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Published in: Annals of Intensive Care 1/2016

Open Access 01-12-2016 | Research

The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients

Authors: Gwénaël Prat, Cyril Charron, Xavier Repesse, Pierre Coriat, Pierre Bailly, Erwan L’her, Antoine Vieillard-Baron

Published in: Annals of Intensive Care | Issue 1/2016

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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).

Conclusion

Inclusion of echocardiographic simulator sessions in a standardized curriculum may improve the learning curve for hemodynamic evaluation of ventilated ICU patients.
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Literature
2.
go back to reference Good ML. Patient simulation for training basic and advanced clinical skills. Med Educ. 2003;37:14–21.CrossRefPubMed Good ML. Patient simulation for training basic and advanced clinical skills. Med Educ. 2003;37:14–21.CrossRefPubMed
3.
go back to reference Stefanidis D, Scerbo MW, Montero PN, Acker CE, Smith WD. Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial. Ann Surg. 2012;255(1):30–7.CrossRefPubMed Stefanidis D, Scerbo MW, Montero PN, Acker CE, Smith WD. Simulator training to automaticity leads to improved skill transfer compared with traditional proficiency-based training: a randomized controlled trial. Ann Surg. 2012;255(1):30–7.CrossRefPubMed
4.
go back to reference Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248(2):166–79.CrossRefPubMed Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248(2):166–79.CrossRefPubMed
5.
go back to reference Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg. 2008;95(9):1088–97.CrossRefPubMed Gurusamy K, Aggarwal R, Palanivelu L, Davidson BR. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg. 2008;95(9):1088–97.CrossRefPubMed
6.
go back to reference Van Dongen KW, Ahlberg G, Bonavina L, Hyltander A, Schijven MP, Stefani A, Van Der Zee DC, Broeders IA. European consensus on a competency-based virtual reality training program for basic endoscopic surgical psychomotor skills. Surg Endosc. 2011;25(1):166–71.CrossRefPubMed Van Dongen KW, Ahlberg G, Bonavina L, Hyltander A, Schijven MP, Stefani A, Van Der Zee DC, Broeders IA. European consensus on a competency-based virtual reality training program for basic endoscopic surgical psychomotor skills. Surg Endosc. 2011;25(1):166–71.CrossRefPubMed
7.
go back to reference Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–60.CrossRefPubMed Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P. American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–60.CrossRefPubMed
8.
go back to reference International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077–83. International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37:1077–83.
9.
go back to reference International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40(5):654–666. International consensus statement on training standards for advanced critical care echocardiography. Intensive Care Med. 2014;40(5):654–666.
10.
go back to reference Clau-Terré F, Vivek S, Cholley B, Gonzales-Ajulas T, Galinanes M, Evangelista A, Fletcher N. Can simulation help to answer the demand for echocardiography education? Anesthesiology. 2014;120:32–41.CrossRefPubMed Clau-Terré F, Vivek S, Cholley B, Gonzales-Ajulas T, Galinanes M, Evangelista A, Fletcher N. Can simulation help to answer the demand for echocardiography education? Anesthesiology. 2014;120:32–41.CrossRefPubMed
11.
go back to reference Damp J, Anthony R, Davidson MA, Mendes L. Effects of transesophageal echocardiography simulator training on learning and performance in cardiovascular medicine fellows. J Am Soc Echocardiogr. 2013;26(12):1450–6.CrossRefPubMed Damp J, Anthony R, Davidson MA, Mendes L. Effects of transesophageal echocardiography simulator training on learning and performance in cardiovascular medicine fellows. J Am Soc Echocardiogr. 2013;26(12):1450–6.CrossRefPubMed
12.
go back to reference Charron C, Prat G, Caille V, Belliard G, Lefevre M, Aegerter P, Boles JM, Jardin F, Vieillard-Baron A. Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics. Intensive Care Med. 2007;33(10):1712–8.CrossRefPubMed Charron C, Prat G, Caille V, Belliard G, Lefevre M, Aegerter P, Boles JM, Jardin F, Vieillard-Baron A. Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics. Intensive Care Med. 2007;33(10):1712–8.CrossRefPubMed
13.
