Transesophageal Echocardiography in the Emergency Department: Development of a Validated Checklist for Training

Area of Science:

• Emergency Medicine
• Medical Simulation
• Cardiovascular Imaging

Background:

• Transesophageal echocardiography (TEE) can enhance cardiac arrest management.
• Emergency physicians (EPs) often lack sufficient practice for TEE proficiency.
• Simulation-based mastery learning (SBML) is effective for rare procedural training.

Purpose of the Study:

• To develop and validate a checklist for point-of-care (POC) TEE.
• To create a tool for procedural skills training in the emergency department.
• To improve EP competence in performing TEE for critical care.

Main Methods:

• A modified Delphi method was used to develop a 43-item checklist.
• The checklist was piloted within an SBML training program.
• Pre- and post-training confidence surveys assessed TEE skills.

Main Results:

• The final checklist had 7 sections with 43 items; 4 critical actions were identified.
• Near-perfect inter-rater reliability (Gwet's AC1 = 0.99) was achieved.
• All EPs met the minimum passing score (97.0%), and median confidence significantly improved (23 to 80).

Conclusions:

• A novel POC TEE SBML checklist was developed and validated.
• SBML training using the checklist equalized TEE confidence between experienced and novice EPs.
• The checklist serves as an effective tool for TEE procedural skills training.