Author + information
- Received August 2, 2019
- Revision received September 19, 2019
- Accepted September 30, 2019
- Published online December 2, 2019.
- Benjamin J.W. Chow, MDa,b,∗ (, )
- Ali Alenazy, MDa,
- Gary Small, MB, PhDa,
- Andrew Crean, MDa,
- Yeung Yam, BSca,
- Rob S. Beanlands, MDa,b,
- Owen Clarkin, PhDa,
- Michael Froeschl, MDa,
- Terrence D. Ruddy, MDa,b and
- Alomgir Hossain, PhDc
- aDepartment of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- bDepartment of Radiology University of Ottawa, Ottawa, Ontario, Canada
- cCardiovascular Research Methods Centre, University of Ottawa Heart Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Benjamin J.W. Chow, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Objectives This study sought to: 1) determine if the current training volume guidelines are reasonable for attaining competence for interpreting myocardial perfusion imaging (MPI); and if not, 2) identify potential thresholds for training volumes and competence.
Background There is a growing desire to adopt competency-based medical education (CBME). As such, the implementation of CBME will require new and novel methods of defining, measuring, and assessing clinical competence. The potential use of CBME in cardiac imaging has not been well studied.
Methods Consecutive MPI studies were interpreted independently by trainees, and expert readers reviewed the same studies. Studies were quantified using summed scores and % left ventricular (LV) ischemia and the kappa agreement between trainee and expert were measured every 50 cases. Agreement for all MPI and abnormal MPI cases was calculated.
Results A total of 24 trainees interpreted 9,668 MPI studies over 37 months. Agreement between trainees and expert readers increased with MPI case volumes but at different rates. The threshold for competence was set at 2 SDs below expert interobserver agreement. The average trainee surpassed this threshold for both summed stress score and %LV ischemia after 800 studies and after 400 abnormal MPI studies. Trainees learned at different rates and surpassed the competence threshold after different case volumes.
Conclusions The use of CBME within nuclear cardiology appears to be feasible. Our results suggest that current guidelines may be insufficient to ensure competence and would support the need to increase the MPI case volumes. The use of CBME principles would suggest that trainees may achieve competence at different rates and our results suggest a shift in focus from volume-based learning toward target agreement thresholds.
Dr. Chow has received research support from CV Diagnostix and Ausculsciences, educational support from TeraRecon Inc.; has equity interest in General Electric; and holds the Saul and Edna Goldfarb Research Chair in Cardiac Imaging. Dr. Beanlands is a consultant for and has received research funding from Lantheus Medical Imaging, Jubilant DraxImage, and GE; and is a career investigator supported by the Heart and Stroke Foundation of Ontario, Tier 1 Research Chair supported by the University of Ottawa, and University of Ottawa Heart Institute Vered Chair in Cardiology. Dr. Ruddy has received grant funding from GE Healthcare and Advanced Accelerator Applications International. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
- Received August 2, 2019.
- Revision received September 19, 2019.
- Accepted September 30, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.