Creation of a 4-view cardiac exam for assessment of ultrasound competency in pre-clerkship medical students

There has been growing interest in incorporating point-of-care ultrasound (POCUS) into the curriculum of medical schools. In this study, we describe a condensed version of the 4-view cardiac assessment and assess its reliability and validity in pre-clerkship medical students at Boston University Aram V. Chobanian & Edward Avedisian School of Medicine. Criteria regarding general POCUS principles were adapted from the Objective Structured Assessment of Ultrasound Skills (OSAUS). A condensed assessment was created based on previous studies using the 4-view cardiac exam. Pre-clerkship medical students completed the assessment before and after participation in a 2-week intensive anatomy and ultrasound summer program. Reliability was evaluated using Cronbach's alpha and “alpha if item deleted” analyses. Construct validity of the assessment was evaluated using item discrimination analysis and point-biserial correlation. Twenty pre-clerkship medical students completed the assessments. There was acceptable internal consistency of both assessments. Items of the parasternal long and short axis views had high positive correlation in the initial assessment, while items in the parasternal long, parasternal short, and apical 4-chamber views had high positive correlation in the final assessment. This project outlines the creation of an assessment tool of POCUS competency for future clinicians. There was good reliability and validity in both assessments, especially with the parasternal long and short views in both assessments. The flexibility of POCUS in a broad spectrum of clinical settings and disciplines combined with its growing incorporation into medical education accentuates the need for a standardized and valid assessment of ultrasound competency.