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Khowong TY, Khamis NN. Transformative Learning, Priming, and Simulation Timing: A Randomized Controlled Pilot Study Among Emergency Medicine Residents. Cureus 2023; 15:e47567. [PMID: 38021784 PMCID: PMC10666194 DOI: 10.7759/cureus.47567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Traditionally, learning is thought to occur best when prerequisite cognitive background information is delivered before simulation training. More recent studies have attempted to analyze the transformative nature of simulation by placing simulation before didactics. However, these studies were flawed as they provided background on the subject before the simulation itself. Our study aims to isolate the transformative effect of simulation and answer the question of whether lecture or simulation should come first. Methodology We designed a novel simulation session and accompanying lecture for 18 Emergency Medicine residents in all three years of training regarding a subject they were entirely unfamiliar with, the emergent management of a left ventricular assist device (LVAD). The residents were randomized into two groups. One group had the lecture (8/18) before their simulation, while the other group (10/18) had the simulation first and the lecture afterward, testing the motivational nature. Thereafter, both groups responded to a post-session survey with Likert-style and open-ended comment questions to assess the reaction to the session and a knowledge-based multiple-choice question test. Results Both groups did not score significantly differently on either the immediate post-test or a retention post-test that we administered four weeks later. Three of eight participants reported in open comments that they were much more comfortable with a lecture-first than a simulation-first format. Conclusions Despite controlling for some of the limitations of previous studies, our results including learners' preferences do not support a transformation in the sequence of clinical skills learning. Until other larger studies prove the opposite, we recommend continuing with the lecture followed by the simulation sequence as per existing conceptual simulation learning frameworks.
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Affiliation(s)
- Timothy Y Khowong
- Department of Emergency Medicine, NewYork-Presbyterian Queens, Queens, USA
| | - Nehal N Khamis
- Department of Population Health, Hofstra University, Hempstead, USA
- Department of Advanced Studies in Education/Master of Education for Health Professions Program, Johns Hopkins University, Baltimore, USA
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2
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Pezel T, Coisne A. What other than simulation for the future of echocardiography training? Arch Cardiovasc Dis 2023; 116:298-299. [PMID: 37268492 DOI: 10.1016/j.acvd.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Théo Pezel
- Service de cardiologie, hôpital universitaire Lariboisière - AP-HP, université Paris-Cité, 75010 Paris, France; Centre de simulation de l'université Paris-Cité, centre Ilumens, université de Paris, 75006 Paris, France; Inserm UMRS 942, cardiovascular MArkers in Stressed COndiTions (MASCOT), 75010 Paris, France; French Commission of Simulation Teaching (commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France.
| | - Augustin Coisne
- French Commission of Simulation Teaching (commission d'enseignement par simulation-COMSI) of the French Society of Cardiology, 75012 Paris, France; Université de Lille, Inserm, CHU de Lille, institut Pasteur de Lille, U1011- EGID, 59000 Lille, France; Centre de simulation en santé PRESAGE, faculté de médecine, université de Lille, 59045 Lille, France
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3
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Pezel T, Dreyfus J, Mouhat B, Thébaut C, Audureau E, Bernard A, Badie YL, Bohbot Y, Fard D, Nguyen LS, Monteil C, Bière L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Bazire B, Fauvel C, Cautela J, Cambet T, Le Tourneau T, Donal E, Lafitte S, Magne J, Mansencal N, Coisne A, Aghezzaf S, Blanchard V, Meilhac A. Effectiveness of Simulation-Based Training on Transesophageal Echocardiography Learning. JAMA Cardiol 2023; 8:248-256. [PMID: 37070491 DOI: 10.1001/jamacardio.2022.5016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Trial RegistrationClinicalTrials.gov Identifier: NCT05564507
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Affiliation(s)
- Théo Pezel
- Université de Paris, Service de Cardiologie, Hôpital universitaire Lariboisière – APHP, Paris, France
- Centre de simulation de l’Université de Paris, Centre Ilumens, Université de Paris, Paris, France
- INSERM UMRS 942, Paris, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Clémence Thébaut
