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Meineri M, Menon P, Ender J, Forner A. Impact of a one-day three-dimensional transesophageal echocardiography workshop on clinical practice at a single academic centre. Ann Card Anaesth 2022; 25:479-484. [DOI: 10.4103/aca.aca_97_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jujo S, Nakahira A, Kataoka Y, Banno M, Tsujimoto Y, Tsujimoto H, Oikawa S, Matsui H, Berg BW. Transesophageal Echocardiography Simulator Training: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Simul Healthc 2021; 16:341-352. [PMID: 33428355 DOI: 10.1097/sih.0000000000000537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY STATEMENT We aimed to assess the learning effects of novice transesophageal echocardiography (TEE) simulator training and to identify gaps in existing studies. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the learning effects of novice TEE training with versus without simulators, searching published articles and proceedings in 6 major databases in June 2019. We included 9 RCTs (268 participants). Compared with nonsimulator training, TEE simulator training resulted in higher skill and knowledge posttraining test scores with large effect sizes (standardized mean difference = 0.81 for skill, 1.61 for knowledge; low-certainty evidence) and higher training satisfaction with a small effect size (standardized mean difference = 0.36; very low-certainty evidence). No RCTs reported training budget or patient outcomes. Additional well-designed studies with low risk of bias and large sample sizes are needed to provide reliable and robust findings and develop more effective TEE simulation-based training curricula.
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Affiliation(s)
- Satoshi Jujo
- From the SimTiki Simulation Center (S.J., A.N., B.W.B.), John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI; Department of Anesthesiology (S.J., H.M.), Kameda General Hospital, Chiba; Department of Critical Care Medicine (A.N.), Nara Prefecture General Medical Center, Nara; Department of Respiratory Medicine (Y.K.) and Hospital Care Research Unit (Y.K., H.T.), Hyogo Prefectural Amagasaki General Medical Center, Hyogo; Department of Psychiatry (M.B.), Seichiryo Hospital; Department of Psychiatry (M.B.), Nagoya University Graduate School of Medicine, Aichi; Department of Nephrology and Dialysis (Y.T.), Kyoritsu Hospital, Hyogo; and Department of Healthcare Epidemiology (Y.T.), School of Public Health in the Graduate School of Medicine, and Medical Education Center (S.O.), Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Weber U, Zapletal B, Base E, Hambrusch M, Ristl R, Mora B. Resident performance in basic perioperative transesophageal echocardiography: Comparing 3 teaching methods in a randomized controlled trial. Medicine (Baltimore) 2019; 98:e17072. [PMID: 31490407 PMCID: PMC6738965 DOI: 10.1097/md.0000000000017072] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Ulrike Weber
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine
| | - Bernhard Zapletal
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine
| | - Eva Base
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine
| | - Michael Hambrusch
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine
| | - Robin Ristl
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Bruno Mora
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine
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Zilverschoon M, Kotte EM, van Esch B, ten Cate O, Custers EJ, Bleys RL. Comparing the critical features of e-applications for three-dimensional anatomy education. Ann Anat 2019; 222:28-39. [DOI: 10.1016/j.aanat.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/02/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Al Ghofaily L, Mitchell JD, Woodworth G. Anesthesia Residency Training in Cardiac Anesthesia: Development of a Model Curricula and Educational Resources: The Anesthesia Toolbox. J Cardiothorac Vasc Anesth 2018; 32:621-630. [DOI: 10.1053/j.jvca.2017.11.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Indexed: 11/11/2022]
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Core point-of-care ultrasound curriculum: What does every anesthesiologist need to know? Can J Anaesth 2018; 65:417-426. [DOI: 10.1007/s12630-018-1063-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023] Open
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Callison SAR, Gannon I, Zisblatt L. Introductory Experience in Transesophageal Echocardiography for Anesthesiology Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10666. [PMID: 30800867 PMCID: PMC6342386 DOI: 10.15766/mep_2374-8265.10666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/30/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Transesophageal echocardiography (TEE) has become an important imaging modality for anesthesiologists to monitor and identify major cardiothoracic pathology in both noncardiac and cardiac surgical patients during the perioperative period. Knowledge in basic TEE sonoanatomy and the ability to obtain 11 basic views is a necessary foundation for junior residents so they may focus on using TEE as a monitor and tool to identify major cardiothoracic pathology later in their training. METHODS The purpose of the rotation is to introduce TEE image acquisition to clinical anesthesia Year 1 (CA-1) and CA-2 residents. In this module, the anesthesiology resident is assigned to a specific TEE-week rotation in the cardiovascular center. There are three main components to our TEE curriculum: (1) web-based and simulator-based exposure to image acquisition and sonoanatomy, (2) intraoperative exposure to image acquisition and sonoanatomy, and (3) the 11 standard basic TEE views worksheet and assessment tool. RESULTS Using the 11 standard basic TEE views assessment tool, 100% of the residents who went through the curriculum were able to obtain at least nine of the 11 views without prompting. Forty-five percent (n = 5) of CA-1 were able to obtain all 11 views without prompting, while 58% of the CA-2s were able to obtain all 11 views without prompting. DISCUSSION The preliminary results from our TEE curriculum are promising. We hope that this early exposure will lead to better learning on the residents' cardiac rotations in the CA-2 and CA-3 years by allowing them to start recognizing major pathology on TEE early on.
