Training Medical Residents in the Use of the Venous Excess UltraSound (VExUS) Score for Bedside Volume Assessment.

Training Medical Residents in the Use of the Venous Excess UltraSound (VExUS) Score for Bedside Volume Assessment: a Randomized Controlled Trial

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.

Study Overview

• Status: Recruiting
• Conditions: Congestion; Acute Heart Failure (AHF); Congestion, Venous; Fluid Over-load
• Intervention / Treatment: Behavioral: In-person VExUS Training Program; Behavioral: Remote VExUS Training Program; Other: No intervention

Detailed Description

Accurate assessment of volume status is essential in managing acute heart failure but remains challenging in clinical practice. The VExUS score is a validated ultrasound-based tool integrating inferior vena cava diameter and Doppler assessment of hepatic, portal, and intrarenal veins.

This single-center randomized controlled trial compares two training modalities (in-person vs. remote) in medical residents with basic ultrasound skills. Participants will be randomized 1:1 to either training method and compared to a control group of expert physicians.

Primary outcomes include ultrasound image quality assessed using a standardized 100-point score. Secondary outcomes include time to acquisition, VExUS scoring accuracy, self-confidence, and acceptability of training methods.

• Study Type: Interventional
• Enrollment (Estimated): 23
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Caroline Rimensberger, MD; Phone Number: 0041316322111; Email: caroline.rimensberger@insel.ch
• Study Contact Backup: Name: Claudio Schneider, MD; Phone Number: 0041316322111; Email: claudio.schneider@insel.ch

Study Locations

• Switzerland
  • Bern, Switzerland, 3011
    • Recruiting
    • Inselspital
    • Contact: General Internal Medicine; Phone Number: 0041316322367; Email: sekretariat.meas@insel.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Medical residents in general internal medicine
• Basic ultrasound skills (POCUS component 1 or ≥200 scans)
• Working at study site during study period

Exclusion Criteria:

• SGUM certification in abdominal ultrasound
• Advanced duplex ultrasound experience
• Prior vascular/duplex training

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: In-person Training; 1-hour theoretical introduction 3-hour supervised practical ultrasound session Group-based hands-on training with expert coach	Behavioral: In-person VExUS Training Program; In-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.
Experimental: Remote Training; E-learning theoretical module 20 independently performed ultrasound exams Asynchronous expert feedback (phone/email)	Behavioral: Remote VExUS Training Program; Remote training consisting of an e-learning module followed by independently performed ultrasound examinations with asynchronous expert feedback (via phone or email).
Active Comparator: Control (Expert Physicians); SGUM-certified physicians performing VExUS examinations	Other: No intervention; SGUM-certified physicians performing VExUS examinations as expert reference standard.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	From training until 6 months after completion of training

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time for Image Acquisition and Interpretation	Time required by participants to perform the ultrasound examination and interpret the images during VExUS assessment	From training until 6 months after completion of training
Change in self-confidence in performing VExUS assessment	Self-reported confidence measured using a Likert-scale questionnaire before and after training	From baseline (before training) to immediately after completion of 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.	Immediately after completion of training and during the outcome assessment period (within 2 months after training)
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.	From training until 6 months after completion of training
Acceptability of the program (qualitative assessment)	Acceptability, including perceived barriers and facilitators to implementation, will be explored through semi-structured interviews. Data will be analyzed using thematic analysis guided by an implementation framework.	Immediately after completion of training and during the outcome assessment period (within 2 months after training)

Collaborators and Investigators

• Sponsor: Insel Gruppe AG, University Hospital Bern

Study record dates

Study Major Dates

• Study Start (Actual): March 20, 2026
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: March 31, 2026
• First Submitted That Met QC Criteria: April 16, 2026
• First Posted (Actual): April 21, 2026

Study Record Updates

• Last Update Posted (Actual): April 21, 2026
• Last Update Submitted That Met QC Criteria: April 16, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Bedside Ultrasound; Medical Education; Point-of-Care Ultrasound; POCUS; Venous Congestion; Ultrasound Training; Venous Excess Ultrasound; Vexus; Volume Assessment; Duplex Ultrasound
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Hyperemia
• Other Study ID Numbers: VEXUS Teaching

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No