Design of a workshop for focused rescue transesophageal echocardiography in nurse anesthesia: a small-scale mixed methods study

Background: Use of transesophageal echocardiography (TEE) by certified registered nurse anesthetists to assess hemodynamic instability during noncardiac surgery is an emerging trend which has created a need for additional training. Unfortunately, the ideal TEE curriculum has yet to be defined to teach nurse anesthesia providers the cognitive and motor skills that will allow them to efficiently acquire and accurately interpret images for this purpose. The primary aim of this prospective, observational study was to evaluate the feasibility and efficacy of a 2-day workshop to teach this skill set to nurse anesthesia students with no prior TEE experience. Methods The workshop was based on a focused rescue TEE protocol employing a limited number of views and using a goal-directed, qualitative assessment of critical physiologic parameters. A cohort consisting of 14 second-year nurse anesthesia students was evaluated following this training by quantitative simulator-based testing during hypothetical clinical scenarios. Thereafter, the workshop was assessed by online questionnaire, and quantitative analysis was performed on the results of this qualitative survey. Results Participants acquired appropriate TEE views associated with clinical scenarios 99% of the time and correctly interpreted the pathology in those views 93% of the time. In addition, nurse anesthesia trainees uniformly perceived significant educational value in this workshop and were likely to incorporate TEE in their future clinical practice. Conclusions A 2-day workshop to teach focused rescue TEE to nurse anesthesia trainees directed by a streamlined protocol based on a limited number of views is feasible and provides useful beginning competency in this diagnostic modality.