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Effectiveness of Simulation-Based Training on TEE Learning
Quick Takes
- In this study involving 324 cardiology fellows in France, simulation-based TEE training (2 sessions, 2 hours each) led to improvements in theoretical knowledge and practical skills.
- Improvements with simulator training were greater for fellows in their first or second year of training, and for those who had observed fewer TEEs and performed fewer transthoracic echocardiograms.
Study Questions:
How does simulation-based transesophageal echocardiography (TEE) training impact cardiology fellows’ knowledge and technical skills?
Methods:
This study included cardiology fellows from 42 French centers. Participants were randomized (1:1) into a TEE simulation training group and a traditional training group. Fellows who had previously performed TEEs were excluded. Each fellow performed a pre-training test and a final test 3 months after training program completion. Both tests included theoretical and practical components. During the practical test, fellows were asked to show 10 basic views on the simulator, with a maximum of 1 minute for each view. Participants in the intervention group attended 2 teaching sessions (2 hours each) with the simulator. Both groups had traditional didactic training in TEE, including an online course that is compulsory for all cardiology fellows in France. The co-primary endpoints were the final test theoretical and practical scores.
Results:
A total of 324 fellows were randomized (162 in each group, mean age 26.4 years, 63% men). Approximately 20% of participants had observed >20 TEEs prior to the training. Pre-training theoretical and practical test scores were comparable between the simulator and control groups. The simulator group had significantly higher theoretical and practical final test scores. Simulator group participants also completed the practical test more quickly (8.3 vs. 9.4 minutes, p < 0.001). Score improvements with simulator training were greater for fellows in their first or second year of training, and for those who had observed fewer TEEs and performed fewer transthoracic echocardiograms. Fellows in the simulation group felt more prepared to perform TEEs alone, and 89.5% of fellows found the training useful.
Conclusions:
Simulation-based TEE training improves cardiology fellows’ knowledge, skills, speed, and confidence. The positive impacts of training are greater among junior fellows and those with less prior exposure to echocardiography.
Perspective:
The findings of this study suggest that simulation-based training can be helpful for teaching basic TEE skills, particularly at the beginning of cardiology training and in lower-volume centers. One limitation of this study was that fellows’ real-world TEE skills were not assessed. Moreover, the numbers of TEEs performed by fellows in the two groups were not reported. Notably, intubation is one of the most challenging TEE skills to teach and learn, and simulator training does not address this.
Clinical Topics: Noninvasive Imaging, Echocardiography/Ultrasound
Keywords: Clinical Competence, Computer Simulation, Diagnostic Imaging, Echocardiography, Echocardiography, Transesophageal, Education, Medical, Fellows in Training, Knowledge, Simulation Training, Test Taking Skills
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