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.
Medical residents in general internal medicine
Basic ultrasound skills (POCUS component 1 or ≥200 scans)
Working at study site during study period
SGUM certification in abdominal ultrasound
Advanced duplex ultrasound experience
Prior vascular/duplex training
Parallel
In-person VExUS Training Program
BehavioralIn-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.
Remote VExUS Training Program
BehavioralRemote training consisting of an e-learning module followed by independently performed ultrasound examinations with asynchronous expert feedback (via phone or email).
No intervention
Other interventionSGUM-certified physicians performing VExUS examinations as expert reference standard.
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.
Time for Image Acquisition and Interpretation
Time required by participants to perform the ultrasound examination and interpret the images during VExUS assessment
Change in self-confidence in performing VExUS assessment
Self-reported confidence measured using a Likert-scale questionnaire before and after 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.
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.
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