Training In Echocardiography Research Articles

Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents

BackgroundTransesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skillset. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients. ObjectivesThe objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR). MethodsA prospective study at a single academic site, enrolling volunteer PGY2 and PGY3 EM residents. Residents underwent the following: Pre-test examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; Post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired t-test or Wilcoxon rank-sum tests. ResultsFifteen residents participated. The pre-test mean score was 11.07, 95% CI: 9.35 – 12.79. The post-test mean score was 19.40, 95% CI: 18.94 – 19.86. A significant difference in scores was noted, t=-11.996, p<0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01 – 1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable. ConclusionsSimulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.

Effectiveness of simulation-based echocardiography training for neonatology residents: A randomized controlled trial

Effectiveness of simulation-based echocardiography training for neonatology residents: A randomized controlled trial

Development of a Curriculum for Emergency Physicians to Teach Transesophageal Echocardiography for Cardiac Arrests: A Kern Six-Step Model

BACKGROUND: The Kern model facilitates the development, implementation, and evaluation of successful educational systems in medicine. It involves six steps that link curricular content to health care needs. One such need is the design of a curriculum to teach emergency physicians practical use of focused transesophageal echocardiography employing a limited number of views for management of out-of-hospital cardiac arrests. The objective of this analysis was to describe the components of such a curriculum based on a Kern model that could be employed to train emergency department providers in this diagnostic modality. METHODS: We predicated our analysis on the American College of Emergency Physicians’ recommendations and goals for use of transesophageal echocardiography to guide emergency department cardiac arrest resuscitation. We then detailed an asynchronous pre-didactic learning experience followed by a synchronous didactic and simulation-based curriculum to teach emergency physicians how to acquire and interpret images for this purpose based upon steps set forth by a Kern model. RESULTS: The component steps in designing a curriculum constructed to teach focused transesophageal echocardiography for out-of-hospital cardiac arrests to emergency physicians are rigorously outlined. These components based on a Kern model include problem identification and a general needs assessment, a targeted needs assessment, defining goals and objectives, choosing educational strategies, curricular implementation, and program evaluation. CONCLUSIONS: Use of a six-step Kern model as a template can facilitate the development and dissemination of a curriculum to teach emergency physicians successfully to employ focused transesophageal echocardiography in the treatment of cardiac arrests. In order to promote its widest dissemination, this model should be pursued in a “train-the-trainer” fashion. In so doing, appropriate education of emergency physicians and their use of transesophageal echocardiography to manage cardiac arrests likely can be rapid and impactful, especially among providers with training and experience in transthoracic echocardiography.

The effect of simulation of sectional human anatomy using ultrasound on students’ learning outcomes and satisfaction in echocardiography education: a pilot randomized controlled trial

BackgroundEffective teaching methods are needed to improve students’ abilities in hand-eye coordination and understanding of cardiac anatomy in echocardiography education. Simulation devices have emerged as innovative teaching tools and exhibited distinctive advantages due to their ability to provide vivid and visual learning experiences. This study aimed to investigate the effect of simulation of sectional human anatomy using ultrasound on students’ learning outcomes and satisfaction in echocardiography education.MethodsThe study included 18 first-year clinical medical students with no prior echocardiography training. After randomization, they underwent a pre-test to assess basic knowledge. Following this, the students were divided into two groups: traditional teaching (traditional group) and simulation of sectional human anatomy using ultrasound (digital group). Each group received 60 min of instruction. Post-tests were assigned to students at two different time points: immediately after the lecture, and one week later (referred to as post-tests 1, and 2). In addition, anonymous questionnaires were distributed to students after class to investigate their satisfaction with teaching.ResultsBoth groups showed significant improvement in their scores on post-test 1 compared to pre-test (traditional group: from 33.1 ± 8.8 to 48.1 ± 13.1, P = 0.034 vs. digital group: from 35.0 ± 6.7 to 58.0 ± 13.2, P = 0.008). However, there were no significant differences between the two groups in several post-test comparisons. Student satisfaction ratings revealed that the digital group experienced significantly greater satisfaction in areas such as subject interest, teaching style, course alignment, and interaction compared to the traditional group. Additionally, 80% of the digital group strongly endorsed the use of simulation of sectional human anatomy using ultrasound for echocardiography teaching, highlighting its effectiveness.ConclusionsSimulation of sectional human anatomy using ultrasound may improve students’ understanding of echocardiography and satisfaction with the course. Our study provides evidence supporting the use of simulation teaching devices in medical education. Further research is needed to explore the long-term impact of this teaching method on students’ learning outcomes and its integration into the medical curriculum.Trial registrationhttp://www.chictr.org.cn (registration number: ChiCTR2300074015, 27/07/2023).