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Affiliation(s)
| | - Ian Gannon
- Assistant Professor, Department of Anesthesiology, University of Michigan Health System
| | - Lara Zisblatt
- Educational Specialist, Department of Anesthesiology, University of Michigan Health System
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Stehouwer N, Okello E, Gupta V, Bailey AL, Josephson R, Madan Mohan SK, Osman MN, Longenecker CT. Development and Validation of a Teaching Module for Echocardiographic Scoring of Rheumatic Mitral Stenosis. Glob Heart 2017; 13:105-111. [PMID: 28867640 DOI: 10.1016/j.gheart.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/01/2017] [Accepted: 05/16/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Wilkins score and commissural calcification scores predict outcomes after percutaneous balloon mitral valvuloplasty. However, many cardiologists are inadequately trained in their application-both in the United States where the incidence of rheumatic heart disease has fallen and in rheumatic heart disease endemic countries where training infrastructure is weak. OBJECTIVES This study sought to develop a computer-based educational module teaching 2 scoring systems for rheumatic mitral stenosis and to validate the module among cardiology fellows in the United States and Uganda. METHODS We developed a module organized into 3 sets of 10 echocardiograms each. The module was completed by 13 cardiology fellows from 2 academic centers in the United States and 1 in Uganda. Subject answers were compared with a score assigned by 2 experts in echocardiography. The primary outcome was change in subjects' accuracy from set 1 to set 3, measured by mean absolute deviation from expert scores. Secondary outcomes included change in interoperator variability and individual subject bias from set 1 to set 3. RESULTS The mean absolute deviations from expert scores in sets 1 and 3 were 2.09 and 1.82 for the Wilkins score (possible score range 0 to 16) and 1.13 and 0.94 for the commissural calcification score (possible score range 0 to 4). The change from set 1 to set 3 was statistically significant only for 1 of the Wilkins component scores (leaflet calcification, p < 0.001.) No change was seen in the interoperator variability. Individual subject bias in assigning the total Wilkins score was reduced from set 1 to set 3. CONCLUSIONS Use of this module has the potential to enhance the training of cardiologists in the echocardiographic assessment of mitral stenosis. Modified versions of this module or similar ones should be tested in targeted populations of cardiology trainees with the most exposure to mitral stenosis interventions.
