Low Frequency, High Complexity: Assessing Skill Decay in Transesophageal Echocardiography Post-Simulation Training

Introduction: Resuscitative transesophageal echo (rTEE) is a promising adjunct to cardiac arrest resuscitation. However, it is a high-acuity diagnostic tool that is rarely used in this setting and its safety establishment is limited because of low occurrence. High-acuity, low occurrence skills such as rTEE during cardiac arrest inevitably decay. In this study we examined the content and percentage of rTEE skill decay following simulation-based education (SBE). Methods: Resuscitative TEE-naïve emergency physicians (EP) were trained using a combination of clinical exposure, web-based didactics, and monthly hands-on sessions with a high-fidelity rTEE simulator for four months. The COVID-19 pandemic created a natural wash-out phase where EPs did not perform any actual or SBE for six months after initial training. Unadvertised assessment of rTEE skill occurred at month 6 after rTEE training to test skill decay and at month 7 to determine the effect of spaced repetition. One year later, the EPs completed a questionnaire assessing rTEE comfort. Statistical measures were used to measure skill decay. Results: Seven EPs were individually evaluated in four domains: name recall; probe manipulation (rotation); probe manipulation (omniplane); and image acquisition adequacy. At the end of training, all participants reached a full proficiency score of 32. At month 6, the mean score was 19 of 32 (SD ±7), reflecting a 41% decay (95% confidence interval (CI) −54%, −27%; P < .001) for eight standard rTEE views. Following spaced repetition at month 7, the median score improved to 26 (IQR 23–30), representing a 19% decay (95% CI −35%, −4%; P < .02). For the three guideline-recommended views, the overall decay percentage was 26% (95% CI −36%, −16%; P < .001), although image acquisition skills did not show significant decay. Spaced repetition resulted in a 23% increase in mean scores (95% CI 9–37%), and the average time to obtain all eight rTEE views decreased from 7.3 minutes at month 6 to 5.7 minutes at month 7. Conclusion: After focused, proficiency-based SBE in rTEE, hands-on image acquisition skills showed the least decay compared to name recall and probe manipulation. Spaced repetition mitigated decay over one month, although not back to baseline.

Authors

Institutions

Publication Details

Journal
UNC Libraries
Published
2026-09-12
DOI
https://doi.org/10.17615/v2dn-1338
Primary Topic
Cardiac Arrest and Resuscitation
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
article

Low Frequency, High Complexity: Assessing Skill Decay in Transesophageal Echocardiography Post-Simulation Training

Emily Terian, Mansi Agarwal, Collyn T. Murray, Erica Blustein et al.
UNC Libraries
Cardiac Arrest and Resuscitation
article

Low Frequency, High Complexity: Assessing Skill Decay in Transesophageal Echocardiography Post-Simulation Training

Emily Terian, Mansi Agarwal, Collyn T. Murray, Erica Blustein, Wendy Huang, Enyo Ablordeppey, Ernesto Romo, Laura Wallace, Alexander Croft, Daniel Theodoro
article en

Abstract

Introduction: Resuscitative transesophageal echo (rTEE) is a promising adjunct to cardiac arrest resuscitation. However, it is a high-acuity diagnostic tool that is rarely used in this setting and its safety establishment is limited because of low occurrence. High-acuity, low occurrence skills such as rTEE during cardiac arrest inevitably decay. In this study we examined the content and percentage of rTEE skill decay following simulation-based education (SBE). Methods: Resuscitative TEE-naïve emergency physicians (EP) were trained using a combination of clinical exposure, web-based didactics, and monthly hands-on sessions with a high-fidelity rTEE simulator for four months. The COVID-19 pandemic created a natural wash-out phase where EPs did not perform any actual or SBE for six months after initial training. Unadvertised assessment of rTEE skill occurred at month 6 after rTEE training to test skill decay and at month 7 to determine the effect of spaced repetition. One year later, the EPs completed a questionnaire assessing rTEE comfort. Statistical measures were used to measure skill decay. Results: Seven EPs were individually evaluated in four domains: name recall; probe manipulation (rotation); probe manipulation (omniplane); and image acquisition adequacy. At the end of training, all participants reached a full proficiency score of 32. At month 6, the mean score was 19 of 32 (SD ±7), reflecting a 41% decay (95% confidence interval (CI) −54%, −27%; P < .001) for eight standard rTEE views. Following spaced repetition at month 7, the median score improved to 26 (IQR 23–30), representing a 19% decay (95% CI −35%, −4%; P < .02). For the three guideline-recommended views, the overall decay percentage was 26% (95% CI −36%, −16%; P < .001), although image acquisition skills did not show significant decay. Spaced repetition resulted in a 23% increase in mean scores (95% CI 9–37%), and the average time to obtain all eight rTEE views decreased from 7.3 minutes at month 6 to 5.7 minutes at month 7. Conclusion: After focused, proficiency-based SBE in rTEE, hands-on image acquisition skills showed the least decay compared to name recall and probe manipulation. Spaced repetition mitigated decay over one month, although not back to baseline.

