Short summary

This intervention study will investigate how a simulation-based test in trans-thoracic echocardiography (TTE) can develop basic competencies of doctors prior to patient involvement. 35 doctors, divided on the basis of 3 different levels of experience with TTE, will participate in a simulation test, where they will be scored on differentiated parameters. These different levels of experience will help to form the basic for a level of competence, where through simulation-based training, the right level is achieved before patient involvement. 

Rationale

Transthoracic echocardiography (TTE) is a non-invasive procedure for imaging of the heart. The examine is frequently used and accounts for almost half of all imaging examines of the heart. A TTE provides a quick and simple ultrasound image of the heart's functions and structures through various projections. TTE can help achieving diagnosis and lead to awareness of focus on several cardiovascular diseases as well a provide important knowledge about pathophysiological processes and prognoses. A TTE is based on three basic ultrasound techniques: A) M-mode echo, which is a continuous image-capture in a single standardized section of the heart over a period of time. Today, M-mode echoes are less used than previously, as they have been replaced to a greater extent by 2D echoes. B) 2D echo shows a fan-shaped ultrasound section of the heart in motion, and by changing the position of the transducer, more projection can be obtained. The most commonly used ultrasound plans are suprasternal, parasternal, subcostal as well as apical projections. C) Doppler echo is the last of the three basic study methods and is used to measure blood flow rates, thereby determining the heart's pumping function and pressure gradients.   Thus, due to the low cost of the examine, widespread availability, lack of ionizing rays, and ability to evaluate both anatomy and heart function, TTE is an essential tool in diagnostic perspectives. There is a continuing increase in development in various echocardiographic examination methods such as trans-oesophageal echocardiography, stress echocardiography and contrast echocardiography. Therefore, the requirements for doctors' competences with echocradiography will only increase. Competences in TTE are a requirement for Danish cardiologists, and the possibility of using simulation-based training willl provide a basis for their development. Simulation-based training contributes to developing basic skills and knowledge in several procedures prior to examines in clinic. Therefore it is important to explore the possibilities of using simulation-based training for TTE competence development. In addition to cardiologists, anesthesiologists can also benefit from basic TTE skills. Pre-clinic simulation training can help create a safe and controlled learning environment with the opportunity to gain a certain level of competence before meeting the patient - so called ''Mastery Learning''. The goal of this principle is to reach a certain level on a learning curve, ensuring that everyone has this level before meeting the real patient, rather than training on time. To ensure a satisfactory level of competence, the simulation process must be completed with a pass/fail. There must be evidence that the test is capable of discriminating between different level of experience. There is currently no evidence of a simulation-based test on Simbionix U/S mentor to learn TTE. 

Description of the cohort

35 doctors will be divided into 3 groups, based on their level of experience. Group 1 will be novices who have never done independent TTE. Group 2 are intermediates who are familiar with the test and have done between 20 and 200 TTE themselves. Group 3 are experienced doctors who have conducted more than 1000 independent TTEs. 

Data and biological material

Data is collected on Simbionix U/S mentor. The evaluation score will be based on time, number of correct images, diagnosis, comparison between censor and simulator as well as naming of 3 printed anatomical images with 4 structures each. 

Collaborating researchers and departments

TechSim, Odense University Hospital, Region of Southern Denmark

Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Region Hovedstaden

• MD, Jesper Holmbæk Clausen

•  Lars Konge, Professor PhD
• Anders Bo Nielsen, M.D.