title: Focused transesophageal echocardiography for emergency physicians-description and results from simulation training of a structured four-view examination.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) offers several advantages over transthoracic echocardiography (TTE). Despite these advantages, use of TEE by emergency physicians (EPs) remains rare, as no focused TEE protocol for emergency department (ED) use has been defined nor have methods of training been described.
  
  
  OBJECTIVE
  This study aims to develop a focused TEE examination tailored for the ED and to evaluate TEE skill acquisition and retention by TEE-naïve EPs following a focused 4-h curriculum.
  
  
  METHODS
  Academic EPs were invited to participate in a 4-h didactic and simulation-based workshop. The seminar emphasized TEE principles and views obtained from four vantage points. Following the training, participants engaged in an assessment of their abilities to carry out a focused TEE on a high-fidelity simulator. A 6-week follow-up session assessed skill retention.
  
  
  RESULTS
  Fourteen EPs participated in this study. Immediately following the seminar, 14 (100 %; k = 1.0) and 10 (71.4 %, k = 0.65) successfully obtained an acceptable mid-esophageal four-chamber and mid-esophageal long-axis view. Eleven (78.6 %, k = 1.0) participants were able to successfully obtain an acceptable transgastric short-axis view, and 11 (78.6 %, k = 1.0) EPs successfully obtained a bicaval view. Twelve participants engaged in a 6-week retention assessment, which revealed acceptable images and inter-rater agreement as follows: mid-esophageal four-chamber, 12 (100 %; k = 0.92); mid-esophageal long axis, 12 (100 %, k = 0.67); transgastric short-axis, 11 (91.7 %, k = 1.0); and bicaval view, 11 (91.7 %, k = 1.0).
  
  
  CONCLUSIONS
  This study has illustrated that EPs can successfully perform this focused TEE protocol after a 4-h workshop with retention of these skills at 6 weeks.
authors.affiliation: Western University, London, ON, Canada, robert.arntfield@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Arntfield
authors.forename: Jacob
authors.initials: J
authors.lastname: Pace
authors.forename: Shelley
authors.initials: S
authors.lastname: McLeod
authors.forename: Jeff
authors.initials: J
authors.lastname: Granton
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hegazy
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard