Optimizing simulator-based training for emergency transesophageal echocardiography: A randomized controlled trial.

Background: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively novel ultrasound application; however, optimal teaching methods have not been determined. Previous studies have demonstrated that variable practice (VP), where practice conditions are changed, may improve learning of procedural skills compared with blocked practice (BP), where practice conditions are kept constant. We compared VP and BP for teaching resuscitative TEE to emergency medicine residents using a simulator. Methods: Emergency medicine residents with no prior TEE experience were randomized to the BP or VP groups. The BP group practiced 10 repetitions of a fixed five-view TEE sequence, while the VP group practiced 10 different random five-view TEE sequences on a simulator. Participants completed a performance assessment immediately after training and a transfer test 2 weeks after training. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. The primary outcome was the percentage of successful views on the transfer test. Results: Twenty-eight participants completed the study (14 in the BP group, 14 in the VP group). The BP group had a higher rate of successful views compared with the VP group on the transfer test (93.6% vs. 77.6%; p = 0.002). The BP group also had higher image quality on a 5-point scale (3.3 vs. 2.9; p = 0.01) and fewer probe angular changes (2982.5 degrees vs. 4239.8 degrees; p = 0.04). There were no statistically significant differences between the groups for the rate of correct diagnoses, confidence level, or scan time. Conclusions: Practicing a fixed sequence of views was more effective than a variable sequence of views for learning resuscitative TEE on a simulator. These results should be validated in TEE scans performed in the clinical environment.

Associations between echocardiographic findings and prospective changes in residual renal function in patients new to peritoneal dialysis.

Although echocardiograms are often performed when peritoneal dialysis is started, associations between commonly reported findings and prospective changes in renal function remain understudied. Ninety-nine of 101 patients in the Trio Trial had transthoracic echocardiograms within 6 months of dialysis initiation, and measurements of residual renal function every six weeks for up to two years. Generalized mixed modelling linear regression in STATA was used to examine associations between left atrial size, left ventricular hypertrophy, left ventricular ejection fraction, right ventricular systolic pressure, and left valvular calcification with subsequent slopes in renal function. After echocardiography (performed a median of 16 days following peritoneal dialysis initiation) right ventricular systolic pressure was associated with faster, while declining left ventricular ejection fraction and valvular calcification were associated with slower declines in residual renal function. Future studies could be conducted to confirm these findings, and identify pathophysiological mechanisms.

Simulator-based training for learning resuscitative transesophageal echocardiography.

OBJECTIVES: Transesophageal echocardiography (TEE) is a relatively new resuscitation tool in the emergency department. Recent studies have demonstrated that it can impact diagnosis and management of critically ill patients. The objective of this study is to determine the effectiveness of a simulation-based curriculum for teaching emergency medicine residents a five-view TEE protocol. METHODS: Emergency medicine residents with previous ultrasound experience were invited to attend a 1-hour TEE training session. The training consisted of a didactic lecture followed by guided practice on a simulator. Performance was measured prior to training, after the training session, and by a transfer test 1 to 2 weeks after training. The primary outcome was the percentage of successful image generation using a scoring tool by two blinded reviewers. RESULTS: Twenty-two residents completed the study. The percentage of successful views increased from 44.5% (SD 27.9) at baseline to 98.6% (SD 3.5) after training (p < 0.001), and was 86.8% (SD 12.1) on transfer testing (p < 0.001). CONCLUSION: A brief simulation-based teaching session was effective for teaching emergency medicine residents a five-view resuscitative TEE protocol. Future studies are needed to determine optimal methods for long-term skill retention.

OBJECTIF: Le recours à l'échocardiographie transœsophagienne (ETO) dans les cas de réanimation est relativement nouveau au service des urgences. D'après des études récentes, les résultats de l'examen peuvent avoir une incidence sur le diagnostic et la prise en charge de maladies très graves. L'étude visait donc à déterminer l'efficacité d'une séance de formation par simulation sur un protocole d'ETO en cinq prises de vue à des résidents en médecine d'urgence (MU). MÉTHODE: Des résidents en MU ayant une expérience antérieure en échographie ont été invités à participer à une séance d'une heure sur l'ETO. Celle-ci se divisait en deux parties : enseignement magistral et application pratique guidée sur simulateur. Une mesure de la performance a été effectuée avant et après la séance de formation, puis de 1 à 2 semaines après celle-ci à l'aide d'un test d'application des connaissances. Le critère principal consistait dans le pourcentage de la production d'images réussies d'images et en leur évaluation par deux examinateurs tenus dans l'ignorance des faits, à l'aide d'une méthode de pointage. RÉSULTATS: Au total, 22 résidents ont terminé l'étude. Le pourcentage de prises de vue réussies est passé de 44,5% (écart-type [σ] = 27,9) au départ à 98,6% (σ = 3,5) après la formation (p < 0,001), et celui-ci a atteint 86,8% (σ = 12,1) au test d'application des connaissances (p < 0,001). CONCLUSION: La tenue d'une brève séance de formation par simulation s'est révélée efficace dans l'enseignement d'un protocole d'ETO en cinq prises de vue à des résidents en MU. Il faudrait toutefois mener d'autres études afin de déterminer les meilleures méthodes d'enseignement possible favorisant la mémorisation de la matière à long terme.