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Affiliation(s)
- Nathan Stehouwer
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Vedant Gupta
- Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Alison L Bailey
- Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Richard Josephson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sri Krishna Madan Mohan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mohammed N Osman
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Chris T Longenecker
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Loke YH, Harahsheh AS, Krieger A, Olivieri LJ. Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease. BMC MEDICAL EDUCATION 2017; 17:54. [PMID: 28284205 PMCID: PMC5346255 DOI: 10.1186/s12909-017-0889-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/20/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common human birth defect, and clinicians need to understand the anatomy to effectively care for patients with CHD. However, standard two-dimensional (2D) display methods do not adequately carry the critical spatial information to reflect CHD anatomy. Three-dimensional (3D) models may be useful in improving the understanding of CHD, without requiring a mastery of cardiac imaging. The study aimed to evaluate the impact of 3D models on how pediatric residents understand and learn about tetralogy of Fallot following a teaching session. METHODS Pediatric residents rotating through an inpatient Cardiology rotation were recruited. The sessions were randomized into using either conventional 2D drawings of tetralogy of Fallot or physical 3D models printed from 3D cardiac imaging data sets (cardiac MR, CT, and 3D echocardiogram). Knowledge acquisition was measured by comparing pre-session and post-session knowledge test scores. Learner satisfaction and self-efficacy ratings were measured with questionnaires filled out by the residents after the teaching sessions. Comparisons between the test scores, learner satisfaction and self-efficacy questionnaires for the two groups were assessed with paired t-test. RESULTS Thirty-five pediatric residents enrolled into the study, with no significant differences in background characteristics, including previous clinical exposure to tetralogy of Fallot. The 2D image group (n = 17) and 3D model group (n = 18) demonstrated similar knowledge acquisition in post-test scores. Residents who were taught with 3D models gave a higher composite learner satisfaction scores (P = 0.03). The 3D model group also had higher self-efficacy aggregate scores, but the difference was not statistically significant (P = 0.39). CONCLUSION Physical 3D models enhance resident education around the topic of tetralogy of Fallot by improving learner satisfaction. Future studies should examine the impact of models on teaching CHD that are more complex and elaborate.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Ashraf S. Harahsheh
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Axel Krieger
- Bioengineering Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
| | - Laura J. Olivieri
- Division of Cardiology, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
- Bioengineering Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010-2970 USA
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Nazarnia S, Subramaniam K. Role of Simulation in Perioperative Echocardiography Training. Semin Cardiothorac Vasc Anesth 2016; 21:81-94. [PMID: 27381621 DOI: 10.1177/1089253216655874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Echocardiography plays a major role in the diagnosis and management of hemodynamic compromise during the perioperative period. Both transthoracic and transesophageal echocardiography have been shown to improve outcomes after cardiac and noncardiac surgery. Teaching basic echocardiographic skills to perioperative physicians remains a challenging task. Thus far, simulation-based medical education has been proven useful in teaching specific procedural skills and management of infrequent catastrophic events. Simulation-based echocardiography education has the potential to facilitate clinical training in echocardiography. Several small studies have shown the benefits of echocardiographic simulation on developing psychomotor and cognitive echocardiography skills. Future research should focus on the impact of simulation on actual clinical echocardiographic performance in the operating room and ultimately, patient outcomes.
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Abstract
AIM The aim of this article is to impart knowledge concerning focused transesophageal echocardiographic examination (TEE) for non-cardiac surgery which is an essential part of perioperative monitoring. It allows a rapid echocardiographic examination without interference with the surgical field or under limited transthoracic examination conditions. New recommendations for a comprehensive perioperative TEE examination with expanded standard views and the recently published consensus statement for a shortened baseline examination were crucial for this study. MATERIAL AND METHODS The background is the peer-reviewed literature from PubMed. RESULTS Apart from cardiac surgery TEE has two main applications: firstly, the evaluation of patients developing acute life-threatening hemodynamic instability in the operating room, in the emergency room or in the intensive care unit (ICU). Secondly, TEE is used as planned intraoperative monitoring when severe hemodynamic, pulmonary or neurological complications are expected because of the type of surgery or due to the cardiopulmonary medical history of the patient. In 2013 a total of 11 relevant standard views were defined for the basic perioperative TEE examination in non-cardiac surgery. These 11 views should be performed for each patient. Appropriate extension to a comprehensive examination may be necessary if complex pathology is obvious. DISCUSSION Even in non-cardiac surgery TEE is an important tool allowing clarification of a life-threatening perioperative hemodynamic instability within a few minutes. Furthermore, the hemodynamic management of high-risk patients can be facilitated. Appropriate qualification and continuous training are necessary in order to assure the competence of the examiner.
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Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training. Anesthesiol Res Pract 2015; 2015:971406. [PMID: 26788056 PMCID: PMC4695649 DOI: 10.1155/2015/971406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/29/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Web-based learning (WBL) is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.
