LO23: A brief educational session is effective for teaching emergency medicine residents resuscitative transesophageal echocardiography

Abstract

Introduction: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively new ultrasound application that has the potential to guide the management of critically ill patients in the emergency department. The objective of this study was to determine the effectiveness of a brief training workshop for teaching a resuscitative TEE protocol to emergency medicine residents using a simulator. Methods: Emergency medicine residents with no prior TEE experience from a university-affiliated hospital were invited to participate in the study. Participants completed a questionnaire and baseline skill assessment using a high-fidelity simulator. The training session included a 20-minute lecture followed by 10 simulated repetitions of a 5-view TEE sequence with instructor feedback. Learning was evaluated by a skill assessment immediately after training and a transfer test 1-2 weeks after the training session. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. The primary outcome of this study was the percentage of successful views before and after training. Secondary outcomes included confidence level, image quality, percentage of correct diagnoses, and efficiency of movement. Assessment scores were compared using a two-tailed t-test. Results: 10 of 11 (91%) of invited residents agreed to participate in the study. Confidence level on a 10-point numeric rating scale (NRS) increased from a baseline of 1.0 (SD 0) to 7.0 (SD 1.9) after training (p<0.01). The mean duration between training and transfer test was 9.6 days (SD 1.9). The percentage of successful views increased from 44% at baseline to 100% after training, and 90% on the transfer test (p<0.01). The mean image quality on a 5-point scale was 2.2 (SD 1.0) at baseline, 3.8 (SD 0.7) after training (p<0.01), and 3.1 (SD 0.6) on the transfer test (p<0.01). The mean number of transducer accelerations were 524 (SD 202) at baseline, 219 (SD 54) after training (p<0.01), and 400 (SD 149) on the transfer test (p=0.13). Participants made the correct diagnosis in 70% of cases on the transfer test. Conclusion: After a brief training session using a simulator, emergency medicine residents were able to generate adequate TEE images on a delayed transfer test. Future studies are needed to determine effective strategies for maintaining motion efficiency and imaging quality.