Simulation-based training in echocardiography

1.Simulation-based training in echocardiography

Monodeep Biswas 1, Rajendrakumar Patel 2, Charles German 3, Anant Kharod 4, Ahmed
Mohamed 3, Harvinder S Dod 5, Poonam Malhotra Kapoor 6, Navin C Nanda 
Echocardiography . 2016 Oct;33(10):1581-1588 7
Abstract
The knowledge gained from echocardiography is paramount for the clinician in
diagnosing, interpreting, and treating various forms of disease. While cardiologists
traditionally have undergone training in this imaging modality during their fellowship,
many other specialties are beginning to show interest as well, including intensive care,
anesthesia, and primary care trainees, in both transesophageal and transthoracic
echocardiography. Advances in technology have led to the development of simulation
programs accessible to trainees to help gain proficiency in the nuances of obtaining
quality images, in a low stress, pressure free environment, often with a functioning
ultrasound probe and mannequin that can mimic many of the pathologies seen in living
patients. Although there are various training simulation programs each with their own
benefits and drawbacks, it is clear that these programs are a powerful tool in educating
the trainee and likely will lead to improved patient outcomes.

2. Medical students' knowledge of ultrasonography: effects of a simulation-based

ultrasound training program

Oguz Eroglu 1, Figen Coskun  Pan Afr Med J 2018 Jun 1

Abstract
Introduction: The use of simulation devices in medical education is becoming more
prevalent with each passing day. The present study aimed to teach medical students to
perform ultrasonography via a simulation-based ultrasound training program.
Methods: The study was prospectively conducted on final year medical students who
had not received previous ultrasound training and who came to the Emergency
Department of the Kirikkale University Faculty of Medicine between July 2015 and July
2016. Ultrasound training was provided by two emergency department specialists who
are qualified in this field. The training time was determined to be 20h (4h for theoretical
lessons, 16h for hands-on). The students were evaluated by a theory test and practical
application exam both before and after training.
Results: Obtained were compared using the paired sample t-test, and p < 0.05 was
considered to be significant. Results: Ninety-six final year medical students were
included. Their mean age was 24.1 ± 2.1 years. The mean test score obtained in the
theoretical exam before training was 7.9 ± 2.2, while that after training was 17.1 ± 1.6 (p
< 0.0001). The mean score obtained in the practical application exam before training
was 1.1 ± 0.9 points and that after training was 10.9 ± 0.2 points (p < 0.0001).
Conclusion: Medical students can learn to use an ultrasound device within a short
period of time via simulation-based training programs. New studies must be conducted
for the inclusion of ultrasound training programs in the medical education curriculum.

3.Simulation-based teaching versus point-of-care teaching for identification of

basic transoesophageal echocardiography views: a prospective randomised
study
E Ogilvie 1, A Vlachou, M Edsell, S N Fletcher, O Valencia, M Meineri, V Sharma
Anaesthesia
2015 Mar
Abstract
In recent years, the use of transoesophageal echocardiography has increased in
anaesthesia and intensive care. We explored the impact of two different teaching
methods on the ability of echocardiography-naïve subjects to identify cardiac anatomy
associated with the 20 standard transoesophageal echocardiography imaging planes,
and assessed trainees' satisfaction with these methods of training. Fifty-two subjects
were randomly assigned to one of two groups: a simulation-based and a theatre-based
teaching group. Subjects undertook video-based tests comprised of 20 multiple choice
questions on echocardiography views before and after receiving echocardiography
teaching. Subjects in simulation- and theatre-based teaching groups scored 40% (30-40
[20-50])% and 35% (30-40 [15-55])% in the pre-test, respectively (p = 0.52). Following
echocardiography teaching, subjects within both groups improved upon their pre-test
knowledge (p < 0.001). Subjects in the simulation-based teaching group significantly
outperformed their theatre-based group counterparts in the post-intervention test (p =
0.0002).

4.Using Simulation to Teach Echocardiography: A Systematic Review Simul

Healthc  2018 Dec
Cecil A Rambarat 1, Justin M Merritt, Hannah F Norton, Erik Black, David E Winchester
Abstract
We identified 24 studies of high-fidelity simulation being used to teach
echocardiography. A variety of study designs were used with outcomes ranging from
reports of learner self-confidence up to improvement in organizational practice. Most
studies were carried out in graduate medical populations, specifically in anesthesia
trainees. The substantial majority of studies (91.6%) concluded that simulation has
positive outcomes for teaching echocardiography. Future investigations would benefit
from application of educational theory and should focus on demonstrating whether
simulation can improve care delivery and patient outcomes.
5.Learning echocardiography- what are the challenges and what may favour
learning? A qualitative study
Anna Dieden 1, Elisabeth Carlson 2, Petri Gudmundsson  BMC Med Educ 2019 Jun 13;3
Abstract
Background: Echocardiography is a frequently used imaging modality requiring
extensive training to master. In order to develop curriculums and teaching material fully
favouring students learning within echocardiography, this study aims to investigate
students' experiences of learning echocardiography, focusing on that which is perceived
as the main challenges as well as what might aid learning within the area. The findings
could serve as a foundation in the development of new teaching material or curriculums.
Methods: A qualitative study was performed with data gathered through two audio-
recorded focus group interviews with four third year students from the biomedical
laboratory programme at Malmö University in each group. Data was analysed by
manifest content analysis.
Results: Findings were clustered into two categories reflecting the main findings in the
text - practical skills and bridging the theory-practice-gap. Students expressed that main
challenges when initially learning echocardiography were the projections and handling
the probe as well as connecting ultrasound physics and measurements to practical
application. Things that aided their learning were immediate feedback, "playing" with the
ultrasound machine, video lectures, the possibility to swiftly alternate between practice
and theory as well as the learning by their mistakes in a risk-free environment.
Conclusions: This study shows the main challenges when initially learning
echocardiography and what might be helpful during the learning process. These
findings may be useful when developing curriculums or new teaching material within
echocardiography. One suggestion might be to develop digital resources such as virtual
laboratories (vLABs).

