Table 2 Exemplary OSCE evaluation sheet for transthoracic echocardiography apical four-chamber view

1. Probe Handling and patient guidance

10

- Orientation

 • Correct or directly checked independently by image movement or coupling

2

 • Corrected after initial difficulties or upon request

1

 • Only with manual assistance

0

- Positioning

 • Correct, or directly transferred from another view with optimal pivoting

2

 • Corrected after initial difficulties or upon request

1

 • Only with manual assistance

0

- Coupling

 • Coupling with gel and pressure variation

2

 • Corrected after initial difficulties or upon request

1

 • Missing use of gel or pressure, probe not connected with skin or uncontrolled pressure on xiphoid/ribs

0

- Adequate amplification

  • Adequate and independent adjustment of amplification

2

 • Corrected after initial difficulties or upon request

1

 • No adequate amplification adjustment despite request

0

- Guiding of the patient

 • Positioning on the subject’s left side

1

 • Left arm bended beneath head

1

2. Examination

18

- Standard view anatomical structures

 • Correct view (without assistance) of

  o both ventricles, atria and atrioventricular valves

6

  o Perpendicular septum

2

  o Apex in 12 o’clock direction

2

  o Maximum ventricle extension (no foreshortening)

2

 • Correct view only with verbal assistance

4

 • Correct view only with manual assistance

2

 • Standard view cannot be displayed despite manual assistance

0

- Standard view measurement

 • Correct pulsed wave doppler measurement with

  o sample volume at mitral valve level

  o correct flow profile

2

 • Correct measurement only with manual assistance

2

 • Incorrect measurement despite manual assistance

0

3. (Correct) Image description/explanation

4

- Ventricle left/right

1

- Interventricular septum

1

- Aortic and mitral valve

2

4. Overall Performance

8

 - Confident

8

7

6

5

4

3

2

 - Marked deficits

1

Total score

40