Anesthesiology Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Department of Anesthesiology, Khon Kaen Hospital, 54 Sri Chant Rd, Nai Meuang, Meuang Khon Kaen District, Khon Kaen, 40000, Thailand.
BMC Med Educ. 2022 May 30;22(1):412. doi: 10.1186/s12909-022-03280-3.
Learning to perform intraoperative transesophageal echocardiography takes time and practice. We aimed to determine the cumulative success rate in the first 20 intraoperative transesophageal echocardiography cases performed by trainee anesthesiologists with no transesophageal echocardiography experience.
This prospective observational study included nine anesthesiologists (four cardiovascular and thoracic anesthesia fellows and five short-course perioperative intraoperative transesophageal echocardiography trainees). Overall, 180 studies self-performed by the trainees were reviewed by certified reviewers. A study was considered successful when at least 15 qualified images were collected within 30 min. The cumulative success of each trainee was used as a surrogate of a basic two-dimensional intraoperative transesophageal echocardiography learning curve.
The participants comprised three male and six female anesthesiologists aged 29-43 years with 2-13 years of work experience. Most studies (146/180, 81.11%) were completed within 30 min, and the cumulative success rate was 70-90% (average 82.78 ± 6.71%). The average cumulative success rate in the short-course group (85 ± 7.07%) was higher than that in the official cardiovascular and thoracic fellow trainee group (80 ± 7.07%). The recommended caseload for a 80-100% success rate was 18-20 cases (95% confidence interval, 0.652-0.973). The CUSUM method analysis confirmed that the lower decision limit was crossed after 20 TEE studies among those achieved competence.
We recommended a 18-20 caseload for a target success rate of 80-100% in studies performed by trainees with no previous experience. Our findings will enable the development of programs to train anesthesiologists in intraoperative transesophageal echocardiography.
学习进行术中经食管超声心动图检查需要时间和实践。我们旨在确定没有经食管超声心动图经验的麻醉住院医师在进行前 20 例术中经食管超声心动图检查时的累积成功率。
本前瞻性观察性研究纳入了 9 名麻醉医师（4 名心血管和胸科麻醉研究员和 5 名短期围手术期术中经食管超声心动图培训生）。共有 180 项由培训生自行进行的研究由认证评审员进行了审查。当在 30 分钟内收集到至少 15 个合格图像时，研究被认为是成功的。每位学员的累积成功率被用作基本二维术中经食管超声心动图学习曲线的替代指标。
参与者包括 3 名男性和 6 名女性麻醉师，年龄 29-43 岁，工作经验 2-13 年。大多数研究（146/180，81.11%）在 30 分钟内完成，累积成功率为 70-90%（平均 82.78±6.71%）。短期课程组的平均累积成功率（85±7.07%）高于官方心血管和胸科研究员培训生组（80±7.07%）。达到 80-100%成功率的推荐病例数为 18-20 例（95%置信区间，0.652-0.973）。CUSUM 方法分析证实，在那些达到胜任能力的人中，在完成 20 次 TEE 研究后，下限决策被突破。
我们建议在没有先前经验的情况下，为培训生设定 18-20 个病例的目标成功率为 80-100%。我们的研究结果将为培训麻醉医师进行术中经食管超声心动图的计划的制定提供依据。
