Simulator training for transesophageal echocardiography.

In Reply: We would like to thank Drs. Fletcher and Sharma for their interest in our study.1 We are aware of their study that was published in June 2013 to assess the benefits of transesophageal echocardiography (TEE) simulation training in cognitive skill acquisition among anesthesiology residents in the United Kingdom.2 However, in April 2013, at the time of the initial submission of our article, the above study was not available. We apologize for the omission. Image acquisition is indeed a technical skill that evolves on a continuum starting with knowledge in basic physics, probe manipulation, and anatomic/spatial orientation. This progresses on to supervised hands-on training on actual patients. Advanced levels of expertise are then achieved by on the job experience, which may not reach a plateau for years. Undoubtedly, there is no substitute for an actual patient and only parts of the skill sets can be taught in a classroom. However, different methods of classroom teaching may affect the acquisition of technical skills. To maximize image acquisition skills in the privileged operating room environment, it becomes necessary to prepare the trainees by relying on didactic and Web-based training using anatomic heart models and video clips, similar to what was used in our control group. A majority of training programs do not have access to mannequin-based TEE simulation. Our goal was to compare this current reality, the traditional method of teaching, with mannequin-based teaching on practical image acquisition skills. We also appreciate the critique of our image scoring system. We agree that in the current literature, there are no validated scoring systems to assess image quality. There has been only one other study published simultaneously with Simulator Training for Transesophageal Echocardiography