Basic diaphragm ultrasound training: Curriculum implementation and learning trajectory among diaphragm ultrasound naive trainees

doi:10.5662/wjm.v16.i2.113663

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World Journal of Methodology

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World J Methodol. Jun 20, 2026; 16(2): 113663
Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.113663

Table 1 Patient characteristics (n = 65), n (%)/mean ± SD

Characteristics
Age (years)	57.5 ± 14.0
Gender	Male: 49 (75.4); female: 16 (24.6)
BMI (kg/m²)	26.2 ± 9.3
Primary diagnosis	Gastrointestinal bleed: 1 (1.5); IHD/cardiac failure: 6 (9.2); ischemic stroke: 23 (35.4); intracranial events other than ischemic stroke (CVT, ICH, abscess, status epilepticus): 12 (18.5); myasthenia gravis: 2 (3.1); metabolic abnormality (hypokalaemia, myxoedema coma): 2 (3.1); polytrauma: 1 (1.5); pneumonia: 17 (26.2); urosepsis: 1 (1.5)
Presence of neuromuscular condition	4 (6.2)¹
Respiratory rate (median, range)	20 (13-39)
Ventilation modes	Nil ventilation 26 (40); non-invasive ventilation 5 (7.7); invasive ventilation 34 (52.3)

¹Neuromuscular condition was defined as patient having a concomitant neuromuscular disease (2 had myasthenia, 1 had both myasthenia and facioscapulohumeral muscular dystrophy, 1 had critical illness myopathy).

In total, we imaged 52 patients. Some patients had repeated imaging, and so we had 65 separate occasions in which the 13 trainees received training. The data presented in Table 1 refers to the 65 different data points upon which the trainees were assessed. BMI: Body mass index; IHD: Ischemic heart disease; CVT: Cerebral venous thrombosis; ICH: Intracranial haemorrhage.

Full Size Table

Table 2 Median values of diaphragmatic measurements for trainer and trainee, median (interquartile range)

		Try 1	Try 2	Try 3	Try 4	Try 5
Right DTF ZOA (%, n = 13)	Trainer	40.9 (31.2-46.3)	27.3 (11.3-32.1)	26.7 (14.2-38.1)	17.8 (15.1-38.7)	30.4 (28.4-42.0)
	Trainee	29.9 (24.9-52.2)	27.5 (6.7-36.7)	25.0 (12.7-28.9)	16.3 (5.8-38.7)	29.2 (28.4-42.0)
	P value	0.66	0.76	0.06	0.68	0.34
Right DTF mid-axillary (%, n = 13)	Trainer	38.0 (22.4-77.5)	19.3 (7.0-24.6)	20.6 (14.2-26.1)	31.6 (23.6-55.3)	24.4 (21.6-41.2)
	Trainee	53.9 (13.1-79.9)	19.6 (11.0-27.7)	21.4 (12.8-26.1)	31.6 (15.7-55.3)	24.4 (21.6-41.2)
	P value	0.13	0.43	0.87	0.22	1
Right diaphragm excursion (cm, n = 12)	Trainer	1.27 (1.04-1.82)	1.07 (0.66-1.45)	0.96 (0.81-1.45)	0.88 (0.83-1.38)	1.18 (1.04-1.40)
	Trainee	1.16 (0.92-1.84)	1.03 (0.66-1.36)	1.02 (0.82-1.45)	0.88 (0.70-1.45)	1.18 (1.04-1.40)
	P value	0.09	0.19	0.19	0.49	1
Left DTF ZOA (%, n = 13)	Trainer	25.3 (19.4-72.4)	34.6 (26.1-47.1)	33.3 (23.1-35.3)	31.0 (15.4-48.4)	29.9 (15.3-37.8)
	Trainee	56.2 (14.8-72.4)	34.6 (21.1-53.0)	33.3 (27.7-38.9)	28.6 (15.4-42.3)	29.9 (15.3-37.8)
	P value	0.31	0.78	0.55	0.54	0.34
Left DTF mid-axillary (%, n = 12)	Trainer	32.5 (15.2-53.0)	21.5 (14.6-40.2)	22.9 (10.5-37.9)	31.3 (24.0-39.1)	24.0 (17.6-36.5)
	Trainee	20.5 (15.1-53.0)	18.1 (7.8-41.3)	18.9 (8.8-37.9)	29.0 (22.8-39.1)	24.0 (13.6-36.5)
	P value	0.48	0.55	0.17	0.34	0.34
Left diaphragm excursion (cm, n = 12)	Trainer	1.20 (1.11-1.58)	1.16 (0.83-2.17)	1.19 (0.94-1.34)	1.01 (0.77-1.12)	1.14 (1.05-1.31)
	Trainee	1.24 (1.11-1.60)	1.15 (0.83-2.17)	1.19 (0.89-1.34)	1.01 (0.77-1.12)	1.15 (1.07-1.42)
	P value	0.71	0.25	0.34	0.34	0.34

DTF: Diaphragm thickening fraction; ZOA: Zone of apposition.

