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Salim N, Shoaib A, Amir MA, Shiraz MI, Ayaz A, Shahid AR. Impact of simulation-based training on transesophageal echocardiography learning: A systemic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024; 49:102679. [PMID: 38795801 DOI: 10.1016/j.cpcardiol.2024.102679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Najwa Salim
- Department of Medicine, Karachi Medical and Dental College, Block M, North Nazimabad Town, Karachi, Sindh 74700, Pakistan.
| | - Aqsa Shoaib
- Department of Medicine, Karachi Medical and Dental College, Block M, North Nazimabad Town, Karachi, Sindh 74700, Pakistan
| | - Muhammad Ali Amir
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Moeez Ibrahim Shiraz
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Aliza Ayaz
- Department of Medicine, Karachi Medical and Dental College, Block M, North Nazimabad Town, Karachi, Sindh 74700, Pakistan
| | - Abdul Rehman Shahid
- Department of Medicine, Dow International Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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Khoche S, Ellis J, Poorsattar SP, Kothari P, Oliver A, Whyte A, Maus TM. The Year in Perioperative Echocardiography: Selected Highlights From 2022. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00260-4. [PMID: 37208207 DOI: 10.1053/j.jvca.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023]
Abstract
THIS SPECIAL article is part of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr. Kaplan, and the Editorial Board for the opportunity to continue this series, which focuses on the past year's research highlights that pertain to perioperative echocardiography in relation to cardiothoracic and vascular anesthesia. The major selected themes for 2022 include (1) updates on mitral valve assessments and interventions, (2) training and simulation updates, (3) outcomes and complications of transesophageal echocardiography, and (4) point-of-care cardiac ultrasound. The themes selected for this special article are just a sample of the advances in perioperative echocardiography during 2022. An appreciation and understanding of these highlights will help to ensure and improve the perioperative outcomes for patients with cardiovascular disease undergoing cardiac surgery.
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Affiliation(s)
- Swapnil Khoche
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California
| | - Jon Ellis
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California
| | - Sophia P Poorsattar
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Perin Kothari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ashley Oliver
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles, California
| | - Alice Whyte
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy M Maus
- Department of Anesthesiology, UCSD Medical Center-Sulpizio Cardiovascular Center, La Jolla, California.
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Simulation Based Mastery Learning of Transesophageal Echocardiography. Pediatr Cardiol 2023; 44:572-578. [PMID: 35767021 DOI: 10.1007/s00246-022-02950-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
Transesophageal echocardiography (TEE) education is part of pediatric cardiology fellow training. Simulation-based mastery learning (SBML) is an efficient and valuable education experience. The aim of this project was to equip trainees with the basic knowledge and skill required to perform a pediatric TEE. The secondary aim was to assess the utility of using SBML for pediatric TEE training. The target group is trainees from pediatric cardiology and cardiac anesthesia who participated in a TEE bootcamp. A baseline knowledge pretest was obtained. The knowledge session consisted of preparation via reading material, viewing recorded lectures and completing an iterative multiple-choice examination, which was repeated until a minimum passing score of 90% was achieved. The skills session involved a review of TEE probe manipulation and image acquisition, followed by rapid cycle deliberate practice using simulation to acquire TEE skills at 3 levels, advancing in complexity from level 1 to level 3. Eight individuals (7 pediatric cardiology fellows at varying training levels and one anesthesia attending) participated in the TEE bootcamp. All reached a minimum knowledge post test score of at least 90% before the skills session. All subjects reached mastery in TEE probe manipulation. All reached mastery in image acquisition for the skill level that they attempted (level 1-8/8, level 2-8/8, level 3-4/4, with 4 participants not attempting level 3). A TEE bootcamp using SBML is a powerful medical education strategy. SBML is a rigorous approach that can be used to achieve high and uniform TEE learning outcomes among trainees of different training levels and backgrounds.
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Bu Y, Chen M, Sharkey A, Wong V, Zhong Q, Mahmood F, Matyal R. Novel Three-Dimensional Printed Human Heart Models and Ultrasound Omniplane Simulator for Transesophageal Echocardiography Training. J Cardiothorac Vasc Anesth 2023; 37:1026-1031. [PMID: 36878817 DOI: 10.1053/j.jvca.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
Simulation-based training plays an essential role in transesophageal echocardiography (TEE) education. Using 3-dimensional printing technology, the authors invented a novel TEE teaching system consisting of a series of heart models that can be segmented according to actual TEE views, and an ultrasound omniplane simulator to demonstrate how ultrasound beams intersect the heart at different angles and generate images. This novel teaching system is able to provide a more direct way to visualize the mechanics of obtaining TEE images than traditional online or mannequin-based simulators. It can also provide tangible feedback of both an ultrasound scan plane and a TEE view of the heart, which has been proven to improve trainees' spatial awareness and can significantly help in understanding and memorizing complex anatomic structures. This teaching system itself is also portable and inexpensive, making it conducive to teaching TEE in regions of diverse economic status. This teaching system also can be expected to be used for just-in-time training in a variety of clinical scenarios, including operating rooms, intensive care units, etc.
