi.org/10.1186/s12909-025-08016-7","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-11-11 15:57:47","publishedOnDateReadable":"November 11th, 2025"},"versionCreatedAt":"2025-07-01 10:42:57","video":"","vorDoi":"10.1186/s12909-025-08016-7","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08016-7","workflowStages":[]},"version":"v1","identity":"rs-6771448","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6771448","identity":"rs-6771448","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}