Development of Validity Evidence of a Standardized Competency Tool for Internal Jugular Vein Point of Care Ultrasound: Consensus Recommendations from International Experts

Background

Central venous pressure (CVP) is traditionally evaluated by visually estimating the jugular venous pressure (JVP), but this examination can vary with patient anatomy and operator skill. Point-of-care ultrasound (POCUS) of the internal jugular vein (IJV) presents a promising alternative for evaluating the JVP but a standardized competency-based assessment tool is lacking.

Objective

This study aimed to develop educational tools for assessing competency in IJV POCUS using a modified Delphi method.

Design

Two ultrasound competency checklists were developed by five Internal Medicine physicians experienced in IJV ultrasound. Checklist 1 focused on ultrasound JVP (u-JVP) evaluation with patients positioned at 30–45°, while Checklist 2 focused on upright-JVP with patients in an upright or 90° position based on previously published techniques. Nine expert physicians in POCUS participated in three rounds of a modified Delphi process to determine consensus on checklist items. Consensus was defined as agreement of 80% or more; items that did not reach consensus after three rounds were excluded. A subsequent modified Angoff method was used to establish passing scores and identify critical items.

Key Results

After three rounds of the Delphi process, 18 of 23 items (77%) in Checklist 1 and 15 of 18 items (83%) in Checklist 2 reached consensus for inclusion. Passing scores were established at 69.6% for Checklist 1 and 70.2% for Checklist 2. Additionally, 4/18 items (22%) in Checklist 1 and 3/15 items (20%) in checklist 2 were identified as critical.

Conclusion

Using a modified Delphi method to appraise two competency assessment tools for POCUS evaluation of the IJV, we reached consensus on an 18-item checklist for u-JVP and a 15-item checklist for upright JVP, of which 4 and 3 items were deemed critical, respectively. By defining critical items and setting passing scores, these tools may help standardize the assessment of trainee proficiency in IJV POCUS.