- Université de Limoges, Inserm U1094 IRD U270 EpiMaCT, chercheur en économie de la santé associé LEDA-Legos PSL Paris-Dauphine, Limoges, France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEPIA), IMRB U955, UPEC, CHU Henri Mondor, AP-HP, Creteil, France
| | - Anne Bernard
- Service de Cardiologie, CHRU de Tours, Tours, France
- EA4245, Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
- Centre Régional d’Enseignement par la Simulation en Santé MEDISIM, Université de Tours, Tours, France
| | - Yoan Lavie Badie
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Health Simulation Center SimUSanté, Amiens University Hospital, Amiens, France
| | - Damien Fard
- Department of Cardiology, Cardiology Intensive Care Unit, Henri-Mondor University Hospital, AP-HP, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Lee S. Nguyen
- Research and Innovation, RICAP, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Cécile Monteil
- Centre de simulation de l’Université de Paris, Centre Ilumens, Université de Paris, Paris, France
| | - Loïc Bière
- All’Sims Centre for Simulation in Healthcare, Faculty of Health, University Hospital of Angers, Angers, France
| | - Florent Le Ven
- Department of Cardiology, Brest University Hospital, CHRU de la Cavale Blanche, Brest, France
- Centre de simulation en santé-CESIM Brest, Brest, France
| | - Marjorie Canu
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | | | - Baptiste Mion
- Université de Paris, Service de Cardiologie, Hôpital universitaire Hôtel Dieu – APHP, Paris, France
| | - Baptiste Bazire
- Université de Paris, Service de Cardiologie, Hôpital universitaire Bichat – APHP, Paris, France
| | - Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU CARNAVAL, Rouen, France
- Department of Cardiovascular medicine, Wexner Medical Center, The Ohio State University, Columbus
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Marseille, France
| | - Théo Cambet
- Explorations fonctionnelles cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, BRON Cedex, France
| | - Thierry Le Tourneau
- L’institut du thorax, INSERM, CNRS, Simu de Nantes, Univ Nantes, CHU Nantes, Nantes, France
| | - Erwan Donal
- Cardiologie, CHU de Rennes, LTSI, Inserm 1099, Rennes, France
| | - Stéphane Lafitte
- UMCV, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Julien Magne
- Center of Epidemiology, biostatistics and methodology of research, Limoges, CHU Limoges, Inserm U1094, IRD U270, Univ. Limoges, EpiMaCT - OmegaHealth, Limoges, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Augustin Coisne
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France
- Centre de simulation en santé PRESAGE, Faculté de médecine, Université de Lille, Lille, France
- Cardiovascular Research Foundation, New York, New York
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4
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Field S, Aust Z, Potomac W, Pascual M, Couch C, Bhatia D, Dixon B, Upchurch B, Zozaya J, Jones J, Hansen Z, Roppolo L. An Innovative Curriculum For Teaching Transesophageal Echocardiography (TEE) to Emergency Medicine Residents. J Emerg Med 2022; 63:801-810. [PMID: 36369119 DOI: 10.1016/j.jemermed.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/23/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Focused transesophageal echocardiogram (TEE) can be a valuable tool for emergency physicians (EP) during cardiac arrest. OBJECTIVES We sought to demonstrate the ability of emergency medicine (EM) residents without prior TEE experience to perform a simulated four-view TEE following a short, flipped conference curriculum. METHODS This was a prospective, simulation-based study where EM residents participated in the following four-view TEE curriculum: 1 h of online content reviewed prior to a 20-min in-person lecture and 30-min hands-on practice using a TEE trainer. Each resident attended four testing sessions over an 8-week period and performed a total of 25 TEE scans. Each TEE scan was graded in real time using a 10-point checklist by a TEE-credentialed EP. Interrater reliability of the checklist was calculated using the kappa coefficient (κ). A random sample of 10% of the TEE scans were reviewed by a TEE expert using a standard ultrasound 1-5 scale for image acquisition quality, with a "3" considered to be satisfactory. Residents completed an online pretest and posttest. RESULTS Twenty-four residents participated. Mean pre- and posttest scores were 52% (SD 16) and 92% (SD 12), respectively. Mean TEE scores using the 10-point checklist after sessions one and four were 9.4 (SD 0.4) and 9.7 (SD 0.3), respectively. Mean time to complete each TEE scan after sessions one and four were 118.1 (SD 28.3) and 57.1 (SD 17.0) s, respectively. The κ for the checklist was 1. The median score for the image acquisition review was 3 (interquartile range 3-4). CONCLUSIONS This simplified flipped conference curriculum can train EM residents to competently perform TEE in a simulated environment.