Full Size Table

Table 3 Normal interpretation of diaphragmatic measurements for trainer and trainee, n (%)

		Try 1	Try 2	Try 3	Try 4	Try 5
Right DTF at ZOA (n = 13)	Trainee with normal interpretation	13 (100)	8 (61.5)	8 (61.5)	5 (38.5)	11 (84.6)
	Trainer with normal interpretation	12 (92.3)	8 (61.5)	7 (53.8)	6 (46.2)	11 (84.6)
	P value	1	1	1	1	1
Right DTF at mid-axillary line (n = 13)	Trainee with normal interpretation	8 (61.5)	6 (46.2)	7 (53.8)	9 (69.2)	10 (76.9)
	Trainer with normal interpretation	10 (76.9)	6 (46.2)	7 (53.8)	10 (76.9)	10 (76.9)
	P value	0.6728	1	1	1	1
Right excursion (n = 12)	Trainee with normal interpretation	7 (58.3)	6 (50.0)	6 (50.0)	5 (41.7)	9 (75.0)
	Trainer with normal interpretation	9 (75.0)	8 (66.7)	6 (50.0)	5 (41.7)	9 (75.0)
	P value	0.6668	0.6802	1	1	1
Left DTF at ZOA (n = 13)	Trainee with normal interpretation	9 (69.2)	10 (76.9)	10 (76.9)	9 (69.2)	9 (69.2)
	Trainer with normal interpretation	9 (69.2)	11 (84.6)	10 (76.9)	9 (69.2)	9 (69.2)
	P value	1	1	1	1	1
Left DTF at mid-axillary line (n = 12)	Trainee with normal interpretation	6 (50.0)	6 (50.0)	6 (50.0)	10 (83.3)	7 (58.3)
	Trainer with normal interpretation	7 (58.3)	8 (66.7)	7 (58.3)	11 (91.7)	8 (66.7)
	P value	1	0.6802	1	1	1
Left excursion (n = 12)	Trainee with normal interpretation	10 (83.3)	6 (50.0)	8 (66.7)	6 (50.0)	10 (83.3)
	Trainer with normal interpretation	10 (83.3)	6 (50.0)	8 (66.7)	6 (50.0)	10 (83.3)
	P value	1	1	1	1	1

DTF: Diaphragm thickening fraction; ZOA: Zone of apposition.

Full Size Table

Table 4 Proportion of trainees in agreement with trainers for measurement and interpretation, and proportion of trainees who needed help from trainer, n (%)

			Try 1	Try 2	Try 3	Try 4	Try 5
Right DTF at ZOA (n = 13)	Measurement	Trainee/trainer measurement in agreement	4 (30.8)	8 (61.5)	9 (69.2)	10 (76.9)	13 (100)
	Interpretation	Trainee/trainer interpretation in agreement	12 (92.3)	11 (84.6)	12 (92.3)	12 (92.3)	13 (100)
	Assistance	Needed help	12 (92.3)	8 (61.5)	12 (92.3)	5 (38.5)	0 (0)
Right DTF at mid-axillary line (n = 13)	Measurement	Trainee/trainer measurement in agreement	4 (30.8)	10 (76.9)	10 (76.9)	12 (92.3)	13 (100)
	Interpretation	Trainee/trainer interpretation in agreement	11 (84.6)	13 (100)	13 (100)	12 (92.3)	13 (100)
	Assistance	Needed help	11 (84.6)	6 (46.2)	6 (46.2)	7 (53.8)	0 (0)
Right diaphragm excursion (n = 12)	Measurement	Trainee/trainer measurement in agreement	7 (58.3)	8 (66.7)	8 (66.7)	10 (83.3)	12 (100)
	Interpretation	Trainee/trainer interpretation in agreement	10 (83.3)	10 (83.3)	12 (100)	12 (100)	12 (100)
	Assistance	Needed help	12 (100)	12 (100)	8 (66.7)	5 (41.7)	0 (0)
Left DTF at ZOA (n = 13)	Measurement	Trainee/trainer measurement in agreement	8 (61.5)	10 (76.9)	10 (76.9)	11 (84.6)	13 (100)
	Interpretation	Trainee/trainer interpretation in agreement	13 (100)	12 (92.3)	13 (100)	11 (84.6)	13 (100)
	Assistance	Needed help	12 (92.3)	9 (69.2)	10 (76.9)	7 (53.8)	2 (15.4)
Left DTF at mid-axillary line (n = 12)	Measurement	Trainee/trainer measurement in agreement	8 (66.7)	9 (75.0)	9 (75.0)	11 (91.7)	12 (100)
	Interpretation	Trainee/trainer interpretation in agreement	9 (75.0)	10 (83.3)	11 (91.7)	11 (91.7)	11 (91.7)
	Assistance	Needed help	10 (83.3)	7 (58.3)	5 (41.7)	2 (16.7)	1 (8.3)
Left excursion (n = 12)	Measurement	Trainee/trainer measurement in agreement	7 (58.3)	9 (75.0)	11 (91.7)	12 (100)	11 (91.7)
	Interpretation	Trainee/trainer interpretation in agreement	12 (100)	12 (100)	12 (100)	12 (100)	12 (100)
	Assistance	Needed help	12 (100)	11 (91.7)	6 (50.0)	6 (50.0)	3 (25.0)

The criteria of measurement in agreement was as follows: (1) Measurement in agreement for diaphragm thickening fraction is < 10% difference in diaphragm thickening fraction between trainer and trainee; and (2) Measurement in agreement for diaphragmatic excursion is < 2 mm difference between trainer and trainee. DTF: Diaphragm thickening fraction; ZOA: Zone of apposition.

Full Size Table

Citation: Ng KWP, See KC. Basic diaphragm ultrasound training: Curriculum implementation and learning trajectory among diaphragm ultrasound naive trainees. World J Methodol 2026; 16(2): 113663
URL: https://www.wjgnet.com/2222-0682/full/v16/i2/113663.htm
DOI: https://dx.doi.org/10.5662/wjm.v16.i2.113663