Benjamin Sohmer, MD, MEd
The University of Ottawa Heart Institute
Introduction: Performance of transesophageal echocardiography (TEE) requires two competencies: the psychomotor ability to obtain images and the cognitive ability to interpret these images in correlation with clinical findings. This study focused on psychomotor competencies to acquire images. Commercially available hi-fidelity TEE simulators provide a visual and haptic interface to facilitate psychomotor training of novice echocardiographers. The purpose of this study was to determine the effectiveness of a simulation-based curriculum that uses a TEE simulator to train the psychomotor skills to novice echocardiographers, and to compare instructor guided and self directed online delivery of the curriculum.
Methods: After IRB approval, subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator. Subjects were randomized to two groups. The first (n=17) received an instructor-guided lesson of TEE psychomotor skills demonstrating and practicing with the simulator as an adjunct. The second group (n=16) received a self directed slide presentation of TEE psychomotor skills while practicing with the simulator as an adjunct. Both lessons delivered identical information over 120 min. Following their respective training sessions, all subjects performed a video-taped post-test of their TEE psychomotor skills using the simulator. Two assessors blinded to the instructional format provided to the subject rated the videotaped TEE performances using a validated scoring system for acquisition of images.
Results: Pre-test TEE simulator scores were similar between the two instruction groups (9.0 vs. 5.0; p=NS). Both groups significantly improved following training, regardless of method of instruction (p<0.0001). The improvement in the change of scores (post-test scores minus pre-test scores) were not significantly different between instruction groups. (12.5 vs. 14.5; p=0.552). The inter-rater reliability between assessors was 0.964.
Conclusions: Hi-fidelity TEE simulators are an effective training adjunct for the acquisition of basic TEE psychomotor skills. There was no difference in improvement between the different deliveries of instruction. Further research will examine the need for a faculty resource for a curriculum that uses a simulator as an adjunct.
