Simulation-based Training Changes Attitudes of Emergency Physicians Toward Transesophageal Echocardiography

TL;DR

A simulation-based training program significantly improved emergency physicians' attitudes and confidence in using transesophageal echocardiography during cardiac resuscitation.

Contribution

This study introduces a novel simulation-based training paradigm for emergency physicians to learn transesophageal echocardiography in cardiac arrest scenarios.

Findings

Simulation training significantly reduced perceived barriers to TEE use in resuscitation.

68% of participants expressed high likelihood to use TEE in cardiac arrest with attending assistance.

Post-training survey showed statistically significant improvements in knowledge and confidence across multiple TEE-related domains.

Abstract

The American College of Emergency Physicians recommends that transesophageal echocardiography (TEE) be used to “maintain the standard of ultrasound-informed resuscitation” in cardiac arrest. To date, no standards exist on how to train emergency physicians (EP) on TEE use in the emergency department (ED). We propose a novel educational paradigm using simulation to train EPs on the use of TEE in cardiac arrest.

A total of 63 EPs at a single-center academic teaching hospital participated in a 90-minute simulation-based education session to summarize the use of TEE in cardiac resuscitation and practice related procedural skills. The session consisted of a simulated cardiac arrest scenario using both transthoracic echocardiography (TTE) and TEE and hands-on practice on a high-fidelity TEE task trainer. Participants filled out anonymous surveys before and after the training session, which evaluated their subjective attitudes toward TEE, knowledge of its role in cardiac arrest, and perceived efficacy of the curriculum in introducing the modality.

Survey results indicated fewer perceived barriers to performing TEE in resuscitation after completion of the course, with statistically significant decreases in the following: not understanding image acquisition (85.5% pre vs 27.4% post; P<0.001), interpretation (66.1% pre vs 25.8% post; P<0.001), indications (29.0% pre vs 0.0% post; P<0.001), contraindications (35.5% pre vs. 3.2% post; P<0.001), and the potential benefit for the patient (24.2% pre vs 3.2% post; P <0.001). Finally, 68% of EPs stated they were “extremely likely” to use TEE in cardiac arrest with the availability of assistance from a credentialed attending.

The survey responses suggest that a short, simulation-based course can generate interest in the incorporation of TEE in cardiac resuscitation as well as overcome many of the perceived barriers regarding TEE. Moreover, they suggest that the participating academic EPs would be interested in using TEE in critical patients in the future when available.