The Use of Pulmonary Artery Catheters and Echocardiography in the Cardiac Surgery Setting: A Nationwide Italian Survey

Wide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery. A national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted. The study occurred in Italian cardiac surgery centers (n = 71). Anesthesiologists-intensivists were enrolled. Anonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU). A total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046). Variability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group - CORRIGENDUM.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group - CORRIGENDUM.

Organisation of paediatric echocardiography laboratories and governance of echocardiography services and training in Europe: current status, disparities, and potential solutions. A survey from the Association for European Paediatric and Congenital Cardiology (AEPC) imaging working group.

There is limited data on the organisation of paediatric echocardiography laboratories in Europe. A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs. Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1-12), and echocardiography machines was four (range 1-12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20-60) minutes, and for repeat examination was 20 (5-30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%). Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.

Consensus-Based Development of a Pediatric Echocardiography Complexity Score: Design, Rationale, and Results of a Quality Improvement Collaborative.

The complexity of congenital heart disease has been primarily stratified on the basis of surgical technical difficulty, specific diagnoses, and associated outcomes. We report on the refinement and validation of a pediatric echocardiography complexity (PEC) score. The American College of Cardiology Quality Network assembled a panel from 12 centers to refine a previously published PEC score developed in a single institution. The panel refined complexity categories and included study modifiers to account for complexity related to performance of the echocardiogram. Each center submitted data using the PEC scoring tool on 15 consecutive inpatient and outpatient echocardiograms. Univariate and multivariate analyses were performed to assess for independent predictors of longer study duration. Among the 174 echocardiograms analyzed, 68.9% had underlying congenital heart disease; 44.8% were outpatient; 34.5% were performed in an intensive care setting; 61.5% were follow-up; 46.6% were initial or preoperative; and 9.8% were sedated. All studies had an assigned PEC score. In univariate analysis, longer study duration was associated with several patient and study variables (age <2 years, PEC 4 or 5, initial study, preoperative study, junior or trainee scanner, and need for additional imaging). In multivariable analysis, a higher PEC score of 4 or 5 was independently associated with longer study duration after controlling for study variables and center variation. The PEC scoring tool is feasible and applicable in a variety of clinical settings and can be used for correlation with diagnostic errors, allocation of resources, and assessment of physician and sonographer effort in performing, interpreting, and training in pediatric echocardiography.

An Immersive Virtual Reality Simulator for Echocardiography Examination

Echocardiography is a medical examination that uses ultrasound to assess and diagnose the structure and function of the cardiac. Through the use of ultrasound waves, this examination allows medical professionals to create visualizations of the cardiac muscle, enabling them to diagnose and monitor conditions such as cardiac diseases, abnormalities, and functional disorders. An echocardiogram plays a crucial role in the early detection and diagnosis of various cardiac issues such as hypertension, myocardial infarction, valvular cardiac disease, and myocardial hypertrophy. It significantly contributes to determining treatment and management strategies. To achieve accurate disease diagnosis and develop appropriate treatment plans through echocardiography, it is essential to have a thorough understanding of proper probe usage, the precise acquisition of echocardiographic images, and the ability to interpret various echocardiographic examinations such as two-dimensional, M-mode, Doppler, etc. To enhance the skills required for echocardiography, medical educational institutions conduct theoretical classes, practical sessions using patient models, and clinical practice sessions with actual patients. However, issues such as inadequate practical adaptation due to theory-centric education, limitations in practical opportunities due to insufficient practice equipment, ethical or safety concerns arising during clinical practice, and a lack of educators leading to insufficient feedback, are currently being encountered. Hence, there is a need for new educational methods that can address the existing challenges in echocardiography education. In this paper, as part of these efforts, we propose a virtual reality-based immersive simulator for practical echocardiography training. The proposed echocardiography simulator allows users to explore a virtual echocardiography examination space by wearing a head-mounted display (HMD). This simulator consists of 3D virtual space models, interactive models manipulated by interaction devices, and 3D patient models containing normal or abnormal anatomical cardiac models. Using interactive devices such as HMD controllers and haptic devices, users can manipulate 3D models related to echocardiography within the simulator and interact with 3D patient models containing normal or abnormal anatomical cardiac models, allowing for the practice of echocardiography examinations. Ultimately, a performance evaluation of the developed immersive virtual reality simulator and usability validation targeting medical university students were conducted. The evaluation and validation results confirmed the potential efficacy of the proposed echocardiography VR simulator.

