Abstract
INTRODUCTION: Simulation training is an essential component of transesophageal echocardiography (TEE) education, particularly for novice learners. However, a critical limitation of current mannequin-based TEE simulators is their inability to emphasize the spatial relationship between the probe's position and the resulting ultrasound images. This limitation, referred to as the "black box" effect, can make it difficult to understand how probe manipulation affects image acquisition, including probe orientation, beam trajectory, and the intersection of the ultrasound beam with cardiac structures. As a result, educators may struggle to convey these critical spatial concepts using existing simulation tools.
METHODS: A set of 3D-printed TEE training models was first developed to simulate the steps involved in TEE scanning procedures. They also provide beginners with an intuitive visual representation and a mental rotation process, enhancing their spatial awareness. Then, a pre-post pilot study was conducted among third-year clinical anesthesia (CA-3) residents. Three aspects of teaching quality were evaluated before and after the simulation training with 3D-printed models: TEE view-related knowledge, image quality on a mannequin-based simulator, and learners' confidence.
RESULTS: A total of 10 residents were included in this study. The knowledge assessment score significantly improved after the session (56.0 ± 22.60 vs 93.5 ± 6.26, P < .001). Image quality scores of 8 out of 12 required TEE views were also improved. Using the models positively influenced trainees' confidence in understanding and memorizing basic TEE principles: omniplane angles and corresponding TEE views [1.00 (0.75, 1.25) vs 0.00 (-1.00, 1.00), P < .01]; orientation interpretation [1.00 (1.00, 2.00) vs 0.00 (-1.00, 1.00), P < .01].
CONCLUSIONS: A simulation training session with a set of 3D-printed TEE teaching models significantly improved TEE view-related knowledge, image quality, and learners' confidence among CA-3 residents.