Intensive Care Medicine

, Volume 39, Issue 6, pp 1019–1024

Number of supervised studies required to reach competence in advanced critical care transesophageal echocardiography

  • Cyril Charron
  • Philippe Vignon
  • Gwenaël Prat
  • Alexandre Tonnelier
  • Philippe Aegerter
  • Jean-Michel Boles
  • Jean-Bernard Amiel
  • Antoine Vieillard-Baron
Original

Abstract

Purpose

To determine the minimum number of supervised transesophageal echocardiography (TEE) that intensivists should perform to reach competence in performing and interpreting a comprehensive hemodynamic assessment in ventilated intensive care unit patients.

Methods

Prospective and multicentric study. Skills of 41 intensivists (trainees) with no (level 0) or little (level 1) experience in echocardiography was evaluated over a 6-month period, using a previously validated skills assessment score (/40 points). Trainees were evaluated at 1 (M1), 3 (M3) and 6 months (M6) by their tutor while performing 2 TEE examinations in ventilated patients. Competence was a priori defined by a skills assessment score >35/40 points.

Results

No difference in the score was observed between level 0 and level 1, except at M1 (22.2 ± 6.2 vs. 25.9 ± 4.4 points, p = 0.03). After 6 months, trainees performed a mean of 31 ± 9 supervised TEE. The score gradually increased from M1 to M6 (24 ± 6, 32 ± 3, and 35 ± 3 points, p < 0.001), regardless of trainees’ initial level. A correlation was found between the number of supervised TEE and the skills assessment score (r2 = 0.60; p < 0.001). The number of supervised TEE examinations which best predicted a score >35/40 points was 25, with a sensitivity of 81 % and a specificity of 93 % (area under the ROC curve: 0.91 ± 0.04). A number of 31 supervised TEE examinations predicted a score >35/40 points with a specificity close to 100 %.

Conclusion

The performance of at least 31 supervised examinations over 6 months is required to reach competence in TEE driven hemodynamic evaluation of ventilated patient.

Keywords

Education Transesophageal echocardiography Critical care echocardiography 

Supplementary material

134_2013_2838_MOESM1_ESM.doc (89 kb)
Supplementary material 1 (DOC 89 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Cyril Charron
    • 1
    • 2
  • Philippe Vignon
    • 3
    • 4
    • 5
  • Gwenaël Prat
    • 6
  • Alexandre Tonnelier
    • 6
  • Philippe Aegerter
    • 2
    • 7
  • Jean-Michel Boles
    • 6
  • Jean-Bernard Amiel
    • 3
    • 4
    • 5
  • Antoine Vieillard-Baron
    • 1
    • 2
  1. 1.Intensive Care Unit, Section Thorax—Vascular Diseases—Abdomen—MetabolismUniversity Hospital Ambroise ParéBoulogneFrance
  2. 2.Faculté de Médecine Paris Ile de France OuestUniversité de Versailles Saint Quentin en YvelinesVersaillesFrance
  3. 3.Intensive Care Unit, CHU de LimogesLimogesFrance
  4. 4.Center of Clinical Investigation, INSERM 0801LimogesFrance
  5. 5.University of LimogesLimogesFrance
  6. 6.Medical Intensive Care UnitUniversity Hospital La Cavale BlancheBrestFrance
  7. 7.Department of Biostatistics and Clinical Research UnitUniversity Hospital Ambroise ParéBoulogneFrance

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