Cost-effectiveness analysis of simulation-based training in transesophageal echocardiography: Insights from the SIMULATOR trial

Cost-effectiveness analysis of simulation-based training in transesophageal echocardiography: Insights from the SIMULATOR trial

Contemporary transesophageal echocardiography practice patterns among paediatric cardiology centres in the United States and Canada.

To characterise transesophageal echocardiography practice patterns among paediatric cardiac surgical centres in the United States and Canada. A 42-question survey was sent to 80 echocardiography laboratory directors at paediatric cardiology centres with surgical programmes in the United States and Canada. Question domains included transesophageal echocardiography centre characteristics, performance and reporting, equipment use, trainee participation, and quality assurance. Fifty of the 80 centres (62.5%) responded to the survey. Most settings were academic (86.0%) with 42.0% of centres performing > 350 surgical cases/year. The median number of transesophageal echocardiograms performed/cardiologist/year was 50 (26, 73). Pre-operative transesophageal echocardiography was performed in most surgical cases by 91.7% of centres. Transesophageal echocardiography was always performed by most centres following Norwood, Glenn, and Fontan procedures and by < 10% of centres following coarctation repair. Many centres with a written guideline allowed transesophageal echocardiography transducer use at weights below manufacturer recommendations (50.0 and 61.1% for neonatal and paediatric transducers, respectively). Most centres (36/37, 97.3%) with categorical fellowships had rotations which included transesophageal echocardiography participation. Large surgical centres (>350 cases/year) had higher median number of transesophageal echocardiograms/cardiologist/year (75.5 [53, 86] versus 35 [20, 52], p < 0.001) and more frequently used anaesthesia for diagnostic transesophageal echocardiography ≥ 67% of time (100.0 versus 62.1%, p = 0.001). There is significant variability in transesophageal echocardiography practice patterns and training requirements among paediatric cardiology centres in the United States and Canada. Findings may help inform programmatic decisions regarding transesophageal echocardiography expectations, performance and reporting, equipment use, trainee involvement, and quality assurance.

Heterogeneity Among Countries in the Subspecialty of Cardiovascular Anesthesia in Latin America: Survey Results

ObjectivesTo evaluate demographics, workload, training, facilities, and equipment in cardiovascular anesthesia (CVA) in Latin America (LA) DesignA descriptive cross-sectional study with data collected through a survey. SettingA multicenter, international web-based questionnaire that included 37 multiple-choice questions. ParticipantsPhysicians and specialists in anesthesiology who regularly participated in cardiovascular surgeries and were members of the scientific societies of the Latin American Confederation of Anesthesiology. InterventionsNone Measurements and Main ResultsA total of 484 completed questionnaires were collected. 97.8% of the respondents had a university degree in anesthesiology. Most did not receive formal training in CVA, and only 41.5% received formal training. Moreover, most of them were trained in their own country, and a smaller percentage were trained abroad. Half of the respondents reported receiving less than 12 months of training. A third part of the respondents refers to having received training in transesophageal echocardiography. Only 5.8% of the respondents worked exclusively in CVA, and a high percentage dedicated less than 60% of their weekly work hours to this subspecialty. 80.6% of the centers had less than three cardiac surgery operating rooms. Only one-third of the centers performed heart/lung transplantation, venoarterial ECMO, venovenous ECMO, and ventricular assist device implantation. ConclusionsA significant lack of training programs in anesthesiology practice and complex procedures in medical centers in LA are evident. Thus, basic accredited programs should be developed in medical centers in LA.

Concordancia de la evaluación ecocardiográfica básica funcional del ventrículo izquierdo entre médicos no expertos y cardiólogos especialistas en ecocardiografía

