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

Various metrics have been used in curriculum-based TEE training programs to evaluate acquisition of proficiency. However, the quality of task completion, i.e. the final image quality, was subjectively evaluated in these studies. Ideally, the end point metric should be an objective comparison of the trainee-acquired image with a reference ideal image. Therefore, we developed a simulator-based methodology of pre-clinical 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 in versus ideal image planes determined froma panel of experts. Thirty-three participants completed the study (15 experts, 7 PGY-1, and 11PGY-4). The results of our study demonstrated a significant difference in image capture success rates between learners and experts (X2=14.716, df=2, p<0.001) with the difference between learners (PGY-1 and PGY-4) not being statistically significant (X2=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.