Learning curve for the acquisition of 20 standard two-dimensional images in advanced perioperative transesophageal echocardiography: a prospective observational study

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.