go back to reference Charron C, Vignon P, Prat G, Tonnelier A, Aegerter P, Boles JM, Amiel JB, Vieillard-Baron A. Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography. Intensive Care Med. 2013;39(6):1019–24.CrossRefPubMed Charron C, Vignon P, Prat G, Tonnelier A, Aegerter P, Boles JM, Amiel JB, Vieillard-Baron A. Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography. Intensive Care Med. 2013;39(6):1019–24.CrossRefPubMed
14.
go back to reference Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder TV, Ottesen BS. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ. 2009;338:b1802.CrossRefPubMedPubMedCentral Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder TV, Ottesen BS. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ. 2009;338:b1802.CrossRefPubMedPubMedCentral
15.
go back to reference Rosser JC Jr, Colsant BJ, Lynch PJ, Herman B, Klonsky J, Young SM. The use of a “hybrid” trainer in an established laparoscopic skills program. JSLS. 2006;10(1):4–10.PubMedPubMedCentral Rosser JC Jr, Colsant BJ, Lynch PJ, Herman B, Klonsky J, Young SM. The use of a “hybrid” trainer in an established laparoscopic skills program. JSLS. 2006;10(1):4–10.PubMedPubMedCentral
16.
go back to reference Sedlack RE. Validation of computer simulation training for esophagogastroduodenoscopy: pilot study. J Gastroenterol Hepatol. 2007;22(8):1214–9.CrossRefPubMed Sedlack RE. Validation of computer simulation training for esophagogastroduodenoscopy: pilot study. J Gastroenterol Hepatol. 2007;22(8):1214–9.CrossRefPubMed
17.
go back to reference Sedlack RE, Baron TH, Downing SM, Schwartz AJ. Validation of a colonoscopy simulation model for skills assessment. Am J Gastroenterol. 2007;102(1):64–74.CrossRefPubMed Sedlack RE, Baron TH, Downing SM, Schwartz AJ. Validation of a colonoscopy simulation model for skills assessment. Am J Gastroenterol. 2007;102(1):64–74.CrossRefPubMed
18.
go back to reference Fried MP, Sadoughi B, Weghorst SJ, Zeltsan M, Cuellar H, Uribe JI, Sasaki CT, Ross DA, Jacobs JB, Lebowitz RA, Satava RM. Construct validity of the endoscopic sinus surgery simulator: II. Assessment of discriminant validity and expert benchmarking. Arch Otolaryngol Head Neck Surg. 2007;133(4):350–7.CrossRefPubMed Fried MP, Sadoughi B, Weghorst SJ, Zeltsan M, Cuellar H, Uribe JI, Sasaki CT, Ross DA, Jacobs JB, Lebowitz RA, Satava RM. Construct validity of the endoscopic sinus surgery simulator: II. Assessment of discriminant validity and expert benchmarking. Arch Otolaryngol Head Neck Surg. 2007;133(4):350–7.CrossRefPubMed
19.
go back to reference Bick JS, Demaria S Jr, Kennedy JD, Schwartz AD, Weiner MM, Levine AI, Shi Y, Schildcrout JS, Wagner CE. Comparison of expert and novice performance of a simulated transesophageal echocardiography examination. Simul Healthc. 2013;8(5):329–34.CrossRefPubMed Bick JS, Demaria S Jr, Kennedy JD, Schwartz AD, Weiner MM, Levine AI, Shi Y, Schildcrout JS, Wagner CE. Comparison of expert and novice performance of a simulated transesophageal echocardiography examination. Simul Healthc. 2013;8(5):329–34.CrossRefPubMed
20.
go back to reference Edrich T, Seethala RR, Olenchock BA, Mizuguchi AK, Rivero JM, Beutler SS, Fox JA, Liu X, Frendl G. Providing initial transthoracic echocardiography training for anesthesiologists: simulator training is not inferior to live training. J Cardiothorac Vasc Anesth. 2014;28(1):49–53.CrossRefPubMed Edrich T, Seethala RR, Olenchock BA, Mizuguchi AK, Rivero JM, Beutler SS, Fox JA, Liu X, Frendl G. Providing initial transthoracic echocardiography training for anesthesiologists: simulator training is not inferior to live training. J Cardiothorac Vasc Anesth. 2014;28(1):49–53.CrossRefPubMed
21.
go back to reference Platts DG, Humphries J, Burstow DJ, Anderson B, Forshaw T, Scalia GM. The use of computerised simulators for training of transthoracic and transoesophageal echocardiography. The future of echocardiographic training? Heart Lung Circ. 2012;21(5):267–74.CrossRefPubMed Platts DG, Humphries J, Burstow DJ, Anderson B, Forshaw T, Scalia GM. The use of computerised simulators for training of transthoracic and transoesophageal echocardiography. The future of echocardiographic training? Heart Lung Circ. 2012;21(5):267–74.CrossRefPubMed
22.
go back to reference Matyal R, Mitchell JD, Hess PE, Chaudary B, Bose R, Jainandunsing JS, Wong V, Mahmood F. Simulator-based transesophageal echocardiographic training with motion analysis: a curriculum-based approach. Anesthesiology. 2014;121(2):389–99.CrossRefPubMed Matyal R, Mitchell JD, Hess PE, Chaudary B, Bose R, Jainandunsing JS, Wong V, Mahmood F. Simulator-based transesophageal echocardiographic training with motion analysis: a curriculum-based approach. Anesthesiology. 2014;121(2):389–99.CrossRefPubMed
