235 - Rapid Acquisition of Neonatal Echocardiography Skills Using a Neonatal Echocardiographic Simulator: Will it Affect Transition to Neonatal Echocardiography?

Poster Number: 235
Publication Number: 235.33

Jessica Yom, University of Southern California/Keck School of Medicine of USC, Los Angeles, CA, United States; mohammad Amin. Adie, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Bijan Siassi and Chahrezad S. Siassi, LAC+USC Medical Center, LOS ANGELES, CA, United States; Mahmood ebrahimi, LAC+USC Medical Center, Encin, CA, United States; Rangasamy Ramanathan, Keck School of Medicine of USC, Los Angeles, CA, United States

Background: Learning neonatal echocardiography (ECHO) can be challenging. Trainees are traditionally taught to place the transducer on the patient’s echocardiographic window and follow images on the monitor. Image acquisition in this manner is inefficient.

Objective: Our aim is to train neonatal providers to obtain the necessary windows on a simulator with appropriate angulation, rotation, and tilt of the transducer so that ECHO views can be easily correlated with hand positioning and appropriate surveillance of the monitor.

Design/Methods: In this prospective observational study, participants in the simulator course were evaluated prior to and after hands-on training. This occurred over the course of 3 days and totaled 5 hours. 18 cuts for both pre and post-tests were scored using an automatic machine scoring system which assigned scores from 0 to 3 based on image coordinates with 3 being the highest score. The same images were then scored visually by consensus of a pediatric cardiologist and a hemodynamics focused neonatologist with scores from 0 to 3.
3 months after the course, 6 participants received a 1.5 hour refresher course prior to performing a bedside ECHO on a 2-day-old term neonate. In this group, 17 cuts were performed and assigned visual scores from 0 to 3.

Results: 31 neonatal providers (20 fellows, 10 attendings, and 1 physician assistant) participated in the course. A total of 54 points could be given for each of the automatic and visual scores. The mean scores before and after hands-on training increased from 24.2 ± 9.7 to 43.3 ± 3.3 for machine scoring (average gain = 19.1, p ≤ 0.001), while for visual scoring, mean scores increased from 18.8 ± 12.9 to 47.2 ± 4.7 (average gain = 28.4, p ≤ 0.001). The group that scored below the median on the pre-test machine scoring gained a mean of 25.8 points, while the group that scored above the median gained a mean of 9.9 points. The group that scored below the median on the pre-test visual scoring gained a mean of 35.8 points, while the group that scored above the median gained a mean of 19.3 points.
There was no difference in visual scores of simulator post-test versus bedside ECHO in the 6 post course participants (using Wilcoxon signed-rank test, all critical values ≥ 0 at α = 0.05).

Conclusion(s): Rapid acquisition of neonatal ECHO skills using a simulator is highly effective in acquiring ECHO skills. The skills of all the participants increased significantly; however, the ones with lower initial scores had the greatest improvement. Improvement in scores post simulator training also led to improved bedside ECHO skills.