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

Area of Science:

• Emergency Medicine
• Cardiology
• Medical Simulation

Background:

• Resuscitative transesophageal echo (rTEE) is a valuable tool in cardiac arrest resuscitation.
• Its application is limited due to its high-acuity nature and infrequent use.
• Skills in high-acuity, low-occurrence procedures like rTEE are prone to decay.

Purpose of the Study:

• To examine the skill decay of resuscitative transesophageal echo (rTEE) after simulation-based education (SBE).
• To assess the impact of spaced repetition on mitigating rTEE skill decay.

Main Methods:

• Emergency physicians (EPs) underwent four months of rTEE training (clinical exposure, didactics, simulation).
• A six-month washout period occurred due to the COVID-19 pandemic.
• Skills were assessed at 6 months (decay) and 7 months (spaced repetition effect); comfort was assessed one year later.

Main Results:

• Initial proficiency score was 32/32; at 6 months, the mean score dropped to 19/32 (41% decay).
• Spaced repetition at 7 months improved the median score to 26/32 (19% decay).
• Image acquisition skills decayed less than name recall and probe manipulation; spaced repetition improved mean scores by 23% and reduced image acquisition time.

Conclusions:

• Hands-on image acquisition skills in rTEE demonstrate the least decay after proficiency-based SBE.
• Spaced repetition effectively mitigates skill decay in rTEE over a short period.
• While spaced repetition improves performance, skills may not return to baseline levels without continued practice.