Resident performance in basic perioperative transesophageal echocardiography

Abstract

Background:Training in transesophageal echocardiography (TEE) is based on hands-on training in the operating room, which is time consuming and therefore limits its experience among anesthesiologists. Medical simulations have been successfully used for training of invasive procedures in many areas.This paper compares the difference in effectiveness of teaching the 11 basic TEE views using either e-learning, simulation based training or hands-on training in the operating room in 3 groups of residents.Methods:We included 51 anesthesia and intensive care residents of all training levels but no prior training in echocardiography in this prospective randomized single-center study.Residents received a tutorial about theoretical knowledge followed by 2 practical study sessions either by e-learning using an online simulator (www.pie.med.utoronto.ca/TEE), with the simulation mannequin (CAE Vimedix Simulator) or in the operating room. Both, a theoretical multiple choice test (0–50 points) and a practical exam test (0–110 points) on the simulation mannequin had to be completed.The primary endpoint was the post-training scores in the practical and theoretical exams after all training sessions.Results:Residents received significantly higher test scores in both practical and theoretical examinations after training with the simulation mannequin (108.41 ± 2.09, 40.6 ± 5.23, n = 17) compared with e-learning (106.88 ± 4.53, 36 ± 4.76, n = 17) or hands-on training (106.82 ± 2.01, 34.94 ± 4.72, n = 17).Conclusions:Simulation based TEE training provides more effective training than other teaching methods. It is therefore especially suitable for the initial stages of TEE training to acquire psychomotor skills and knowledge of echo-anatomy.

Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents

“…The following demographic data will be collected: age, sex, residency semester, having the national diploma in echocardiography (validation on the SIDES platform), number of TTE performed, number of TEE observed, desire for a technical specialty in cardiology (cardiovascular imaging, interventional cardiology, electrophysiology, pediatric and congenital cardiology, or no technical specialty). All participants will answer a questionnaire on their prior experience of video games in childhood or currently, defined by more than 1 hour per week, as this seemed to be associated with performance on simulation-based models in previous studies ( 15 , 24 ).…”

“…Immediately after each theoretical test (pre-training and final tests), all participants will be asked to demonstrate 10 basic views on a TEE simulator ( Table 1 ), as previously described ( 14 , 15 ). Of note, all residents of the two groups will have a few minutes before the practical test, to familiarize themselves with the handling of the simulator, without specific training and before the probe introduction.…”

“…The teacher will time the duration between TEE probe introduction and obtention of the specified view judged successful by the trainee. The modified Ferrero grading scale will be used to assess the quality of achievement of the views ( 14 , 15 , 23 ). In this grading system, each view will be marked out of 10 points according to the quality of the view.…”

“…After completion of the two training sessions, the participant satisfaction will be assessed by an anonymous questionnaire on the quality and effectiveness of the TEE training received during this study for the simulation group. As already published ( 15 , 19 ), the questionnaire will include six statements on different aspects of the training such as ( 1 ) overall satisfaction and usefulness; ( 2 ) perceived benefit; ( 3 ) duration of the sessions; ( 4 ) relevance of the current level of training; ( 5 ) ideas of improvement; and ( 6 ) whether the participants would recommend this educational program for others. Satisfaction will be assessed using a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree.…”

“…Based on recent available literature ( 13 , 15 , 19 , 21 ) and considering normalized 0–100 points score ranges for the two co-primary outcomes, a minimally important difference of 5 points (standard deviation 7 points) will be considered for the difference in change from pre- to post-training scores in theoretical and practical tests between the two randomized groups. Under these assumptions, a sample size of 50 subjects per group (for an overall population of 100 participants) will provide 90% power to detect a statistically significant difference between the two groups at a significance level of alpha = 2.5%, applying a Bonferroni correction to account for multiple testing of the two co-primary outcomes.…”