Echocardiography curriculum development for physician assistants using entrustable professional activities

BACKGROUND: With the projected increase of cardiovascular disease in the aging population, a higher demand for echocardiography use is predicted. However, there is a shortage in the supply of cardiologists, to the point that a 2009 American College of Cardiology survey report called it a "cardiology workforce crisis". The report also recommends a more aggressive use of PAs and NPs as one of the solutions to fill the shortage. Currently, echocardiography is not routinely included in the scope of practice for PAs in cardiology. While PAs attain strong basic science knowledge and clinical training experience in PA school, they typically do not receive additional formal postgraduate training. PAs have limited training opportunities to train in echocardiography and receive certification of recognition, but a formally standardized training program and certifying examination geared specifically for PAs are yet to be developed. This study seeks to develop a pilot curriculum in training echocardiography which can be standardized for utilization across various regions and medical subspecialties. The curriculum draws on the concept of Entrustable Professional Activities (EPA), which is being actively used in graduate medical education. HYPOTHESIS: After participating in the proposed pilot curriculum which involves online didactic learning and supervised hands-on clinical training, trained PAs will be able to reach proficiency in echocardiography operation and interpretation at level 4 supervision according to the EPA guidelines. METHODS: This study proposes a pilot curriculum with framework based on the EPA titled “performing and interpreting echocardiography” by PAs. The curriculum involves didactic and clinical training in echocardiography, with the goal to achieve mastery of level 4 supervision (minimal supervision). 2 subjects will be recruited from a teaching medical institution in the Greater Boston area with an IAC accredited echocardiography laboratory. After the 12-month training, participants will take ASCeXAM/ReASCE Online Practice Exam Simulation offered by the ASE. Upon 1) achievement of individualized EPAs as assessed by supervisor, and 2) simulation exam score of >80%, participants will earn a STAR in echocardiography. CONCLUSION: The study is the first step to establishing an effective training curriculum that will eventually be a basis for creating a certifying exam in echocardiography, designed specifically for PAs. As this study merely suggests a new curriculum, future studies should focus on identifying strengths and weaknesses of the curriculum after implementation and expansion to multiple sites, and gather data to use for continual improvement of the training curriculum

A Framework for XML-based Integration of Data, Visualization and Analysis in a Biomedical Domain

Biomedical data are becoming increasingly complex and heterogeneous in nature. The data are stored in distributed information systems, using a variety of data models, and are processed by increasingly more complex tools that analyze and visualize them. We present in this paper our framework for integrating biomedical research data and tools into a unique Web front end. Our framework is applied to the University of Washington’s Human Brain Project. Specifically, we present solutions to four integration tasks: definition of complex mappings from relational sources to XML, distributed XQuery processing, generation of heterogeneous output formats, and the integration of heterogeneous data visualization and analysis tools

The Digital Anatomist Information System and Its Use in the Generation and Delivery of Web-Based Anatomy Atlases

Advances in network and imaging technology, coupled with the availability of 3-D datasets such as the Visible Human, provide a unique opportunity for developing information systems in anatomy that can deliver relevant knowledge directly to the clinician, researcher or educator. A software framework is described for developing such a system within a distributed architecture that includes spatial and symbolic anatomy information resources, Web and custom servers, and authoring and end-user client programs. The authoring tools have been used to create 3-D atlases of the brain, knee and thorax that are used both locally and throughout the world. For the one and a half year period from June 1995–January 1997, the on-line atlases were accessed by over 33,000 sites from 94 countries, with an average of over 4000 ‘‘hits’’ per day, and 25,000 hits per day during peak exam periods. The atlases have been linked to by over 500 sites, and have received at least six unsolicited awards by outside rating institutions. The flexibility of the software framework has allowed the information system to evolve with advances in technology and representation methods. Possible new features include knowledge-based image retrieval and tutoring, dynamic generation of 3-D scenes, and eventually, real-time virtual reality navigation through the body. Such features, when coupled with other on-line biomedical information resources, should lead to interesting new ways for managing and accessing structural information in medicine

Health-related quality of life, adiposity, and sedentary behavior in patients with early schizophrenia: Preliminary study

Objective: To examine adiposity and sedentary behavior in relation to health-related quality of life (QoL) in patients with early schizophrenia. Methods: A cross-sectional study was used to assess adiposity by dual-energy X-ray absorptiometry scans, habitual physical activity and idle sitting time by the Short Form International Physical Activity Questionnaire, and health-related QoL by the RAND Medical Outcomes Study SF-36. QoL scores were compared with age-adjusted Canadian normative population data. Results: There were 36 participants with early schizophrenia, average age 25.1 (±3.6). Twenty-nine (72.5%) were males. Mean illness duration was 30 (±18) months, and mean body mass index was 28.3 (±5). Females had higher body fat content than males (30.8±6.9 vs 24.7±10.6; t=-2.6, df=34; P=0.015). Total body fat (F=14; P=0.001), lean body mass (F=10.2; P=0.001), and sedentary behavior (F=5; P=0.013) significantly increased across body mass index categories. Total body fat was correlated with sedentary behavior (r=0.62; P=0.001), and total lean body mass was negatively correlated with sedentary behavior (r=0.39; P=0.03). Based on SF-36scores, participants had significantly lower physical functioning (P=0.0034), role physical (P=0.0003), general health (P,0.0001), vitality (P=0.03), and physical component scores (P=0.003) than Canadian population comparisons. Habitual sedentary behavior, more than activity or adiposity levels, was associated with health-related QoL in early schizophrenia. Conclusion: Health-related QoL is lower in early schizophrenia and is predominantly experienced in the physical domain. QoL in early schizophrenia relates to sedentary behavior more than to activity and adiposity levels. © 2012 Strassnig etal, publisher and licensee Dove Medical Press Ltd

Focal Spot, Winter 2005/2006

https://digitalcommons.wustl.edu/focal_spot_archives/1101/thumbnail.jp