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Am J Perinatol
DOI: 10.1055/a-1845-2083
Original Article

Effectiveness of Simulation Training in Acquiring Echocardiography Skills among Neonatology Care Providers

Shahab Noori 
1   Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Mahmood Ebrahimi
2   Division of Neonatology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Merujan Uzunyan
3   Division of Cardiology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Dariush Bazyani
1   Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Aryan J. Noori
1   Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
,
Bijan Siassi
2   Division of Neonatology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
,
Rangasamy Ramanathan 
2   Division of Neonatology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
› Author Affiliations Funding None.
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Abstract

Objective The objective of this study was to test the hypothesis that simulation training improves echocardiography skills.

Study Design In this prospective study, 43 participants (16 neonatologists, 26 neonatology fellows, and 1 nurse practitioner) were tested on the simulator after 4 hours of didactic sessions on topographical cardiac anatomy and standard echocardiographic views. Participants were given 20 minutes to obtain and save the standard views. After the simulation hands-on training for 8 hours over 3 days, they were tested again. Each image was scored from 0 to 3 based on the image quality. Pre- and postsimulator training data were compared using both automated and visual scoring methods.

Results After the hands-on simulator training, the automated median (interquartile) score for the quality of acquired images increased from 36 (22, 43) to 55 (48, 58), p < 0.0001. The increase was similar using visual scoring. The number of views with acceptable or good image quality (scores of 2 or 3) increased from 11 (6, 16) to 20 (17, 21), p < 0.0001. The neonatology fellows and faculty, as well as those with or without prior echocardiography experience, demonstrated significant improvement.

Conclusions Echocardiography simulation is an effective tool in improving echocardiography skills among neonatology care providers.

Key Points

  • Simulation is effective in acquiring echocardiography skills among neonatology care providers.

  • Simulation improves image acquisition in those with and without prior echocardiography experience.

  • Effectiveness of simulation in retaining the acquired echocardiography skill should be investigated.

Keywords

echocardiography - neonate - simulation training - Doppler


Publication History

Received: 26 October 2021

Accepted: 28 April 2022

Accepted Manuscript online:
06 May 2022

Article published online:
06 June 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Nguyen J, Amirnovin R, Ramanathan R, Noori S. The state of point-of-care ultrasonography use and training in neonatal-perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol 2016; 36 (11) 972-976
    CrossrefPubMedGoogle Scholar
  • 2 Schachinger S, Stansfield RB, Ensing G, Schumacher R. The prevalence of and attitudes toward neonatal functional echocardiography use and training in the United States: a survey of neonatal intensive care unit medical directors. J Neonatal Perinatal Med 2014; 7 (02) 125-130
    CrossrefPubMedGoogle Scholar
  • 3 Mertens L, Seri I, Marek J. et al; Writing Group of the American Society of Echocardiography, European Association of Echocardiography, Association for European Pediatric Cardiologists. Targeted Neonatal Echocardiography in the Neonatal Intensive Care Unit: practice guidelines and recommendations for training. Writing Group of the American Society of Echocardiography (ASE) in collaboration with the European Association of Echocardiography (EAE) and the Association for European Pediatric Cardiologists (AEPC). J Am Soc Echocardiogr 2011; 24 (10) 1057-1078
    CrossrefPubMedGoogle Scholar
  • 4 de Boode WP, Singh Y, Gupta S. et al. Recommendations for neonatologist performed echocardiography in Europe: consensus statement endorsed by European Society for Paediatric Research (ESPR) and European Society for Neonatology (ESN). Pediatr Res 2016; 80 (04) 465-471
    CrossrefPubMedGoogle Scholar
  • 5 Singh Y, Gupta S, Groves AM. et al. Expert consensus statement 'neonatologist-performed echocardiography (NoPE)'-training and accreditation in UK. Eur J Pediatr 2016; 175 (02) 281-287
    CrossrefPubMedGoogle Scholar
  • 6 Kluckow M. Use of ultrasound in the haemodynamic assessment of the sick neonate. Arch Dis Child Fetal Neonatal Ed 2014; 99 (04) F332-F337
    CrossrefPubMedGoogle Scholar
  • 7 Kluckow M, Evans N. Point of care ultrasound in the NICU-training, accreditation and ownership. Eur J Pediatr 2016; 175 (02) 289-290
    CrossrefPubMedGoogle Scholar
  • 8 Neelankavil J, Howard-Quijano K, Hsieh TC. et al. Transthoracic echocardiography simulation is an efficient method to train anesthesiologists in basic transthoracic echocardiography skills. Anesth Analg 2012; 115 (05) 1042-1051
    CrossrefPubMedGoogle Scholar
  • 9 Edrich T, Seethala RR, Olenchock BA. et al. Providing initial transthoracic echocardiography training for anesthesiologists: simulator training is not inferior to live training. J Cardiothorac Vasc Anesth 2014; 28 (01) 49-53
    CrossrefPubMedGoogle Scholar
  • 10 Rambarat CA, Merritt JM, Norton HF, Black E, Winchester DE. Using simulation to teach echocardiography: a systematic review. Simul Healthc 2018; 13 (06) 413-419
    CrossrefPubMedGoogle Scholar
  • 11 Siassi B, Ebrahimi M, Noori S, Sheng S, Ghosh D, Seri I. Virtual neonatal echocardiographic training system (VNETS): an echocardiographic simulator for training basic transthoracic echocardiography skills in neonates and infants. IEEE J Transl Eng Health Med 2018; 6: 4700113
    CrossrefPubMedGoogle Scholar
  • 12 Weidenbach M, Paech C. Simulation in neonatal echocardiography. Clin Perinatol 2020; 47 (03) 487-498
    CrossrefPubMedGoogle Scholar
  • 13 Hébert A, Lavoie PM, Giesinger RE. et al. Evolution of training guidelines for echocardiography performed by the neonatologist: toward hemodynamic consultation. J Am Soc Echocardiogr 2019; 32 (06) 785-790
    CrossrefPubMedGoogle Scholar
  • 14 Wagner R, Razek V, Gräfe F. et al. Effectiveness of simulator-based echocardiography training of noncardiologists in congenital heart diseases. Echocardiography 2013; 30 (06) 693-698
    CrossrefPubMedGoogle Scholar
  • 15 Dayton JD, Groves AM, Glickstein JS, Flynn PA. Effectiveness of echocardiography simulation training for paediatric cardiology fellows in CHD. Cardiol Young 2018; 28 (04) 611-615
    CrossrefPubMedGoogle Scholar
  • 16 Noori S, Ebrahimi M, Luo H, Seri I, Siassi B. Development and validation of an automated assessment tool of echocardiography skills acquired on a neonatal simulator. Echocardiography 2021; 38 (02) 217-221
    CrossrefPubMedGoogle Scholar