Comparison of simulation versus didactic-based instruction for transesophageal echocardiography teaching: the SIMULATOR randomized clinical trial

1. This randomized clinical trial demonstrated significantly increased post-training theoretical and practice scores among cardiology fellows who received simulation-based teaching compared to didactic-based teaching for transesophageal echocardiography training.

2. Simulation-based training resulted in greater self-proficiency scores compared to didactic-based training when assessing feelings of preparedness and confidence.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Echocardiography is a crucial skill for cardiologists. Learning transesophageal echocardiography (TEE) may be challenging, given the requirement to intubate patients and the limited number of skilled teachers and resources. Therefore, simulation and didactic lectures are often used to teach this skill. Recent evidence has demonstrated that simulation-based teaching may be superior to didactic teaching; however, these studies have significant limitations. The SIMULATOR multicentre, randomized controlled trial compared the efficacy of simulation-based teaching versus traditional didactic teaching of TEE among cardiology fellows. The study was conducted between November 2020 and November 2021. Cardiology fellows (n = 324) were randomized 1:1. Fellows completed pre-training and post-training theoretical and practical tests. The primary outcomes were the differences between intervention groups in the post-training theoretical and practical test scores. The pre-training test scores were similar between groups. Post-training, the fellows who received simulation teaching demonstrated higher theoretical (47.2 [SD,15.6] vs. 38.3 [SD, 19.8] points; p < 0.001) and practical test scores (74.5 [SD,17.7] vs. 59.0 [SD, 25.1] points; p < 0.001) than those who received didactic teaching. Additionally, the increase in theoretical (14.2% [SD, 16.2] vs. 5.8% [SD, 16.0]; p < 0.001) and practical (30.3% [SD, 23.3] vs. 12.9% [SD, 18.3]; p < 0.001) test scores were greater among the simulation-based training group. Additionally, self-assessment of proficiency was assessed. Fellows who received simulation training expressed feeling more prepared (mean scores: 3.0 [95% CI, 2.9-3.2] vs. 1.7 [95% CI, 1.4-1.9]; p < 0.001) and confident (mean scores: 3.3 [95% CI, 3.1-3.5] vs. 2.4 [95% CI, 2.1-2.6]; p < 0.001) about providing TEE alone. Overall, the SIMULATOR trial demonstrated that TEE training via simulation was more effective than didactic teaching in several objective and subjective measures. However, this study was limited as there were no clinical-based outcomes or assessments on real patients; therefore, there is no clinical benefit proven from this study.

Click to read the study in JAMA Cardiology  

Click to read an accompanying editorial in JAMA Cardiology

Relevant Reading: Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers

Image: PD

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