3D models and simulations training improves TEE performance on pediatric patients with simple valvular congenital heart disease compared to traditional apprenticeship training: a clinical randomized controlled trial

Transesophageal echocardiography (TEE) is indispensable for intraoperative guidance and evaluation in pediatric cardiac surgery. While simulation-based medical education offers a promising alternative to the traditional apprenticeship model, evidence directly comparing its efficacy in improving live pediatric TEE performance remains limited. This study aimed to evaluate whether simulation-based training using a 3D pediatric TEE simulator is superior to traditional apprenticeship training for enhancing clinical TEE proficiency among anesthesia residents. First- through third-year anesthesia resident physicians without prior echocardiography experience were randomized into two groups. All participants first completed a standardized 2-hour web-based foundational course. Subsequently, the intervention group (Simulation group, Group S; n = 22) received 1 h of supervised hands-on practice using the BabyWorks® simulator, while the control group (Traditional group, Group T; n = 22) received 1 h of bedside apprenticeship training on live patients. One week later, all participants were assessed on their ability to independently acquire 11 standardized TEE views in pediatric patients. Performance was scored across three dimensions (imaging angle, anatomical structure, and image clarity), with a maximum total score of 110 points. The total examination duration (time) was also recorded. Baseline knowledge scores were comparable between groups. In the clinical assessment, Group S achieved significantly higher total performance scores than Group T (Group S: 88.60 ± 15.60 vs. Group T: 64.70 ± 16.70; p < 0.001). Group S also demonstrated shorter examination durations (Group S: 447.60s vs. Group T: 584.50s; p = 0.007). Specifically, Group S significantly outperformed Group T in 7 of the 11 anatomical landmarks (p < 0.05), primarily in the technically demanding transgastric and advanced mid-esophageal views. Regarding dimensions, Group S scored higher in angle (p = 0.031), clarity (p < 0.001), and structures (p < 0.001). In summary, this trial provides robust evidence that 3D simulation training significantly improves live TEE performance among novice operators compared to conventional training, contributing valuable insights toward optimizing echocardiography education and enhancing perioperative safety in pediatric cardiac care. Chinese Clinical Trial Registry (ChiCTR.org.cn). Registration number: ChiCTR2500105325. Date of the study first posted on ChiCTR.org.cn: 2025-07-02. Date of the enrolment of the first research participant: 202507-03.