23.
go back to reference Matyal R, Bose R, Warraich H, Shahul S, Ratcliff S, Panzica P, Mahmood F. Emerging technology review. J Cardiothorac Vasc Anesth. 2011;25:177–81.CrossRefPubMed Matyal R, Bose R, Warraich H, Shahul S, Ratcliff S, Panzica P, Mahmood F. Emerging technology review. J Cardiothorac Vasc Anesth. 2011;25:177–81.CrossRefPubMed
24.
go back to reference Bose R, Matyal R, Panzica P, Karthik S, Subramaniam B, Pawlowski J, Mitchell J, Mahmood F. Transesophageal echocardiography simulator: a new learning tool. J Cardiothorac Vasc Anesth. 2009;23(4):544–8.CrossRefPubMed Bose R, Matyal R, Panzica P, Karthik S, Subramaniam B, Pawlowski J, Mitchell J, Mahmood F. Transesophageal echocardiography simulator: a new learning tool. J Cardiothorac Vasc Anesth. 2009;23(4):544–8.CrossRefPubMed
25.
go back to reference Vegas A, Meineri M, Jerath A, Corrin M, Silversides C, Tait G. Impact of online transesophageal echocardiographic simulation on learning to navigate the 20 standard views. J Cardiothorac Vasc Anesth. 2013;27(3):531–5.CrossRefPubMed Vegas A, Meineri M, Jerath A, Corrin M, Silversides C, Tait G. Impact of online transesophageal echocardiographic simulation on learning to navigate the 20 standard views. J Cardiothorac Vasc Anesth. 2013;27(3):531–5.CrossRefPubMed
26.
go back to reference Ogilvie E, Vlachou A, Edsell M, Fletcher SN, Valencia O, Meineri M, Sharma V. Simulation-based teaching versus point-of-care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study. Anaesthesia. 2015;70(3):330–5.CrossRefPubMed Ogilvie E, Vlachou A, Edsell M, Fletcher SN, Valencia O, Meineri M, Sharma V. Simulation-based teaching versus point-of-care teaching for identification of basic transoesophageal echocardiography views: a prospective randomised study. Anaesthesia. 2015;70(3):330–5.CrossRefPubMed
27.
go back to reference Neelankavil J, Howard-Quijano K, Hsieh TC, Ramsingh D, Scovotti JC, Chua JH, Ho JK, Mahajan A. Transthoracic echocardiography simulation is an efficient method to train anesthesiologists in basic transthoracic echocardiography skills. Anesth Analg. 2012;115(5):1042–51.CrossRefPubMed Neelankavil J, Howard-Quijano K, Hsieh TC, Ramsingh D, Scovotti JC, Chua JH, Ho JK, Mahajan A. Transthoracic echocardiography simulation is an efficient method to train anesthesiologists in basic transthoracic echocardiography skills. Anesth Analg. 2012;115(5):1042–51.CrossRefPubMed
28.
go back to reference Ferrero NA, Bortsov AV, Arora H, Martinelli SM, Kolarczyk LM, Teeter EC, Zvara DA, Kumar PA. Simulator training enhances resident performance in transesophageal echocardiography. Anesthesiology. 2014;120(1):149–59.CrossRefPubMed Ferrero NA, Bortsov AV, Arora H, Martinelli SM, Kolarczyk LM, Teeter EC, Zvara DA, Kumar PA. Simulator training enhances resident performance in transesophageal echocardiography. Anesthesiology. 2014;120(1):149–59.CrossRefPubMed
29.
go back to reference Jelacic S, Bowdle A, Togashi K, VonHomeyer P. The use of TEE simulation in teaching basic echocardiography skills to senior anesthesiology residents. J Cardiothorac Vasc Anesth. 2013;27(4):670–5.CrossRefPubMed Jelacic S, Bowdle A, Togashi K, VonHomeyer P. The use of TEE simulation in teaching basic echocardiography skills to senior anesthesiology residents. J Cardiothorac Vasc Anesth. 2013;27(4):670–5.CrossRefPubMed
30.
go back to reference Bose RR, Matyal R, Warraich HJ, Summers J, Subramaniam B, Mitchell J, Panzica PJ, Shahul S, Mahmood F. Utility of a transesophageal echocardiographic simulator as a teaching tool. J Cardiothorac Vasc Anesth. 2011;25(2):212–5.CrossRefPubMed Bose RR, Matyal R, Warraich HJ, Summers J, Subramaniam B, Mitchell J, Panzica PJ, Shahul S, Mahmood F. Utility of a transesophageal echocardiographic simulator as a teaching tool. J Cardiothorac Vasc Anesth. 2011;25(2):212–5.CrossRefPubMed
Metadata
Title
The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients
Authors
Gwénaël Prat
Cyril Charron
Xavier Repesse
Pierre Coriat
Pierre Bailly
Erwan L’her
Antoine Vieillard-Baron
Publication date
01-12-2016
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2016
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-016-0132-x

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