IntroductionThe clinical decisions of patients in the intensive care unit are based on the integration of the clinical history and complementary tests. The echocardiographic evaluation can reveal decisive information in the interventions and in the prognosis of the patients. ObjectiveTo determine the concordance in the analysis of left ventricular systolic function performed by physicians with basic training in echocardiography compared with the assessment by expert cardiologists. MethodologyCross-sectional study of diagnostic concordance with prospective recruitment. Patients hospitalized in the intensive care unit during 2023 in a university clinic with a high level of complexity were included. The concordance between the trained physician and the expert was analyzed using the Kappa index (κ) for the qualitative variables, and the intraclass correlation coefficient for the quantitative ones. Results131 patients were included, with a mean age of 62 years. The concordance of the echocardiographic assessment was determined, finding very good concordance for left ventricular contractility (κ: 0.97), pericardial effusion (κ: 0.82) and its location (κ: 0.85), contractility disorders (κ: 0.84) and in the quantitative measurement of the ejection fraction (intraclass correlation coefficient: 0.91). ConclusionsThere is agreement in the evaluation of left ventricular systolic function in patients hospitalized in the intensive care unit by non-expert medical personnel with training and expert cardiologists. The results should be interpreted as part of a comprehensive assessment at the patient's bedside and not as an isolated diagnosis, always under quality standards and with the necessary verification.

Stroke Volume Measurements by Echocardiography and Ultrasonic Cardiac Output Monitor in Children: A Prospective Observational Cohort Study.

Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Noninvasive technologies are increasingly used in children. This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (ultrasonic cardiac output monitor [USCOM]), transthoracic echocardiography jugular (TTE-J), and parasternal (TTE-P) views performed by pediatric intensivists (OP-As) with limited training in cardiac sonography (20 previous examinations) and pediatric cardiologists (OP-Bs) with limited training in USCOM (30 previous examinations) in spontaneously ventilating children. A single-center study was conducted in 37 children. Each operator obtained 3 sets of USCOM SV measurements within a period of 3 to 5 minutes, followed with TTE measurements from both apical and jugular views. The investigators were blinded to each other's results to prevent visual and auditory bias. Both USCOM and TTE methods were applicable in 89% of patients. The intraobserver variability of USCOM, TTE-J, and TTE-P were less than 10% in both investigators. The SV measurements by OP-As using USCOM, TTE-J, and TTE-P were 46.15 (25.48) mL, 39.45 (20.65) mL, and 33.42 (16.69) mL, respectively. The SV measurements by OP-Bs using USCOM, TTE-J, and TTE-P were 43.99 (25.24) mL, 38.91 (19.98) mL, and 37.58 (19.81) mL, respectively.The percentage error in SV with USCOM relative to TTE-J was 36% in OP-As and 37% in OP-Bs. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-As and 21% in OP-Bs. Our findings show that the methods are not interchangeable because SV values by USCOM are higher in comparison with the SV values obtained by TTE. Both methods have low level of intraobserver variability. The SV measurements obtained by TTE-P were significantly lower compared with the TTE-J for the operator with limited training in echocardiography. The TTE-P requires longer practice compared with the TTE-J; therefore, we recommend to prefer TTE-J to TTE-P for inexperienced operators.

Controlled prospective study on ultrasound simulation training in fetal echocardiography: FESIM II

PurposeTo analyze the learning curves of ultrasound novices in fetal echocardiography during structured simulation-based ultrasound training (SIM-UT) including a virtual, randomly moving fetus.Methods11 medical students with minimal (< 10 h) prior obstetric ultrasound experience underwent 12 h of structured fetal echocardiography SIM-UT in individual hands-on sessions during a 6-week training program. Their learning progress was assessed with standardized tests after 2, 4, and 6 weeks of SIM-UT. Participants were asked to obtain 11 fetal echocardiography standard planes (in accordance with ISUOG and AHA guidelines) as quickly as possible. All tests were carried out under real life, examination-like conditions on a healthy, randomly moving fetus. Subsequently, we analyzed the rate of correctly obtained images and the total time to completion (TTC). As reference groups, 10 Ob/Gyn physicians (median of 750 previously performed Ob/Gyn scans) and 10 fetal echocardiography experts (median of 15,000 previously performed Ob/Gyn scans) were examined with the same standardized tests.ResultsThe students showed a consistent and steady improvement of their ultrasound performance during the training program. After 2 weeks, they were able to obtain > 95% of the standard planes correctly. After 6 weeks, they were significantly faster than the physician group (p < 0.001) and no longer significantly slower than the expert group (p = 0.944).ConclusionSIM-UT is highly effective to learn fetal echocardiography. Regarding the acquisition of the AHA/ISUOG fetal echocardiography standard planes, the students were able to reach the same skill level as the expert group within 6 weeks.