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Sharma V, Fletcher SN. A review of echocardiography in anaesthetic and peri‐operative practice. Part 2: training and accreditation. Anaesthesia 2014; 69:919-27. [DOI: 10.1111/anae.12709] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 11/27/2022]
Affiliation(s)
- V. Sharma
- St George's University of London London UK
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Abstract
There has been a recent explosion of education and training in echocardiography in the specialties of anesthesiology and critical care. These devices, by their impact on clinical management, are changing the way surgery is performed and critical care is delivered. A number of international bodies have made recommendations for training and developed examinations and accreditations.The challenge to medical educators in this area is to deliver the training needed to achieve competence into already over-stretched curricula.The authors found an apparent increase in the use of simulators, with proven efficacy in improving technical skills and knowledge. There is still an absence of evidence on how it should be included in training programs and in the accreditation of certain levels.There is a conviction that this form of simulation can enhance and accelerate the understanding and practice of echocardiography by the anesthesiologist and intensivists, particularly at the beginning of the learning curve.
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Sohmer B, Hudson C, Hudson J, Posner GD, Naik V. Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers. Can J Anaesth 2013; 61:235-41. [PMID: 24271567 DOI: 10.1007/s12630-013-0081-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/05/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Performance of transesophageal echocardiography (TEE) requires the psychomotor ability to obtain interpretable echocardiographic images. The purpose of this study was to determine the effectiveness of a simulation-based curriculum in which a TEE simulator is used to teach the psychomotor skills to novice echocardiographers and to compare instructor-guided with self-directed online delivery of the curriculum. METHODS After institutional review board approval, subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator. Subjects were randomized to two groups. The first group received an instructor-guided lesson of TEE psychomotor skills with the simulator. The second group received a self-directed slide presentation of TEE psychomotor skills with the simulator. Both lessons delivered identical information. Following their respective training sessions, all subjects performed a post-test of their TEE psychomotor skills using the simulator. Two assessors rated the TEE performances using a validated scoring system for acquisition of images. RESULTS Pre-test TEE simulator scores were similar between the two instruction groups (9.0 vs 5.0; P = 0.28). The scores in both groups improved significantly following training, regardless of the method of instruction (P < 0.0001). The improvement in scores (post-test scores minus pre-test scores) did not differ significantly between instruction groups (12.5 vs 14.5; P = 0.55). There was strong inter-rater reliability between assessors (α = 0.98; 95% confidence interval [CI]: 0.97 to 0.99). CONCLUSIONS High-fidelity TEE simulators are an effective training adjunct for the acquisition of basic TEE psychomotor skills. There was no difference in improvement between the different modalities of instruction. Further research will examine the need for a faculty resource for a curriculum in which a simulator is used as an adjunct.
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Affiliation(s)
- Benjamin Sohmer
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, 40 Ruskin Street, Suite H2410, Ottawa, ON, K1Y 4W7, Canada,
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Damp J, Anthony R, Davidson MA, Mendes L. Effects of transesophageal echocardiography simulator training on learning and performance in cardiovascular medicine fellows. J Am Soc Echocardiogr 2013; 26:1450-1456.e2. [PMID: 24055126 DOI: 10.1016/j.echo.2013.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The role of transesophageal echocardiography (TEE) simulation in cardiology fellows' learning is unknown. Standard TEE training at the authors' institution occurs during the second of 3 clinical years. Fellows spend 2 months in the TEE laboratory learning through hands-on experience. The addition of TEE simulation to this experience may improve proficiency, speed learning, and increase fellows' comfort with TEE. This study was designed to compare methods of TEE simulator training with standard training. METHODS Group A (n = 8) consisted of fellows who had completed standard TEE training. Fellows starting their second clinical year were randomly assigned to group B (n = 10), simulator training during month 1, or group C (n = 9), simulator training during month 2. All groups completed 2 months of standard TEE training. All groups underwent assessment of TEE performance and a self-assessment of ability and comfort level with TEE. RESULTS Groups B and C had higher total assessment scores than group A. Groups B and C had higher numbers of views achieved without assistance (P = .01). After month 1, group B had higher total scores and number of views achieved without assistance compared with group C (P = .02 and P = .02, respectively). The length of time of the examination tended to be lower for group B, and fellows in group B had greater comfort with TEE than those in group C (P = .01). CONCLUSIONS These data suggest that TEE simulator training improves proficiency and helps speed learning and comfort with TEE.