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Affiliation(s)
- Steven Field
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Zachary Aust
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Whitney Potomac
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Mandy Pascual
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Christopher Couch
- Cardiovascular Intensive Care Unit, Medical City Dallas Heart Hospital, Dallas, Texas
| | - Deven Bhatia
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Bryant Dixon
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Bradley Upchurch
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Josue Zozaya
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Jodi Jones
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Zachary Hansen
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Lynn Roppolo
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
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5
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Zhao Y, Yuan ZY, Zhang HY, Yang X, Qian D, Lin JY, Zhu T, Song HB. Simulation-based training following a theoretical lecture enhances the performance of medical students in the interpretation and short-term retention of 20 cross-sectional transesophageal echocardiographic views: a prospective, randomized, controlled trial. BMC MEDICAL EDUCATION 2021; 21:336. [PMID: 34107936 PMCID: PMC8191119 DOI: 10.1186/s12909-021-02753-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Abstract
Background Both simulation-based training and video-based training serve as educational adjuncts for learning TEE among medical students. In the present study, we hypothesized that simulation-based training would better enhance the performance of medical students in the interpretation of 20 cross-sectional views compared to video-based training. Methods A total of 120 4th-year undergraduate medical students were enrolled in the present study. The study began with a pre-test of all the participants, followed by a 90-min theoretical lecture and a post-test. Subsequently, the participants were randomly divided into the video-based group (Group V) and simulation-based group (Group S). Next, Group V received 60 min of TEE video learning, while Group S received 60 min of TEE simulator training. After the respective training, both the groups undertook the retention-test 1 and retention-test 2, 1 week and 1 month later, respectively. The performance for each test was evaluated by five views, which were selected randomly and, respectively, from a set of 20 cross-sectional views. The primary outcome was the performance of the retention-test 1. Secondary outcomes included: (1) comparison the performances of the pre-test, post-test, and retention-test 2 between two groups; (2) comparison the performances of pre-test and post-test in the same group; (3) comparison the performances of retention-test 1, and retention-test 2 in the same group. Results Better performances were observed in Group S in both retention-test 1 (Group V: 63.2 [52.6, 77.6] vs. Group S: 89.5 [68.4, 100.0], P < 0.001) and retention-test 2 (Group V: 58.0 [48.0, 72.0] vs. Group S: 74.0 [64.0, 80.0], P < 0.001) compared to Group V. No statistically significant differences were observed in the performances of pre-test (Group V: 8.3 [4.2, 12.5] vs. Group S: 8.3 [4.2, 12.5], P = 0.825) or post-test (Group V: 46.2 [38.5, 57.7] vs. Group S: 44.2 [38.5, 56.7], P = 0.694) between the two groups. The improvement had been observed in the post-test, compared with pre-test in the same group, respectively (Group V in post-test: 46.2 [38.5, 57.7] vs. Group V in pre-test: 8.3 [4.2, 12.5], P < 0.001; Group S in post-test: 44.2 [38.5, 56.7] vs. Group S in pre-test: 8.3 [4.2, 12.5], P < 0.001). However, the performance in retention-test 2 was significantly reduced, compared with retention-test 1 in the same group, respectively (Group V in retention-test 2: 58.0 [48.0, 72.0] vs. Group V in retention-test 1: 63.2 [52.6, 77.6] P = 0.005; Group S in retention-test 2: 74.0 [64.0, 80.0] vs. Group S in retention-test 1: 89.5 [68.4, 100.0], P < 0.001). Conclusions Following a 90-min theoretical lecture, simulation-based training better enhanced the performance of medical students in the interpretation and short-term retention of 20 cross-sectional views compared to video-based training. Trial registration http://www.chictr.org.cn (ChiCTR2000033519, 3/June/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12909-021-02753-1.
