Effectiveness of simulation-based echocardiography training for neonatology residents: A randomized controlled trial

Introduction

Transthoracic echocardiography (TTE) is a valuable tool in neonatal intensive care units (NICUs) and allows rapid hemodynamic evaluation. Increasingly, fast TTE is performed not only by cardiologists but also by neonatologists, to support bedside clinical decision-making. These changes imply a new need for training, which is not easy to achieve due to the instability of critically ill neonatal patients, who do not always tolerate long-lasting TTE, necessary for good-quality teaching. Also, simulation-based training using high-technology neonatal echocardiography simulators might be a good approach for residents training.

Objective

This study aimed to demonstrate the benefits of simulation-based training for neonatal echocardiography learning.

Methods

This study was a multicentered randomized controlled trial, involving residents from 3 French NICUs, comparing a control group with theorical and bedside training, with a simulation group with theorical training, a 3-hour simulation session and bedside training. An evaluation using the EchoComNeo simulator was conducted at 3 and 6 months from initial training based on two scoring methods by two evaluators: a reference score for quality of TTE sections, and a custom-made score to assess the recognition of the anatomical structures. TTE duration and resident's satisfaction was also assessed.

Results

From May 2021 to May 2023, 52 residents were randomized, 17 in the control group and 35 in the simulation group. At 3 months, residents in the simulation group exhibited a higher mean score for both the reference score (11.5 ± 2.3 points versus 7.4 ± 3.4 points, P < 0.001) and the custom-made score (25.8 ± 5.3 points versus 16.9 ± 7.8 points, P < 0.001) than residents in the control group. At 6 months, the difference between groups remained significant. TTE duration did not significantly differ between groups. The custom-made score showed good agreement with the reference score (Fig. 1).

Conclusion

Simulation-based training seems to be a valuable approach for echocardiography training of NICU residents and should be developed to more extensive training courses.