Evaluation of the quality of transesophageal echocardiography images and verification of proficiency

Abstract

Various metrics have been used in curriculum-based transesophageal echocardiography (TEE) training programs to evaluate acquisition of proficiency. However, the quality of task completion, that is the final image quality, was subjectively evaluated in these studies. Ideally, the endpoint metric should be an objective comparison of the trainee-acquired image with a reference ideal image. Therefore, we developed a simulator-based methodology of preclinical verification of proficiency (VOP) in trainees by tracking objective evaluation of the final acquired images. We utilized geometric data from the simulator probes to compare image acquisition of anesthesia residents who participated in our structured longitudinal simulator-based TEE educational program vs ideal image planes determined from a panel of experts. Thirty-three participants completed the study (15 experts, 7 postgraduate year (PGY)-1 and 11 PGY-4). The results of our study demonstrated a significant difference in image capture success rates between learners and experts (χ2 = 14.716, df = 2, P < 0.001) with the difference between learners (PGY-1 and PGY-4) not being statistically significant (χ2 = 0, df = 1, P = 1.000). Therefore, our results suggest that novices (i.e. PGY-1 residents) are capable of attaining a level of proficiency comparable to those with modest training (i.e. PGY-4 residents) after completion of a simulation-based training curriculum. However, professionals with years of clinical training (i.e. attending physicians) exhibit a superior mastery of such skills. It is hence feasible to develop a simulator-based VOP program in performance of TEE for junior anesthesia residents.

Keywords: transesophageal echocardiography; training; proficiency; echocardiographic quality; task; performance; expert; target planes.

Figure 1

3D rendering of the unit direction vectors of the ultrasound beam from 15 experts capturing the mid-esophageal aortic valve short axis transesophageal echocardiography target cut plane (A). The derived range of acceptable probe positions (B) and orientations (C) are displayed as spheres with centers and radii generated from the distribution of expert unit vectors as described. The probe manipulations of the PGY-1 group and the PGY-4 groups were then overlaid on the same plot (D), with red vectors corresponding to the PGY-1 group and orange vectors corresponding to the PGY-4 group. PGY, postgraduate year.