213 A Brief Cadaver Training Session Is Feasible for Training Novice Users on Transesophageal Echocardiography Transducer Insertion

Abstract

Transesophageal echocardiography (TEE) is used in the emergency department to guide resuscitative efforts during cardiac arrest. Insertion of a TEE transducer requires manual skill and experience, yet in some residency training centers cardiac arrest is not a common entity and some physicians may lack the means to sufficiently acquire the manual skills to perform TEE in clinical practice. For other infrequently performed life-saving procedural skills there are mannequins, tissue models, or other simulations that allow physicians to obtain sufficient training in a laboratory setting, yet there is currently no model that adequately simulates TEE transducer insertion. The aim of this study is to evaluate the feasibility and efficacy of using a brief training session to teach novice TEE users to properly insert a TEE transducer using a cadaver model. A convenience sample of emergency medicine residents was enrolled during an annual single-day procedure education workshop using cadavers as tissue models. A pre-test was used to determine prior knowledge, experience and confidence level regarding TEE. Participants then attended a brief didactic and hands-on education session on TEE insertion methods. All participants were allowed to practice inserting the TEE transducer until they felt comfortable with the procedure and were able to pass an objective assessment of their technical skill. After the educational session, participants completed a post-test. Wilcoxon sign-rank tests were used to compare pre- and post- tests and linear regression analysis was performed between training level and test results. Twenty-five residents participated in the procedure course. Level of training included PGY-1 (42%), PGY-2 (37%), PGY-3 (21%) Mean test scores increased from the pre-test (6.2 out of 10, SD=1.6) to the post-test (8.7 out of 10, SD=1.0) (p<0.001). Confidence levels increased after the training session in TEE insertion, identification of anatomy with TEE, and using TEE to guide resuscitation (p≤0.001 for all 3). There was no relationship between training level and the change in test scores nor confidence levels in TEE insertion, identification of anatomy with TEE, and using TEE to guide resuscitation. The training session, using cadavers as a tissue model, was feasible and may be an effective method of improving knowledge, confidence and technical skill in TEE insertion among novices.