170 Evaluation of Performance of Transesophageal Echocardiography by Emergency Medicine Residents After a Single Simulation-Based Training Session

Abstract

The primary objective of this study was to evaluate the proficiency and skills retention of performing transesophageal echocardiography (TEE) by emergency medicine (EM) residents after completion of a single simulation-based training session. Secondary objectives included assessing accuracy and time to diagnosis of simulated pathologies. This was a prospective, observational study which took place at a large community emergency department that has a 3-year emergency medicine residency. Eighteen EM residents without prior experience in TEE across all training levels were enrolled. This study was exempt by the institutional review board. Residents asynchronously viewed a 20-minute pre-recorded lecture on the basics of TEE followed by a 1-hour hands-on didactic session using a high-fidelity TEE simulator (CAE Vimedix, Montreal, Canada) led by ultrasound faculty. The residents’ ability to perform a 3-view protocol was evaluated at 4 and 8 weeks after the initial training. Residents were also time-tested on their ability to recognize 3 separate simulated pathologies during the 4-week follow-up session. 18/18 (100%) residents completed the 4 week assessment; 16/18 (88%) completed the 8 week assessment. At 4 weeks, 100% (18/18) of residents demonstrated adequacy on all 3 TEE views; at 8 weeks 100% of residents who completed the session (16/16) demonstrated adequacy on all 3 views. On average, residents were able to adequately demonstrate and recognize cardiac tamponade, ventricular fibrillation, and severe systolic dysfunction in 9.4 s (median 9 s; range 3-23 s), 13.4 s (median 12 s; range 8-26 s), and 25.6 s (median 18 s; range 6-56 s), respectively. After implementation of a 20-minute lecture and a 1-hour hands-on simulation-based training session, EM residents were able to adequately perform a 3-view TEE protocol at 4 and 8 weeks post-training sessions.