title: Validation of a test of competence in transesophageal echocardiography.
abstract: OBJECTIVE
  A test was developed that is based on intraoperative findings to evaluate knowledge of intraoperative echocardiography. This study examines the performance of attending anesthesiologists and residents at various levels of training in order to validate the test's ability to measure physician competence in intraoperative echocardiographic diagnosis.
  
  
  METHODS
  This study was a prospective evaluation of a test of competence in transesophageal echocardiography.
  
  
  METHODS
  Two university medical centers.
  
  
  METHODS
  Volunteer anesthesia faculty and residents.
  
  
  METHODS
  The participants took an echocardiographic examination that consisted of 34 "K"-type multiple-choice questions and a 45-second video-loop sequence for each question. The video sequences were chosen for their high quality and unambiguous representation of both normal and pathologic images obtained by transverse transesophageal echocardiographic imaging. The questions were written by experienced echocardiographers. The test was administered to 25 individuals at two academic institutions: 11 residents with minimal transesophageal echocardiography exposure and 14 faculty who were relatively experienced with transesophageal echocardiography. All of the residents repeated the examination at the end of their third clinical anesthesia year, which included transesophageal echocardiography training. The differences between the groups' scores were analyzed using the Kruskal-Wallis test and Wilcoxon's rank-sum test. To correct for the multiple comparisons, p < 0.025 was deemed significant. MEASUREMENTS AND MAIN RESULTS. Before their transesophageal echocardiography training, the residents scored significantly lower than the faculty (p < 0.002). After 1 year of training, their scores significantly increased (p = 0.021), and their scores were not significantly different from the faculty level (p = 0.052).
  
  
  CONCLUSIONS
  Test performance differed according to level of experience. This suggests that the test is a valid measure of intraoperative transesophageal echocardiography competence.
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Konstadt
authors.forename: D L
authors.initials: DL
authors.lastname: Reich
authors.forename: T
authors.initials: T
authors.lastname: Rafferty
mesh_terms: D000776:Anesthesiology / Q000193:education*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging; D006332:Cardiomegaly / Q000000981:diagnostic imaging; D002983:Clinical Competence; D017548:Echocardiography, Transesophageal; D004521:Educational Measurement / Q000379:methods; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging; D005069:Evaluation Studies as Topic; D005180:Faculty, Medical; D006343:Heart Septal Defects / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D006801:Humans; D007396:Internship and Residency; D007430:Intraoperative Care; D008943:Mitral Valve; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left; D014741:Video Recording