Online learning and echocardiography boot camp: Innovative learning platforms promoting blended learning and competency in pediatric echocardiography

Authors: KAILIN, JOSHUA - Baylor College Of Medicine; KYLE, WILLIAM - Baylor College Of Medicine; ALTMAN, CAROLYN - Baylor College Of Medicine; WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); SCHLINGMANN, TOBIAS - Baylor College Of Medicine

Submitted to: Pediatric Cardiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/30/2020
Publication Date: 11/11/2020
Citation: Kailin, J.A., Kyle, W.B., Altman, C.A., Wood, A.C., Schlingmann, T.S. 2020. Online learning and echocardiography boot camp: Innovative learning platforms promoting blended learning and competency in pediatric echocardiography. Pediatric Cardiology. https://doi.org/10.1007/s00246-020-02494-w.
DOI: https://doi.org/10.1007/s00246-020-02494-w

Interpretive Summary: Children with obesity are at an increased risk of cardiovascular complications. Echocardiography offers promise for identifying such complications early, and allowing clinicians to administer preventative care to reduce adverse cardiovascular events in children with obesity. However, performing and interpreting echocardiographs in children with obesity is challenging, since the excess adipose tissue can distort signals and add noise. The goal of this study was to see whether easily accessible, self-directed online learning modules and/or an in-person "Echo Boot Camp" would improve the pediatric echocardiography knowledge of cardiology for intensive care unit fellows, and improve their ability to interpret echocardiographs in their future clinical practice. We found that after receiving the standard echocardiography training in fellowship (lectures and hands-on models) the addition of the online learning modules improved test scores. Participation in the Echo Boot Camp lead to additional improvement in the final test scores. Both forms of additional learning also improved the fellows' confidence at interpreting echocardiograms. Taken together, this study suggests that online modules are a cheap, accessible and effective way of improving fellows' pediatric echocardiography knowledge and confidence. A "boot camp" style learning environment also improves fellows' knowledge and confidence, but we acknowledge that boot camps place more burden on fellows' time and on hospitals budgets. This information is important for children with obesity as it may help foster a better ability to predict cardiovascular complications and so prevent the occurrence of adverse cardiovascular events.

Technical Abstract: Mastering pediatric echocardiography (PE) requires a substantial knowledge base of echo theory and congenital heart disease (CHD), along with technical proficiency. Online self-directed learning has become increasingly utilized among medical trainees to promote competency within medical subspecialties. We sought to evaluate the impact of online learning combined with lecture-based and hands-on teaching on the acquisition of PE knowledge and confidence in pediatric cardiology and pediatric critical care fellows. We prospectively enrolled 124 learners from 2016 to 2019. These included 40 incoming cardiology and critical care fellows at Texas Children's Hospital (TCH) as well as 84 national and international participants recruited from our online echo education website. All participants completed online learning modules through our website (www.pedecho.org), which covers pediatric echo physics, Doppler, technique, normal anatomy, atrial septal defects, and ventricular septal defects. TCH cardiology and critical care fellows subsequently participated in an Echo Boot Camp (BC), a 3-day training program with hands-on workshops and didactic lectures. Knowledge was assessed using an 80-question pre and post-test multiple choice exams. The online learning group demonstrated improvement in exam scores following online learning (PRE 49.1+/-15.3 vs. POST 67.8+/-17%; p<=0.01). Echo Boot Camp fellows were noted to have further incremental improvement in test scores following BC (PRE 48%+/-13% vs. POST MODULE 68.6%+/-15% vs. POST BC 75.7%+/-13%; p<=0.01). Self-assessment regarding confidence in context areas showed a substantial gain in self perceived interpretive confidence across all groups as well as procedural confidence in BC participants. Online learning significantly promotes the acquisition of echocardiography knowledge. Additional lecture-based and hands-on teaching in the form of an Echo Boot Camp can further enhance knowledge and interpretative skills. Both of these learning platforms appear to work in concert as powerful and effective tools in fellow education.