title: Transthoracic echocardiography simulation is an efficient method to train anesthesiologists in basic transthoracic echocardiography skills.
abstract: BACKGROUND
  The clinical utility of focused transthoracic echocardiography (TTE) is increasingly recognized in perioperative medicine. However its use is limited among anesthesiologists because of a lack of training. The most efficient training methods have not been determined. We hypothesized that simulation-based TTE training would be more effective than traditional lecture-based methods for teaching basic TTE skills to the anesthesiology residents.
  
  
  METHODS
  In this prospective randomized study, 61 anesthesiology residents (in anesthesia clinical training years 1 to 3) were randomized to either control (n = 30) or simulation groups (n = 31) for TTE training. A standardized pretest was administered before TTE training sessions of 45 minutes each. The first training session used a lecture-based video didactic in the control group or a TTE simulator in the simulation group. Comprehension in both groups was then assessed using a written posttest and by performing a TTE examination on a volunteer subject. TTE examinations were graded on the ability to acquire the correct image, image quality, anatomy identification, and time required to attain proper imaging by 2 blinded experts. A second training session incorporating "hands-on" training with a volunteer subject was conducted in a subset of 21 residents (n = 11 control, n = 10 simulation). The simulation group included additional simulator training. After the second session, another posttest on a volunteer subject was administered.
  
  
  RESULTS
  Pretest scores revealed similar preintervention knowledge among residents (56.0% ± 11.9% vs 59.3% ± 11.0%, P = 0.25; control versus simulator group, respectively). The simulation group scored higher on all criteria after the first training session: written posttest (57.9% ± 8.8% vs 68.2% ± 10.1%; P < 0.001), volunteer subject posttest image quality scores (0 to 25 scale) (6.4 ± 3.5 vs 12.4 ± 4.2; P = 0.003), anatomy identification scores (0 to 25 scale) (8.3 ± 6.6 vs 17.8 ± 6.6; P = 0.003), and percentage correct views (50 ± 19 vs 78 ± 21; P < 0.001). After the second session, all scores were again improved in the simulation group: volunteer subject posttest image quality scores (9.6 ± 3.3 vs 15.6 ± 2.8; P = 0.002), anatomy identification scores: (17.6 ± 3.8 vs 22.8 2.4; P = 0.003), and percentage correct views (80 ± 16 vs 96 ± 8; P = 0.007).
  
  
  CONCLUSIONS
  This prospective randomized study demonstrated that anesthesiology residents trained with simulation acquired better skills in TTE image acquisition and anatomy identification on volunteer subjects. The educational benefit of simulation persisted even with introduction of hands-on instruction with volunteer subjects in both groups. The impact of these short-term educational approaches on longer-term retention and actual clinical application warrants further investigation.
authors: Department of Anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors: Jacques
authors: J
authors: Neelankavil
authors: Kimberly
authors: K
authors: Howard-Quijano
authors: Tyken C
authors: TC
authors: Hsieh
authors: Davinder
authors: D
authors: Ramsingh
authors: Jennifer C
authors: JC
authors: Scovotti
authors: Jason H
authors: JH
authors: Chua
authors: Jonathan K
authors: JK
authors: Ho
authors: Aman
authors: A
authors: Mahajan
mesh_terms: D000776:Anesthesiology / Q000193:education* / Q000379:methods* / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D003198:Computer Simulation / Q000592:standards; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D011446:Prospective Studies