Simulation-based training of transesophageal echocardiography for cardiology fellows.

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Methods We created a curriculum on a TEE simulator (HeartWorks, Inventive Medical Ltd., London, UK) that applied B-mode imaging and a three-dimensional model (Fig. 1); Doppler functions and pathology cases were not available. The curriculum was divided into four sessions of 1–2 h duration; each session was a one-on-one between one experienced echocardiographer (DW, AW, RD, or CS) and one fellow. The topics for the four sessions were: (1) basic imaging planes and ventricular function; (2) aortic and mitral valve imaging; (3) pulmonary and tricuspid valve imaging; and (4) other structures (pulmonary veins, great vessels, interatrial septum). Fellows assessed the curriculum and TEE self-confidence with a five-point scale and narrative responses. The fellows’ curriculum evaluations were anonymized and their use was authorized for research purposes by our Institutional Review Board; the requirement for informed consent was waived.

Results Between 2012 and 2014, 17 fellows completed the curriculum, of which 15 completed the assessment. All fellows were encouraged to complete the assessment; however, because they were anonymous, we could not directly encourage them further. The median self-confi- dence increased from 3 to 4 (P = 0.02, Wilcoxon signedrank test). After the training, all fellows reported that their self-confidence in TEE skills was at least ‘‘moderate’’ (Fig. 2). All fellows agreed or strongly agreed that the curriculum was ‘‘a valuable addition to my training’’; 86.7% felt the duration was appropriate. Multiple fellows indicated a preference for additional training on pathologic conditions. No negative comments were received.

Discussion Cardiology fellows report value and increased self-confi- dence in TEE skills after completing a simulator-based training curriculum. Reports from other institutions using TEE simulators have found improvements in image acquisition and self-reported confidence [1–4].




Medical Sciences | Medicine and Health Sciences




Department of Medicine, Cardiology Division, Department of Medicine Faculty

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