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The Creation and Validation of a Transesophageal Echocardiography (TEE) Objective Standardized Clinical Exam (OSCE).

Steven Shen, David Bahner, Timothy Obarski, Amar Bhatt, William Perez, John Su, Michael Prats

LEARNING OBJECTIVE

Transesophageal echocardiography (TEE) offers benefits over transthoracic echocardiography (TTE) in cardiac resuscitation.

Using a cardiac ultrasound simulator, an Objective Standardized Clinical Exam (OSCE) has been created to assess the skill, knowledge, and attitude of its participants in TEE.

AIMS

Transoesophageal echocardiography (TEE) offers many benefits over transthoracic echocardiography (TTE) in cardiac resuscitation.

These advantages include less time spent off the patient’s chest during compressions and higher resolution imaging less confounded by visceral tissue or medical devices in the thorax. TEE, however, remains a complex skill that is highly operator dependent.

Using a cardiac ultrasound simulator, an Objective Standardized Clinical Exam (OSCE) has been created to assess the relative skill, knowledge, and attitude of its participants in TEE.

METHODS

A combination of residents (PGY1-PGY4), fellows (PGY5+), and faculty (PGY5+) specialized in Cardiac Anesthesiology and Cardiology were recruited for our study.

Using Qualtrics, participants first took a 31-item demographic survey that classified them based medical specialty, previous TEE experience, and their confidence levels in performing a TEE scan.

Following the survey, participants took a preliminary 10-question knowledge exam. They then completed three simulated clinical cases in which they acquired ultrasound images and answered questions based on their findings: one 24-point normal physiology scan and two 6-point scans featuring abnormal ultrasound findings. These points were totaled for a composite score of 46 possible points.

RESULTS

Based on our current data, residents that participated in our study scored an average of 26.5 points whereas fellows and faculty demonstrated an average score of 42.5.

Additionally, participants who noted no prior TTE experience scored an average of 29.5 points compared to those who noted prior TTE experience scoring an average of 39.8.

Currently, we have data from 9 participants and another 6 are signed up to take the simulation later in the month. Recruitment is still ongoing.

We aim to have a preliminary analysis of our data no later than the end of February.

CONCLUSION

Ultrasound simulation offers a low-risk environment in which learners can safely develop the psychomotor and decision-making skills to better approach real world clinical scenarios.

As the use of TEE continues to gain popularity in the setting of cardiac arrest and peri-arrest, new training options will need to be developed to meet this rising need. In that vein, we constructed an OSCE to create standardized benchmarks for judging TEE proficiency.

In future studies, we hope to continue exploring novel means of assessing varying levels of TEE competency as well as potential avenues for reframing the way the technique is taught.

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