Manual Skill Acquisition During Transesophageal Echocardiography Simulator Training of Cardiology Fellows: A Kinematic Assessment.
OBJECTIVE
To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model.


METHODS
A prospective cohort study.


METHODS
A tertiary-care university hospital.


METHODS
TEE-naïve cardiology fellows.


METHODS
Participants underwent an 8-session multimodal TEE training program. Manual skills were assessed at the end of sessions 2 and 8 using motion analysis of the TEE simulator's probe. At the end of the course, participants performed an intraoperative TEE; their examinations were video captured, and a blinded investigator evaluated the total time and image transitions needed for each view. Results are reported as mean±standard deviation, or median (interquartile range) where appropriate.


RESULTS
Eleven fellows completed the knowledge and kinematic portions of the study. Five participants were excluded from the evaluation in the clinical setting because of interim exposure to TEE or having participated in a TEE rotation after the training course. An increase of 12.95% in post-test knowledge scores was observed. From the start to the end of the course, there was a significant reduction (p<0.001 for all) in the number of probe. During clinical performance evaluation, trainees were able to obtain all the required echocardiographic views unassisted but required a longer time and had more probe transitions when compared with an expert.


CONCLUSIONS
A curriculum-based approach to TEE training for cardiology fellows can be complemented with kinematic analyses to objectify acquisition of manual skills during simulator-based training.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
Robina
R
Matyal
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
Mario
M
Montealegre-Gallegos
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
John D
JD
Mitchell
Department of Anesthesia, St. Michael's Hospital, Toronto, Canada;
Han
H
Kim
Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Remco
R
Bergman
Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Katie M
KM
Hawthorne
Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
David
D
O'Halloran
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
Vanessa
V
Wong
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;
Phillip E
PE
Hess
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;. Electronic address: fmahmood@bidmc.harvard.edu.
Feroze
F
Mahmood
D001696:Biomechanical Phenomena; D002309:Cardiology / Q000193:education* / Q000295:instrumentation / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D003198:Computer Simulation / Q000592:standards*; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D008297:Male; D011446:Prospective Studies
kinematic analysis; simulation; transesophageal echocardiography