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Background:
Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies.
Objectives:
This large multicenter randomized, parallel-group, unblinded, study will assess the impact of simulation-based versus traditional teaching on TEE knowledge and performance for medical fellows in cardiology.
Eligibility:
Design:
Background:
Recent studies suggested that simulation-based transesophageal echocardiography (TEE) teaching is displaying significant benefit over conventional methods based on academic lectures in terms of improving TEE skills and accelerating learning. However, evidence on the impact of simulation-based training in TEE is scarce. Indeed, all the studies assessing the effectiveness of TEE simulation-based teaching were non-randomized or randomized with limited single-center sample size
Objectives:
This large multicenter randomized, parallel-group, unblinded, study will assess the impact of simulation-based versus traditional teaching on TEE knowledge and performance for medical fellows in cardiology.
Methods:
The SIMULATOR study will be a multicenter, parallel-group, unblinded, randomized study including all consecutive fellows in cardiology of all training level (year 1 to 4) who will be randomized (1:1) to either a TEE simulation group or to a traditional group through 42 French centers. Fellows who had already performed a TEE alone, with or without supervision, will be excluded. All the fellows will give their consent to participate to the study and agree to provide their honest answers and thoughts about their skills and confidence about their practices.
Each participant will complete two different tests during the study: 1) a pre-training test before starting the educational program; and 2) a final test performed 3 months after the end of the educational program. Each of these tests will include a theoretical test and a practical test on a TEE simulator.
Endpoints:
The coprimary endpoints of the study will be the difference in the final theoretical and practical tests score after the training between the two groups. The secondary endpoints will be the difference in change in theoretical and practical tests scores from pre- to final training. In addition, we will assess the global score defined as the sum of the theoretical test and the practical test scores, the TEE exam duration, and the self-assessment of proficiency of the fellows.
Sample size calculation:
Details regarding the determination of the sample size have been reported previously. Based on recent available literature and considering normalized 0-100 points score ranges for the two co-primary outcomes, a minimally important difference of 5 points (standard deviation 7 points) will be considered for the difference in change from pre- to post-training scores in theoretical and practical tests between the two randomized groups. Under these assumptions, a sample size of 50 subjects per group (for an overall population of 100 participants) will provide 90% power to detect a statistically significant difference between the two groups at a significance level of alpha = 2.5%, applying a Bonferroni correction to account for multiple testing of the two co-primary outcomes.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TEE simulation-based training group | Experimental | All participants of the TEE simulation group received: 1) a traditional didactic training using e-learning with a national free-access online course; and 2) two teaching sessions using a TEE simulator for 2 hours per session. |
|
| TEE traditional group | No Intervention | All participants of the TEE traditional group received only a traditional didactic training using e-learning with a national free-access online course (same e-learning program allocated for the TEE simulation group). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TEE simulation-based training | Diagnostic Test | All participants of the TEE simulation-based training group received:
|
| Measure | Description | Time Frame |
|---|---|---|
| Difference in the final theoretical test score after the training between the two groups. | Each resident completed two sets of tests during the study: 1) a pre-training test before starting the training program to assess the baseline TEE level of each resident; and 2) a final test performed 3 months after the end of the training program. The theoretical test included 20 video-based questions online that evaluate recognition of standard TEE views, normal anatomy and some pathological cases as already described. The fellows were given 90 seconds for each question to choose the best answer out of a multiple-choice of 5 propositions. Each question was scored on 5 points (5 points if all the propositions were correct and 0 point if at least one error was observed), for a total of 100 points per test. | 3 months after completion of the training program |
| Difference in the final practical test score after the training between the two groups. | Each resident completed two sets of tests during the study: 1) a pre-training test before starting the training program to assess the baseline TEE level of each resident; and 2) a final test performed 3 months after the end of the training program. Each of these tests included a practical test on a TEE simulator . Immediately after each theoretical test (pre-training and final tests), all fellows underwent the practical test. The fellows were asked to show ten basic views on a TEE simulator, as previously described, and were given a maximum of one minute for each view. The practical test was stopped after a maximum of 10 minutes. Each view was scored on 10 points using the modified Ferrero grading scale, for a total of 100 points per practical test. | 3 months after completion of the training program |
| Measure | Description | Time Frame |
|---|---|---|
| Difference in change in theoretical test scores from pre- to final training | Difference in change in theoretical test scores from pre- to final training. The theoretical test included 20 video-based questions online that evaluate recognition of standard TEE views, normal anatomy and some pathological cases as already described. The fellows were given 90 seconds for each question to choose the best answer out of a multiple-choice of 5 propositions. Each question was scored on 5 points (5 points if all the propositions were correct and 0 point if at least one error was observed), for a total of 100 points per test. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Augustin Coisne | Lille | Hauts-de-France | 59000 | France |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37070491 | Derived | Pezel T, Dreyfus J, Mouhat B, Thebaut C, Audureau E, Bernard A, Badie YL, Bohbot Y, Fard D, Nguyen LS, Monteil C, Biere L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Bazire B, Fauvel C, Cautela J, Cambet T, Le Tourneau T, Donal E, Lafitte S, Magne J, Mansencal N, Coisne A; SIMULATOR investigators. Effectiveness of Simulation-Based Training on Transesophageal Echocardiography Learning: The SIMULATOR Randomized Clinical Trial. JAMA Cardiol. 2023 Mar 1;8(3):248-256. doi: 10.1001/jamacardio.2022.5016. |
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| ID | Term |
|---|---|
| D001519 | Behavior |
| D002318 | Cardiovascular Diseases |
| D006349 | Heart Valve Diseases |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
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| 3 months after completion of the training program |
| Difference in change in practical test scores from pre- to final training | Difference in change in practical test scores from pre- to final training. To standardize the training and the practical test on TEE simulator, all trainers followed a dedicated webinar of 30 minutes presenting the entire content of each session and the final test. Immediately after each theoretical test (pre-training and final tests), all fellows underwent the practical test. The fellows were asked to show ten basic views on a TEE simulator, as previously described, and were given a maximum of one minute for each view. The teacher timed the duration between the TEE probe introduction and obtention by the trainee of all ten views required. The practical test was stopped after a maximum of 10 minutes. Each view was scored on 10 points using the modified Ferrero grading scale, for a total of 100 points per practical test. | 3 months after completion of the training program |
| Difference in the final global score after the training between the two groups. | The global score was defined as the sum of the theoretical test and the practical test scores, the TEE exam duration, and the self-assessment of proficiency of the fellows. | 3 months after completion of the training program |
| Difference in TEE exam duration after the training between the two groups. | The trainer measured the TEE exam duration during the practical test using simulator. | 3 months after completion of the training program |
| Self-assessment of proficiency of the fellows | The self-assessment of proficiency of all the fellows was assessed with four standardised questions asked before and immediately after the training program:
In the simulation group, satisfaction after the simulation training was assessed by an anonymous questionnaire including six statements on different aspects of the training, as already published. | 3 months after completion of the training program |