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Affiliation(s)
- Yang Zhao
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Department of Anesthesiology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Zong-Yi Yuan
- Department of Oral and Maxillofacial, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Han-Ying Zhang
- Department of Anesthesiology, Pidu District People's Hospital, 156# East Street, Pitong Town, Pidu District, Chengdu, Sichuan, 611730, People's Republic of China
| | - Xue Yang
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Duo Qian
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Department of Anesthesiology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jing-Yan Lin
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.,Department of Anesthesiology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Hai-Bo Song
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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6
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Pezel T, Bernard A, Lavie Badie Y, Dreyfus J, Audureau E, Bohbot Y, Fard D, Hubert A, Nguyen LS, Monteil C, Bière L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Mouhat B, Bazire B, Fauvel C, Ternacle J, Cautela J, Cambet T, Le Tourneau T, Donal E, Lafitte S, Mansencal N, Coisne A. 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. Front Cardiovasc Med 2021; 8:661355. [PMID: 34109225 PMCID: PMC8180582 DOI: 10.3389/fcvm.2021.661355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology. Materials and Methods: Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of >70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition. Results: All residents will undergo both a theoretical test (0-100 points) and a practical test on a TEE simulator (0-100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training. Conclusion: Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.
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Affiliation(s)
- Théo Pezel
- University of Paris, Department of Cardiology, Lariboisiere Hospital—APHP, Paris, France
- INSERM UMRS 942, Paris, France
- Ilumens Healthcare Simulation Department, Paris University, Paris, France
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Anne Bernard
- Service de Cardiologie, CHRU de Tours, Toulouse, France
- EA4245, Loire Valley Cardiovascular Collaboration, Université de Tours, Tours, France
- Centre Régional d'Enseignement par la Simulation en Santé, Faculté de Médecine de Tours, Tours, France
| | - Yoan Lavie Badie
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | - Etienne Audureau
- Clinical Epidemiology and Ageing (CEPIA), IMRB U955, UPEC, Creteil, France
- CHU Henri Mondor, AP-HP, Creteil, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Health Simulation Center SimUSanté®, Amiens University Hospital, Amiens, France
| | - Damien Fard
- Department of Cardiology, Cardiology Intensive Care Unit, Henri-Mondor University Hospital, AP-HP, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | | | - Lee S. Nguyen
- Research and Innovation, RICAP, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Cécile Monteil
- Ilumens Healthcare Simulation Department, Paris University, Paris, France
| | - Loïc Bière
- Department of Cardiology, Angers University Hospital, Angers, France
| | - Florent Le Ven
- Department of Cardiology, Brest University Hospital, CHRU de la Cavale Blanche, Brest, France
| | - Marjorie Canu
- Department of Cardiology, Grenoble University Hospital, Grenoble, France
| | | | - Baptiste Mion
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Baptiste Bazire
- University of Paris, Department of Cardiology, Bichat Hospital—APHP, Paris, France
| | - Charles Fauvel
- Department of Cardiology, CHU Rouen, FHU REMOD-VHF, Rouen, France
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jennifer Cautela
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique—Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Marseille, France
| | - Théo Cambet
- Explorations fonctionnelles cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Thierry Le Tourneau
- Inserm UMR1087, Institut du thorax, Université de Nantes, CHU de Nantes, Nantes, France
| | - Erwan Donal
- Cardiologie, CHU de Rennes, LTSI, Rennes, France
| | - Stéphane Lafitte
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Augustin Coisne
- Department of Cardiovascular Explorations and Echocardiography—Heart Valve Clinic, CHU Lille, Lille, France
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
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7
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Flower L, Dempsey M, White A, Sanfilippo F, Olusanya O, Madhivathanan PR. Training and Accreditation Pathways in Critical Care and Perioperative Echocardiography. J Cardiothorac Vasc Anesth 2020; 35:235-247. [PMID: 32768252 DOI: 10.1053/j.jvca.2020.07.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