Short period of training in 3D echocardiography provides good feasibility and reproducibility of right ventricular assessment in heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PROHEART 3D. Background Right ventricular (RV) dysfunction is an independent risk factor for increased mortality and morbidity. Standard approach for assessing is 2-dimensional echocardiography (2DE). However, 2DE is prone to errors due to increased variability of the anatomical cut-planes and geometrical assumptions due to the complex triangular and "wrapped-around" RV shape. Meanwhile, 2DE reflects mainly the RV longitudinal function, at the expense of the radial and global RV functions. 3D echocardiography (3DE) enabled itself as a more accurate method for assessment of cardiac volumes and calculation of ejection fraction (EF), but with a cumbersome learning time-curve. Objectives To establish if trainees in 3DE provide feasible and reproducible 3D measurements of RV size and function, by comparison to 2DE assessment, after a short period of training by an expert in echocardiography. Methods 161 consecutive patients (58±17 years, 71% males, 3D left ventricular EF 35±10%), hospitalized for heart failure (HF), underwent standard precordial 2DE acquisitions and 3DE multi-beat full-volumes of the RV. One expert in both 2DE and 3DE, and one fellow trained for 2 years in 2DE and for 3 months in 3DE, performed measurements of both 2DE and 3DE parameters for RV size and function, in a blinded fashion. 2DE parameters were measured first, in the following order: RV diameter, RV end-diastolic (RVED) and end-systolic (RVES) areas, RV fractional area change (RV FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (RV S’), and RV free wall longitudinal strain (RV LS). Then, 3D RVED and RVES volumes were measured, and RV ejection fraction (RVEF) was calculated, using a semi-automated software package. Endocardial borders were corrected, as needed. Results Feasibility of 2DE and 3DE was 97% and 92%, respectively, patients being excluded due to poor quality images, similarly for expert vs. trainee. Mean RVED volume was 94.0±30.6 ml/m2, and mean RVEF was 37.3±9.6%. Reproducibility of 2DE parameters obtained by the expert vs. trainee were good for the assessment of RV longitudinal function (TAPSE, RV S', and RV LS), but suboptimal for the assessment of RV size and global function (RV diameter, RV areas, and RV FAC) (Table). Reproducibility of 3DE parameters obtained by the expert vs. trainee were also good, even after a short period of training (3 months) (Table). Conclusions A short period of training in 3DE provides a good feasibility and reproducibility of the assessment of RV size and function, in a large cohort of hospitalized patients with HF. 3DE might be a more reliable method than 2D for the initial assessment of patients with HF.

What other than simulation for the future of echocardiography training?

What other than simulation for the future of echocardiography training?

Tomographic Plane Visualization (ToPlaV): a Tool to Enhance Echocardiographic Training.

Visual learning is an important part of echocardiographic training. Our aim is to describe and evaluate a visual teaching tool, tomographic plane visualization (ToPlaV) as an adjunct to skills training in pediatric echocardiography image acquisition. This tool incorporates learning theory by applying psychomotor skills that closely emulate the skills used in echocardiography. ToPlaV was used as part of a transthoracic bootcamp for first year cardiology fellows. A qualitative survey was given to trainees to evaluate their perceptions of its usefulness. There was universal agreement among fellow trainees that ToPlaV is a useful training tool. ToPlaV is a simple, low cost, education tool which can complement a simulator and live models. We propose that ToPlaV should be incorporated into early training in echocardiography skills for pediatric cardiology fellows.

Comprehensive Training Model for Procedural Guidance of Transcatheter Mitral Valve Edge-to-Edge Repair: Divide and Conquer Approach

Transcatheter edge-to-edge repair (TEER) of the mitral valve is a complex procedure requiring continuous image guidance with 2-dimensional and 3-dimensional transesophageal echocardiography. In this context, the role of the echocardiographer is of paramount importance. Training in interventional echocardiography for procedures such as TEER requires comprehending the complicated workflow of the hybrid operating room and advanced imaging skills that go beyond traditional echocardiography training to guide the procedure. Despite TEER being more commonly performed, the training structure for interventional echocardiographers is lagging, with many practitioners not having any formal training in image guidance for this procedure. In this context, novel training strategies must be developed to increase exposure and aid training. In this review, the authors present a step-wise approach to training for image guidance during TEER of the mitral valve. The authors have deconstructed this complex procedure into modular components and have incremental stages of training based on different steps of the procedure. At each step, trainees must demonstrate proficiency before advancing to the next step, thus ensuring a more structured approach to attaining proficiency in this complex procedure.

AB172. SOH23ABS_245. The image management challenges of running a basic cardiac echocardiography training programme

AB172. SOH23ABS_245. The image management challenges of running a basic cardiac echocardiography training programme