Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies.

To assess the impact of simulation-based training on TEE learning using TEE simulators compared to traditional teaching in residents in cardiology.

French prospective randomized multicenter study involving 43 centers. All cardiology residents naive from TEE were included. Randomization with stratification by center allocated residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator. All residents underwent both a theoretical test (0–100 points) and a practical test on a TEE simulator (0–100 points) before and three months after the training. The primary outcome was to compare the scores in the final theoretical and practical tests between the two groups, 3months after the end of the training.

Among the 208 residents in cardiology (age 28±2years; 51% male), 104 were assigned to the simulation group and 104 to the control group. At baseline, there was no significant difference in theoretical and practical scores between the two groups (both P>0.05). Residents in the simulation group significantly improved their theoretical and practical scores from baseline to 3months after completion of TEE simulator training (P<0.001). The improvement in the simulation group was significantly greater than in the control group (P<0.001) (Fig. 1).

The SIMULATOR study is the largest multicentre randomized study to show the benefit from the simulation-based TEE teaching on the level of skills and practices of residents in cardiology. These findings suggest that such an educational program could be proposed in first line for TEE teaching.