In recent years, there has been a dramatic rise in the use of echocardiography in perioperative and critical care medicine. It is now recommended widely as a first-line diagnostic tool when approaching patients in shock, due to its ability to identify shock etiology and response to treatment noninvasively. To match the increasing training demand, and to ensure maintenance of high-quality and reproducible scanning, several accreditation pathways have been developed worldwide. Critical care echocardiography training pathways can include both transthoracic and transesophageal scanning and range from basic focused protocols to advanced comprehensive scans. The complexity of each individual training program is reflected in its accreditation process. While basic accreditations may require only course attendance and a relatively brief logbook, comprehensive accreditations often require extensive logbooks and written and practical examinations. Currently, the use of transoesophageal echocardiography remains restricted largely to cardiothoracic anesthesia and critical care; however, its use in the general intensive care setting is growing. This narrative review summarizes the most common training pathways, their curricula, and accreditation requirements. The authors initially focus on echocardiography training in the United Kingdom, and then go on to describe similar international accreditations available in Europe, North America, and Australasia.
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Affiliation(s)
- Luke Flower
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, United Kingdom.
| | - Martin Dempsey
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Alexander White
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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8
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Ashokka B, Dong C, Law LSC, Liaw SY, Chen FG, Samarasekera DD. A BEME systematic review of teaching interventions to equip medical students and residents in early recognition and prompt escalation of acute clinical deteriorations: BEME Guide No. 62. MEDICAL TEACHER 2020; 42:724-737. [PMID: 32493155 DOI: 10.1080/0142159x.2020.1763286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Current educational interventions and teaching for acute deteriorations seem to address acute care learning in discreet segments. Technology enhanced and team training methodologies are in vogue though well studied in the nursing profession, teaching avenues for junior 'doctors in training' seem to be a lacuna.Aims: The BEME systematic review was designed to (1) appraise the existing published evidence on educational interventions that are intended for 'doctors in training' to teach early recognition and prompt escalation in acute clinical deteriorations (2) to synthesise evidence & to evaluate educational effectiveness.Methodology: The method applied was a descriptive, justification & clarification review. Databases searched included PubMed, PsycINFO, Science Direct and Scopus for original research and grey literature with no restrictions to year or language. Abstract review, full text decisions and data extraction were completed by two primary coders with final consensus by a third reviewer.Results: 5592 titles and abstracts were chosen after removal of 905 duplications. After exclusion of 5555 studies, 37 full text articles were chosen for coding. 22 studies met final criteria of educational effectiveness, relevance to acute care. Educational platforms varied from didactics to blended learning approaches, small group teaching sessions, simulations, live & cadaveric tissue training, virtual environments and insitu team-based training. Translational outcomes with reduction in long term (up to 3-6 years) morbidity & mortality with financial savings were reported by 18% (4/22) studies. Interprofessional training were reported in 41% (9/22) of studies. Recent evidence demonstrated effectiveness of virtual environment and mobile game-based learning.Conclusions: There were significant improvements in teaching initiatives with focus on observable behaviours and translational real patient outcomes. Serious game-based learning and virtual multi-user collaborative environments might enhance individual learners' cognitive deliberate practice. Acute care learning continuum with programmatic acute care portfolios could be a promise of the future.
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Affiliation(s)
| | | | | | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Fun Gee Chen
- Anaesthesia, National University of Singapore, Singapore
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