title: Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics.
abstract: BACKGROUND
  Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training.
  
  
  RESULTS
  During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance.
  
  
  CONCLUSIONS
  Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Montealegre-Gallegos
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Han
authors.initials: H
authors.lastname: Kim
authors.forename: Remco
authors.initials: R
authors.lastname: Bergman
authors.forename: John D
authors.initials: JD
authors.lastname: Mitchell
authors.forename: Ruma
authors.initials: R
authors.lastname: Bose
authors.forename: Katie M
authors.initials: KM
authors.lastname: Hawthorne
authors.forename: T David
authors.initials: TD
authors.lastname: O'Halloran
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wong
authors.forename: Philip E
authors.initials: PE
authors.lastname: Hess
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
mesh_terms: D000328:Adult; D000465:Algorithms; D001696:Biomechanical Phenomena; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D004452:Echocardiography; D004521:Educational Measurement; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008348:Manikins; D009038:Motion; D011597:Psychomotor Performance