title: Comparison of expert and novice performance of a simulated transesophageal echocardiography examination.
abstract: BACKGROUND
  Training in transesophageal echocardiography (TEE) requires a significant commitment of time and resources on behalf of the trainees and the instructors. Training opportunities may be limited in the busy clinical environment. Medical simulation has emerged as a complementary means by which to develop clinical skills. Transesophageal echocardiography simulators have been commercially available for several years, yet their ability to distinguish experts from novices has not been demonstrated. We used a standardized assessment tool to distinguish experts from novices using a commercially available TEE simulator.
  
  
  METHODS
  Anesthesiologists certified in advanced perioperative TEE and anesthesiology resident physicians were recruited into the expert and novice cohorts, respectively. The cohorts were recruited from 2 academic medical centers. The novice cohort received a structured introduction to the basic TEE examination. Both cohorts then proceeded to perform a basic TEE examination involving normal cardiac anatomy, which was evaluated by blinded raters using a standardized assessment tool.
  
  
  RESULTS
  The expert cohort consistently demonstrated the ability to obtain standard TEE imaging views in less time and more accurately than the novice cohort during the course of a simulated TEE examination.
  
  
  CONCLUSIONS
  A simulated transesophageal examination of normal cardiac anatomy in concert with a standardized assessment tool permits ample discrimination between expert and novice echocardiographers as defined for this investigation. Future research will examine in detail the role echocardiography simulators should play during echocardiography training including assessment of training level.
authors.affiliation: From the Department of Anesthesiology (J.S.B., J.S.S.), and Department of Biostatistics (Y.S., J.S.S.), School of Medicine, Vanderbilt University; and Department of Anesthesiology (J.D.K., C.E.W.), Vanderbilt University Medical Center Nashville, TN; Department of Anesthesiology (S.D.M., A.D.S., M.M.W., A.I.L.), Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Julian S
authors.initials: JS
authors.lastname: Bick
authors.forename: Samuel
authors.initials: S
authors.lastname: Demaria
authors.forename: Jason D
authors.initials: JD
authors.lastname: Kennedy
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Schwartz
authors.forename: Menachem M
authors.initials: MM
authors.lastname: Weiner
authors.forename: Adam I
authors.initials: AI
authors.lastname: Levine
authors.forename: Yaping
authors.initials: Y
authors.lastname: Shi
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.forename: Chad E
authors.initials: CE
authors.lastname: Wagner
mesh_terms: D000776:Anesthesiology / Q000193:education* / Q000379:methods / Q000592:standards; D002568:Certification; D003198:Computer Simulation; D017548:Echocardiography, Transesophageal / Q000379:methods* / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D008348:Manikins; D009518:New York; D015397:Program Evaluation / Q000379:methods; D011446:Prospective Studies; D013714:Tennessee; D013997:Time Factors