UNC Libraries
University of North Carolina at Chapel Hill (US)
Schmidt Futures, National Science Foundation, U.S. Department of Veterans Affairs, Bill and Melinda Gates Foundation, Simons Foundation, Gordon and Betty Moore Foundation, Alzheimer's Association, American Epilepsy Society, American Society of Nephrology, Charles H. Hood Foundation, Pharmaceutical Research and Manufacturers of America Foundation, Alexander von Humboldt-Stiftung, Takeda Science Foundation, University of Pittsburgh, Kræftens Bekæmpelse, Japan Agency for Medical Research and Development, Wellcome Trust, Agentschap Innoveren en Ondernemen, Royal University Hospital Foundation, Charles E. Kaufman Foundation, Australian Government, Fundación Carmen y Severo Ochoa, Otsuka America, BAND foundation, Bakewell Foundation, Japan Health Promotion and Fitness Foundation, Multiple Sclerosis Society of Canada, National Institute for Health and Care Research, Leverhulme Trust, Royal Academy of Engineering, Royal Society, Marie Curie, Pathological Society of Great Britain and Ireland, Royal Commission for the Exhibition of 1851, European Commission, University of Sussex, Ministry of Health, New Zealand, New Zealand Equine Research Foundation, Deutsche Forschungsgemeinschaft, Agence Nationale de la Recherche, Fundação de Amparo à Pesquisa do Estado de São Paulo, National Natural Science Foundation of China, Grantová Agentura České Republiky, Forskningsrådet för Arbetsliv och Socialvetenskap, Bundesministerium für Bildung und Forschung, Chinese Academy of Sciences, Generalitat de Catalunya, Fondation pour la Recherche Médicale, Ministero della Salute, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, Nederlands Instituut voor Onderzoek van de Gezondheidszorg, Ministry of Business, Innovation and Employment, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Natural Science Foundation of Hebei Province, Kato Memorial Bioscience Foundation, Knut och Alice Wallenbergs Stiftelse, Vetenskapsrådet, Hrvatska Zaklada za Znanost, Ministère des Affaires Sociales et de la Santé, Astellas Pharma, Scion, National University of Defense Technology, Tokyo Medical and Dental University, ITEA3, Beijing Municipal Administration of Hospitals, Kieikai Research Foundation, Fondation Institut de Cardiologie de Montréal, Alzheimer’s Society, National Science and Technology Major Project, Wuhan Union Hospital, William Demant Fonden, Australian Youth and Health Foundation, National Institutes of Health, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Agricultural Research Service, Chicago Center for Diabetes Translation Research, School of Medicine, University of Virginia, Social Sciences and Humanities Research Council of Canada, Fonds de Recherche du Québec - Santé, Medical Research Council, Engineering and Physical Sciences Research Council, Australian Research Council, National Health and Medical Research Council, Korea National Institute of Health, European Regional Development Fund, National Key Research and Development Program of China, Tongji Medical College, Huazhong University of Science and Technology, National Science Fund for Distinguished Young Scholars, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, U.S. National Library of Medicine, NIH Clinical Center, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Research Institute of Science and Technology for Society, Lawrence Berkeley National Laboratory, HORIZON EUROPE Marie Sklodowska-Curie Actions, HORIZON EUROPE European Research Council, Institute for Collaborative Biotechnologies, National Science Foundation Graduate Research Fellowship Program, Janssen Australia, Instituto de Salud Global de Barcelona
Quality Education
Openalex Percentile: Top 7%
Cardiac Arrest and Resuscitation
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.