{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:17:24Z","timestamp":1754162244980,"version":"3.41.2"},"reference-count":0,"publisher":"California Digital Library (CDL)","issue":"4","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Western Journal of Emergency Medicine"],"abstract":"<p>Introduction: Resuscitative transesophageal echo (rTEE) is a promising adjunct to cardiac arrest resuscitation. However, it is a high-acuity diagnostic tool that is rarely used in this setting and its safety establishment is limited because of low occurrence. High-acuity, low occurrence skills such as rTEE during cardiac arrest inevitably decay. In this study we examined the content and percentage of rTEE skill decay following simulation-based education (SBE). Methods: Resuscitative TEE-na\u00efve emergency physicians (EP) were trained using a combination of clinical exposure, web-based didactics, and monthly hands-on sessions with a high-fidelity rTEE simulator for four months. The COVID-19 pandemic created a natural wash-out phase where EPs did not perform any actual or SBE for six months after initial training. Unadvertised assessment of rTEE skill occurred at month 6 after rTEE training to test skill decay and at month 7 to determine the effect of spaced repetition. One year later, the EPs completed a questionnaire assessing rTEE comfort. Statistical measures were used to measure skill decay. Results: Seven EPs were individually evaluated in four domains: name recall; probe manipulation (rotation); probe manipulation (omniplane); and image acquisition adequacy. At the end of training, all participants reached a full proficiency score of 32. At month 6, the mean score was 19 of 32 (SD \u00b17), reflecting a 41% decay (95% confidence interval (CI) -54%, -27%; P &amp;lt; .001) for eight standard rTEE views. Following spaced repetition at month 7, the median score improved to 26 (IQR 23-30), representing a 19% decay (95% CI -35%, -4%; P &amp;lt; .02). For the three guideline-recommended views, the overall decay percentage was 26% (95% CI -36%, -16%; P &amp;lt; .001), although image acquisition skills did not show significant decay. Spaced repetition resulted in a 23% increase in mean scores (95% CI 9-37%), and the average time to obtain all eight rTEE views decreased from 7.3 minutes at month 6 to 5.7 minutes at month 7. Conclusion: After focused, proficiency-based SBE in rTEE, hands-on image acquisition skills showed the least decay compared to name recall and probe manipulation. Spaced repetition mitigated decay over one month, although not back to baseline.<\/p>","DOI":"10.5811\/westjem.35857","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T03:32:51Z","timestamp":1750908771000},"source":"Crossref","is-referenced-by-count":0,"title":["Low Frequency, High Complexity: Assessing Skill Decay in Transesophageal Echocardiography Post-Simulation Training"],"prefix":"10.5811","volume":"26","author":[{"given":"Enyo","family":"Ablordeppey","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Terian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Collyn T.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Wallace","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Blustein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Croft","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernesto","family":"Romo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansi","family":"Agarwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Theodoro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2025,6,25]]},"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"link":[{"URL":"https:\/\/escholarship.org\/content\/qt6js543k6\/qt6js543k6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T02:21:54Z","timestamp":1753842114000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/6js543k6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":0,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,7,19]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.35857","relation":{},"ISSN":["1936-9018"],"issn-type":[{"type":"electronic","value":"1936-9018"}],"subject":[],"published":{"date-parts":[[2025,6,25]]}}}