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This randomized controlled trial evaluates the effectiveness of two training approaches (in-person versus remote) for teaching medical residents to apply the Venous Excess Ultrasound (VExUS) score for bedside volume assessment in patients with acute heart failure. Resident performance will be compared to that of expert physicians certified in abdominal and duplex sonography.
Accurate assessment of volume status is essential in managing acute heart failure but remains challenging in clinical practice. The VExUS score is a validated ultrasound-based tool integrating inferior vena cava diameter and Doppler assessment of hepatic, portal, and intrarenal veins.
This single-center randomized controlled trial compares two training modalities (in-person vs. remote) in medical residents with basic ultrasound skills. Participants will be randomized 1:1 to either training method and compared to a control group of expert physicians.
Primary outcomes include ultrasound image quality assessed using a standardized 100-point score. Secondary outcomes include time to acquisition, VExUS scoring accuracy, self-confidence, and acceptability of training methods.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| In-person Training | Experimental | 1-hour theoretical introduction 3-hour supervised practical ultrasound session Group-based hands-on training with expert coach |
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| Remote Training | Experimental | E-learning theoretical module 20 independently performed ultrasound exams Asynchronous expert feedback (phone/email) |
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| Control (Expert Physicians) | Active Comparator | SGUM-certified physicians performing VExUS examinations |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| In-person VExUS Training Program | Behavioral | In-person training consisting of a 1-hour theoretical introduction followed by a 3-hour supervised hands-on ultrasound training session focusing on acquisition and interpretation of the VExUS score. |
| Measure | Description | Time Frame |
|---|---|---|
| Ultrasound Image Quality Score | The primary outcome will be a quality score, adapted from a quality score used in a previous randomized controlled trial which investigated a simulator-based training program for transoesophageal echocardiography.11 The quality score will include items commonly used for assessment of ultrasound quality: angle and depth, overall clarity, visualization of the anatomical structures, focus, doppler gain, scale and baseline resulting in a maximum achievable quality score of 100 points. If multiple images of the predefined views are captured, each image will be rated, and the best rating will be kept to calculate the final score. If a view is missing, 0 point will be awarded for that view. All ultrasound images will be independently assessed by experts for abdominal sonography and use Doppler sonography in their daily clinical practice and are blinded to the role (resident vs. SGUM-certified physician) and training (in-person vs. remote) program of the participants. | From training until 6 months after completion of training |
| Measure | Description | Time Frame |
|---|---|---|
| Time for Image Acquisition and Interpretation | Time required by participants to perform the ultrasound examination and interpret the images during VExUS assessment | From training until 6 months after completion of training |
| Change in self-confidence in performing VExUS assessment |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Caroline Rimensberger, MD | Contact | 0041316322111 | caroline.rimensberger@insel.ch | |
| Claudio Schneider, MD | Contact | 0041316322111 | claudio.schneider@insel.ch |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Inselspital | Recruiting | Bern | 3011 | Switzerland |
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| Remote VExUS Training Program | Behavioral | Remote training consisting of an e-learning module followed by independently performed ultrasound examinations with asynchronous expert feedback (via phone or email). |
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| No intervention | Other | SGUM-certified physicians performing VExUS examinations as expert reference standard. |
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Self-reported confidence measured using a Likert-scale questionnaire before and after training |
| From baseline (before training) to immediately after completion of training |
| Acceptability of the program (quantitative assessment) | Acceptability of the program will be assessed using a structured survey with 5-point Likert scale items based on an implementation framework (e.g., Theoretical Domains Framework). Results will be reported as mean scores or median values on a 5-point scale, where higher scores indicate greater acceptability. | Immediately after completion of training and during the outcome assessment period (within 2 months after training) |
| VEXUS score | The Venous Excess Ultrasound Score (VExUS) is a semi-quantitative ultrasound-based score used to assess systemic venous congestion by combining inferior vena cava (IVC) diameter and Doppler flow patterns of abdominal veins, including hepatic, portal, and intrarenal veins. The score ranges from 0 to 3, with 0 indicating no congestion, 1 indicating mild congestion, 2 indicating moderate congestion, and 3 indicating severe venous congestion. Higher scores indicate greater venous congestion and worse clinical status. | From training until 6 months after completion of training |
| Acceptability of the program (qualitative assessment) | Acceptability, including perceived barriers and facilitators to implementation, will be explored through semi-structured interviews. Data will be analyzed using thematic analysis guided by an implementation framework. | Immediately after completion of training and during the outcome assessment period (within 2 months after training) |
| ID | Term |
|---|---|
| D006940 | Hyperemia |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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