title: The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients.
abstract: BACKGROUND
  Our aim was to evaluate the impact of a computerized echocardiographic simulator on the learning curve for transesophageal echocardiography (TEE) hemodynamic assessment of ventilated patients in the ICU.
  
  
  METHODS
  We performed a prospective study in two university hospital medical ICUs. Using our previously validated skill assessment scoring system (/40 points), we compared learning curves obtained with (interventional group, n = 25 trainees) and without (control group, n = 31 trainees) use of a simulator in the training. Three evaluations were performed after 1 (M1), 3 (M3) and 6 months (M6) while performing two TEE examinations graded by an expert. Competency was defined as a score >35/40.
  
  
  RESULTS
  Competency was achieved after an average of 32.5 ± 10 supervised studies in the control group compared with only 13.6 ± 8.5 in the interventional group (p < 0.0001). At M6, a significant between-group difference in number of supervised TEE was observed (17 [14-28] in the control group vs. 30.5 [21.5-39.5] in the interventional group, p = 0.001). The score was significantly higher in the interventional group at M1 (32.5 [29.25-35.5] vs. 24.75 [20-30.25]; p = 0.0001), M3 (37 [33.5-38.5] vs. 32 [30.37-34.5]; p = 0.0004), but not at M6 (37.5 [33-39] vs. 36 [33.5-37.5] p = 0.24).
  
  
  CONCLUSIONS
  Inclusion of echocardiographic simulator sessions in a standardized curriculum may improve the learning curve for hemodynamic evaluation of ventilated ICU patients.
authors.affiliation: Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France. gwenael.prat@chu-brest.fr.|Centre de Simulation en Santé, Université de Bretagne Occidentale, Brest, France. gwenael.prat@chu-brest.fr.
authors.forename: Gwénaël
authors.initials: G
authors.lastname: Prat
authors.affiliation: Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Charron
authors.affiliation: Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Repesse
authors.affiliation: Hospital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie-Curie-Paris 6, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Coriat
authors.affiliation: Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France.|Centre de Simulation en Santé, Université de Bretagne Occidentale, Brest, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bailly
authors.affiliation: Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France.|LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, France.|FHU TechSan, Université de Bretagne Occidentale/Université de Rennes, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: L'her
authors.affiliation: Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France.|INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807, Villejuif, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
keywords: Critical care; Echocardiography; Education; Mannequin echocardiographic simulator; Transesophageal echocardiography