The ideal sequence of didactic lectures and simulation in teaching transoesophageal echocardiography (TOE) to anaesthesiologists

Introduction Performing Basic TOE needs psychomotor skills, 3D knowledge of cardiac anatomy and image interpretation. It requires expensive simulation facilities, skilled manpower and time to teach. Hence, it is important to teach TOE in the most time and resource efficient manner. Conventionally, TOE is taught using Lecture followed by Simulation1. Differences occur among learners when this sequencing of instructional components is altered2 .We investigated, the ideal sequence of lectures and simulation in teaching basic TOE. Methods Forty-three non-cardiac anaesthesiologists, at trainee or specialist levels with no prior knowledge of TOE, underwent a TOE training program conducted at a single university hospital.They were randomized into 2 groups. Both groups were exposed to a 1-hour didactic lecture and hands on simulation, in which they were taught about indication, contraindication, patient safety, basic probe handling and obtaining 11 basic views. The first group (LS) attended the lecture followed by a simulation session. The second group (SL) attended the simulation followed by the lecture. A HeartWorks® (MedaPhor Ltd, Cardiff, UK) simulator was used for training. All participants took pre- and post-course multiple -choice question (MCQ) and post-course practical skill tests, which were repeated 1 month after the course. Thirty MCQs assessed safety, probe manipulation, and basic views. The practical test assessed the skill of acquiring 11 basic views on the simulator. Results Table 1 shows the baseline characteristics of both groups. Group SL, which underwent simulation followed by lecture, consistently scored better in both post-course MCQ and skill test. This group also demonstrated significantly better retention of knowledge and skills than the other (Table 2). Discussion Similar results have been seen in surgical simulation studies.Recall of prior factual knowledge and psychomotor skills happens during simulation session.The lecture, which follows, helps to activate, synthesise and reinforce this learning. Better consolidation of knowledge and skills helps them perform better 1 month later compared to LS group. Our study suggests that, for long-term retention of both knowledge and skills, it is preferable to teach practical skills followed by theoretical knowledge to an intermediate level group of anesthesiologists who are complete novices to TOE.