Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography.
OBJECTIVE
To determine the minimum number of supervised transesophageal echocardiography (TEE) that intensivists should perform to reach competence in performing and interpreting a comprehensive hemodynamic assessment in ventilated intensive care unit patients.


METHODS
Prospective and multicentric study. Skills of 41 intensivists (trainees) with no (level 0) or little (level 1) experience in echocardiography was evaluated over a 6-month period, using a previously validated skills assessment score (/40 points). Trainees were evaluated at 1 (M1), 3 (M3) and 6 months (M6) by their tutor while performing 2 TEE examinations in ventilated patients. Competence was a priori defined by a skills assessment score >35/40 points.


RESULTS
No difference in the score was observed between level 0 and level 1, except at M1 (22.2 ± 6.2 vs. 25.9 ± 4.4 points, p = 0.03). After 6 months, trainees performed a mean of 31 ± 9 supervised TEE. The score gradually increased from M1 to M6 (24 ± 6, 32 ± 3, and 35 ± 3 points, p < 0.001), regardless of trainees' initial level. A correlation was found between the number of supervised TEE and the skills assessment score (r (2) = 0.60; p < 0.001). The number of supervised TEE examinations which best predicted a score >35/40 points was 25, with a sensitivity of 81 % and a specificity of 93 % (area under the ROC curve: 0.91 ± 0.04). A number of 31 supervised TEE examinations predicted a score >35/40 points with a specificity close to 100 %.


CONCLUSIONS
The performance of at least 31 supervised examinations over 6 months is required to reach competence in TEE driven hemodynamic evaluation of ventilated patient.
Intensive Care Unit, Section Thorax-Vascular Diseases-Abdomen-Metabolism, University Hospital Ambroise Paré, 9 Avenue Charles de Gaulle, 92104 Boulogne, France.
Cyril
C
Charron
Philippe
P
Vignon
Gwenaël
G
Prat
Alexandre
A
Tonnelier
Philippe
P
Aegerter
Jean-Michel
JM
Boles
Jean-Bernard
JB
Amiel
Antoine
A
Vieillard-Baron
D002983:Clinical Competence / Q000592:standards*; D003422:Critical Care / Q000592:standards*; D017548:Echocardiography, Transesophageal / Q000592:standards*; D004521:Educational Measurement; D005602:France; D006439:Hemodynamics; D006801:Humans; D007318:Inservice Training; D011446:Prospective Studies