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Affiliation(s)
- Yifan Bu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Michael Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Aidan Sharkey
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vanessa Wong
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Qiaoqing Zhong
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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Arango S, Gorbaty B, Buyck D, Johnson J, Porter ST, Iaizzo PA, Perry TE. A Free-Access Online Interactive Simulator to Enhance Perioperative Transesophageal Echocardiography Training Using a High-Fidelity Human Heart 3D Model. J Cardiothorac Vasc Anesth 2023; 37:308-313. [PMID: 36372718 DOI: 10.1053/j.jvca.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
The clinical uses of perioperative transesophageal echocardiography have grown exponentially in recent years for both cardiac and noncardiac surgical patients. Yet, echocardiography is a complex skill that also requires an advanced understanding of human cardiac anatomy. Although simulation has changed the way echocardiography is taught, most available systems are still limited by investment costs, accessibility, and qualities of the input cardiac 3-dimensional models. In this report, the authors discuss the development of an online simulator using a high-resolution human heart scan that accurately represents real cardiac anatomies, and that should be accessible to a wide range of learners without space or time limitations.
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Affiliation(s)
- Susana Arango
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN; The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN.
| | - Benjamin Gorbaty
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
| | - David Buyck
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - James Johnson
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Samantha T Porter
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Paul A Iaizzo
- The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN
| | - Tjörvi E Perry
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
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Chahal N, Feinman J. Welcome to the Machine: The Role of Online Simulation in TEE Training. J Cardiothorac Vasc Anesth 2023; 37:314-315. [PMID: 36473762 DOI: 10.1053/j.jvca.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Navdeep Chahal
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jared Feinman
- Hospital of the University of Pennsylvania, Philadelphia, PA.
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Arango S, Gorbaty B, Tomhave N, Shervheim D, Buyck D, Porter ST, Iaizzo PA, Perry TE. A High-Resolution Virtual Reality-Based Simulator to Enhance Perioperative Echocardiography Training. J Cardiothorac Vasc Anesth 2023; 37:299-305. [PMID: 36229288 DOI: 10.1053/j.jvca.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/13/2022] [Accepted: 09/02/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Susana Arango
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN; The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN.
| | - Benjamin Gorbaty
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
| | - Nicholas Tomhave
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
| | - Daniel Shervheim
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - David Buyck
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Samantha T Porter
- Liberal Arts Technologies and Innovation Services, College of Liberal Arts, Minneapolis, MN
| | - Paul A Iaizzo
- The Visible Heart Laboratories, Department of Surgery, Institute for Engineering in Medicine University of Minnesota, Minneapolis, MN
| | - Tjörvi E Perry
- University of Minnesota, Division of Cardiothoracic Anesthesia, Department of Anesthesiology, Minneapolis, MN
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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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Greenstein YY, Guevarra K. Point-of-Care Ultrasound in the Intensive Care Unit: Applications, Limitations, and the Evolution of Clinical Practice. Clin Chest Med 2022; 43:373-384. [PMID: 36116807 DOI: 10.1016/j.ccm.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The use of point-of-care ultrasonography in the intensive care unit has been rapidly advancing over the past 20 years. This review will provide a broad overview of the discipline spanning lung ultrasonography to advanced critical care echocardiography. It will highlight new research that questions the utility of the inferior vena cava for determining volume responsiveness and will introduce the reader to cutting-edge technology including artificial intelligence, which is likely to revolutionize ultrasound teaching and image interpretation, increasing the reach of this modality for the frontline clinician.
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Affiliation(s)
- Yonatan Y Greenstein
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers - New Jersey Medical School, University Hospital Building, Room I-354, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Keith Guevarra
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers - New Jersey Medical School, University Hospital Building, Room I-354, 150 Bergen Street, Newark, NJ 07103, USA
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McGough EK, Franklin M, Brewer J, Garvan C, Fahy BG. Effective Preparation for the Echocardiography Portion of the Objective Structured Clinical Examination (OSCE). J Cardiothorac Vasc Anesth 2021; 36:1221-1222. [PMID: 34969564 DOI: 10.1053/j.jvca.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Edward K McGough
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL.
| | - Michael Franklin
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Jordan Brewer
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
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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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