Acceleration of the learning curve for mastering basic critical care

echocardiography using computerized simulation

Philippe Vignon 1 2 3 4, Benjamin Pegot 5, François Dalmay 6, Vanessa Jean-Michel 7, Simon

Bocher 7, Erwan L'her 7 8 9, Jérôme Cros 10, Gwenaël Prat 7, EchoSimu Group Intensive Care Med
2018 Jul;
Abstract
Purpose: To assess the impact of computerized transthoracic echocardiography (TTE)
simulation on the learning curve to achieve competency in basic critical care
echocardiography (CCE).
Methods: In this prospective bicenter study, noncardiologist residents novice in
ultrasound followed either a previously validated training program with adjunctive
computerized simulation on a mannequin (two 3 h-sessions; Vimedix simulator, CAE
Healthcare) (interventional group; n = 12) or solely the same training program (control
group; n = 12). All trainees from the same institution were assigned to the same study
group to avoid confusion bias. Each trainee was evaluated after 1 (M1), 3 (M3) and 6
(M6) months of training using our previously validated scoring system. Competency was
defined by a score ≥ 90% of the maximal value.
Results: The 24 trainees performed 965 TTE in patients with cardiopulmonary
compromise during their 6-month rotation. Skills assessments relied on 156 TTE
performed in 106 patients (mean age 53 ± 14 years; mean Simplified Acute Physiologic
Score 2: 55 ± 19; 79% ventilated). When compared to the control group, trainees of the
interventional group obtained a significantly higher mean skills assessment score at M1
(41.5 ± 4.9 vs. 32.3 ± 3.7: P = 0.0004) and M3 (45.8 ± 2.8 vs. 42.3 ± 3.7: P = 0.0223), but
not at M6 (49.7 ± 1.2 vs. 50.0 ± 2.7: P = 0.6410), due to higher practical and technical
skills scores. Trainees of the control group required significantly more supervised TTE to
obtain competency than their counterparts (36 ± 7 vs. 30 ± 9: p = 0.0145).
Conclusions: Adjunctive computerized simulation accelerates the learning curve of
basic CCE in improving practical and technical skills and reduces the number of TTE
examinations required to reach competency.

7.Resident performance in basic perioperative transesophageal

echocardiography: Comparing 3 teaching methods in a randomized
controlled trial
Medicine (Baltimore) 2019 Sep
Ulrike Weber 1, Bernhard Zapletal 1, Eva Base 1, Michael Hambrusch 1, Robin Ristl 2, Bruno
Mora 1
Abstract
Background: Training in transesophageal echocardiography (TEE) is based on hands-on
training in the operating room, which is time consuming and therefore limits its
experience among anesthesiologists. Medical simulations have been successfully used
for training of invasive procedures in many areas.This paper compares the difference in
effectiveness of teaching the 11 basic TEE views using either e-learning, simulation
based training or hands-on training in the operating room in 3 groups of residents.
Methods: We included 51 anesthesia and intensive care residents of all training levels
but no prior training in echocardiography in this prospective randomized single-center
study.Residents received a tutorial about theoretical knowledge followed by 2 practical
study sessions either by e-learning using an online simulator
(www.pie.med.utoronto.ca/TEE), with the simulation mannequin (CAE Vimedix Simulator)
or in the operating room. Both, a theoretical multiple choice test (0-50 points) and a
practical exam test (0-110 points) on the simulation mannequin had to be
completed.The primary endpoint was the post-training scores in the practical and
theoretical exams after all training sessions.
Results: Residents received significantly higher test scores in both practical and
theoretical examinations after training with the simulation mannequin (108.41 ± 2.09,
40.6 ± 5.23, n = 17) compared with e-learning (106.88 ± 4.53, 36 ± 4.76, n = 17) or
hands-on training (106.82 ± 2.01, 34.94 ± 4.72, n = 17).
Conclusions: Simulation based TEE training provides more effective training than other
teaching methods. It is therefore especially suitable for the initial stages of TEE training
to acquire psychomotor skills and knowledge of echo-anatomy.