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Affiliation(s)
- Julie Damp
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Jelacic S, Bowdle A, Togashi K, VonHomeyer P. The Use of TEE Simulation in Teaching Basic Echocardiography Skills to Senior Anesthesiology Residents. J Cardiothorac Vasc Anesth 2013; 27:670-5. [DOI: 10.1053/j.jvca.2013.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Indexed: 11/11/2022]
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Vegas A, Meineri M, Jerath A, Corrin M, Silversides C, Tait G. Impact of Online Transesophageal Echocardiographic Simulation on Learning to Navigate the 20 Standard Views. J Cardiothorac Vasc Anesth 2013; 27:531-5. [DOI: 10.1053/j.jvca.2012.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Indexed: 11/11/2022]
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Innovative transesophageal echocardiography training and competency assessment for Chinese anesthesiologists: role of transesophageal echocardiography simulation training. Curr Opin Anaesthesiol 2013; 25:686-91. [PMID: 23079579 DOI: 10.1097/aco.0b013e32835a10fb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Transesophageal echocardiography (TEE) is playing an invaluable role in diagnosing and monitoring the patient's hemodynamics in both cardiac and noncardiac surgery. There have been many obstacles in TEE training. RECENT FINDINGS The TEE simulation provides an ideal environment for anesthesiologists to practice their echocardiography skills out of the operation room. It consists of a manikin and a dummy probe that enable the trainees to perform a hands-on operation with echocardiographic views and allow a virtual scene consisting of a three-dimensional cardiac model, probe tip and image plane be presented side by side simultaneously. SUMMARY The TEE simulator provides an easy comprehensive learning interface and a friendly environment without the psychological pressure and time limitation frequently experienced in the operation room. The simulator can also be used to assess and evaluate the trainees' manipulation skills, space thinking, and clinical judgment ability. TEE simulation-based training and testing can be an important part in TEE training curriculum before the trainees start their clinical training in the operation room.
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Sharma V, Chamos C, Valencia O, Meineri M, Fletcher SN. The impact of internet and simulation-based training on transoesophageal echocardiography learning in anaesthetic trainees: a prospective randomised study. Anaesthesia 2013; 68:621-7. [DOI: 10.1111/anae.12261] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - M. Meineri
- Department of Anesthesia and Pain Medicine, Toronto General Hospital; Toronto; ON; Canada
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Roscher C, Reidy C, Augoustides JGT. Progress in perioperative echocardiography: focus on safety, clinical outcomes, 3-dimensional imaging, and education. J Cardiothorac Vasc Anesth 2011; 25:559-64. [PMID: 21493095 DOI: 10.1053/j.jvca.2011.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Indexed: 12/14/2022]
Abstract
Gastric decompression with an orogastric tube after anesthetic induction does not appear to enhance image quality for routine cases. The insertion of a transesophageal echocardiographic (TEE) probe can cause significant upper-airway trauma, which can be minimized with rigid laryngoscopy. Limited TEE imaging without transgastric views appears to be safe and clinically adequate in patients with advanced liver disease and esophageal varices. Although esophagogastric perforation because of transesophageal echocardiography is rare, the risk is significantly higher with advanced age and female sex. The echocardiographic assessment of right ventricular function and left ventricular diastolic function can improve the prediction of atrial arrhythmias after elective lung resection. Furthermore, asymptomatic left ventricular systolic or diastolic dysfunction is an independent predictor of cardiovascular mortality and morbidity after open vascular surgery. Advances in 3D echocardiography have shown that hypertrophic cardiomyopathy frequently is associated with changes in the mitral valve complex that predispose to left ventricular outflow tract obstruction. Furthermore, 3D imaging of the mitral apparatus has highlighted the importance of the annular saddle shape and the anatomic variability in ischemic mitral regurgitation. Education in perioperative echocardiography is experiencing high demand that can be satisfied partially with simulators and Internet-based educational activities. These modalities will aid in the dissemination of echocardiography through perioperative practice.
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Affiliation(s)
- Christopher Roscher
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Denault AY, Rochon AG. Transesophageal echocardiography training: looking forward to the next step. Can J Anaesth 2010; 58:1-7. [PMID: 21076951 DOI: 10.1007/s12630-010-9411-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 10/14/2010] [Indexed: 12/27/2022] Open
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