Chenkin Jordan, Jelic Tomislav, Hockmann Edgar
Department of Emergency Services Sunnybrook Health Sciences Centre Toronto Ontario Canada.
Division of Emergency Medicine University of Toronto Toronto Ontario Canada.
AEM Educ Train. 2023 Jan 27;7(1):e10845. doi: 10.1002/aet2.10845. eCollection 2023 Feb.
Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively novel ultrasound application; however, optimal teaching methods have not been determined. Previous studies have demonstrated that variable practice (VP), where practice conditions are changed, may improve learning of procedural skills compared with blocked practice (BP), where practice conditions are kept constant. We compared VP and BP for teaching resuscitative TEE to emergency medicine residents using a simulator.
Emergency medicine residents with no prior TEE experience were randomized to the BP or VP groups. The BP group practiced 10 repetitions of a fixed five-view TEE sequence, while the VP group practiced 10 different random five-view TEE sequences on a simulator. Participants completed a performance assessment immediately after training and a transfer test 2 weeks after training. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. The primary outcome was the percentage of successful views on the transfer test.
Twenty-eight participants completed the study (14 in the BP group, 14 in the VP group). The BP group had a higher rate of successful views compared with the VP group on the transfer test (93.6% vs. 77.6%; = 0.002). The BP group also had higher image quality on a 5-point scale (3.3 vs. 2.9; = 0.01) and fewer probe angular changes (2982.5 degrees vs. 4239.8 degrees; = 0.04). There were no statistically significant differences between the groups for the rate of correct diagnoses, confidence level, or scan time.
Practicing a fixed sequence of views was more effective than a variable sequence of views for learning resuscitative TEE on a simulator. These results should be validated in TEE scans performed in the clinical environment.
复苏时由临床医生操作的经食管超声心动图（TEE）是一种相对新颖的超声应用；然而，最佳教学方法尚未确定。先前的研究表明，与练习条件保持不变的集中练习（BP）相比，改变练习条件的可变练习（VP）可能会提高操作技能的学习效果。我们使用模拟器比较了VP和BP用于向急诊医学住院医师教授复苏TEE的效果。
没有TEE经验的急诊医学住院医师被随机分为BP组或VP组。BP组对固定的五视图TEE序列进行10次重复练习，而VP组在模拟器上练习10个不同的随机五视图TEE序列。参与者在训练后立即完成性能评估，并在训练后2周进行迁移测试。模拟器捕获超声图像和换能器运动指标以进行盲法分析。主要结局是迁移测试中成功视图的百分比。
28名参与者完成了研究（BP组14名，VP组14名）。在迁移测试中，BP组成功视图的比例高于VP组（93.6%对77.6%；P = 0.002）。BP组在5分制的图像质量评分上也更高（3.3对2.9；P = 0.01），探头角度变化更少（2982.5度对4239.8度；P = 0.04）。两组在正确诊断率、信心水平或扫描时间方面没有统计学上的显著差异。
在模拟器上学习复苏TEE时，练习固定的视图序列比可变的视图序列更有效。这些结果应在临床环境中进行的TEE扫描中得到验证。
