Training Pulmonary/Critical Care Fellows in Advanced Critical Care Transesophageal Echocardiography: A Simulator Based Training Project

Astha Chichra, MD; Seth Koenig, MD; Viera Lakticova, MD; Mangala Narasimhan, DO; Paul Mayo, MD
Chest. 2015;148(4_MeetingAbstracts):455A. doi:10.1378/chest.2280908
Sunday, October 25, 2015 at 04:30 PM – 05:30 PM
PURPOSE:Critical care transesophageal echocardiography (cTEE) is an important component of advanced critical care echocardiography. Experiential training in cTEE requires greater than 30 real case patients to achieve competence1. The effectiveness of high fidelity TEE simulator (simulator) training to achieve competence is unknown. We studied the effectiveness of using a simulator to train pulmonary/critical care medicine fellows (fellows) in cTEE image acquisition and interpretation.
METHODS:We trained 12 fellows with no experience in cTEE using a simulator. Using a standardized cTEE image acquisition format, trainees performed 14 complete studies, with image acquisition testing on the 15th study. We used a validated system for scoring the operative and interpretive skills of the trainees 2. Once competent on the simulator1, they performed cTEEs under direct attending supervision on patients. Each patient cTEE was graded using the same scoring system as for the simulator. Successful training outcome was defined as a score of >35/401.
RESULTS:Twelve fellows received training with the simulator, consisting of a 3 hour training period. All fellows achieved perfect performance in image acquisition on the simulator at the 15th cTEE study. Eight fellows have further performed at least 5 patient cTEEs. Six fellows achieved a score of >35/40 on their first patient cTEE. The other 2 fellows required an average of 3 studies to achieve a score >35/40.
CONCLUSIONS:Training fellows to perform cTEE using a simulator is effective and may reduce the number of real patient cTEEs needed for training purposes.
CLINICAL IMPLICATIONS:Simulator training can accelerate the training curve for cTEE in fellows. Further studies need to be performed in order to establish the minimum number of cTEEs to be performed to achieve competency. References: 1.Charron, C et al. Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography.Intensive care medicine (2013): 1-6. 2. 2.Charron, C et al. Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics. Intensive care medicine 33.10 (2007): 1712-1718.
DISCLOSURE:The following authors have nothing to disclose: Astha Chichra, Seth Koenig, Viera Lakticova, Mangala Narasimhan, Paul Mayo