Generative Retrieval Improves Learning and

Retention of Cardiac Anatomy Using Transesophageal Echocardiography

經(jīng)食管超聲心動圖（TEE）是監(jiān)測心臟或非心臟手術(shù)患者的一種有價值的監(jiān)護儀，因為它可以評估圍手術(shù)期患者的心血管損害。對于麻醉醫(yī)師和醫(yī)學(xué)生來說,，在臨床環(huán)境中學(xué)習使用和解讀TEE是很困難的,。學(xué)習使用和解讀TEE的關(guān)鍵是掌握正常心血管超聲解剖。

15名大四醫(yī)學(xué)生和15名一年級或二年級麻醉研究生（PGY）均無心臟麻醉學(xué)習或觀看正常心血管解剖TEE視頻剪輯;參與者學(xué)習心臟解剖學(xué)并被隨機分配到生成檢索組（GR）或標準實踐組（SP）,。 GR組被要求在10秒內(nèi)口頭描述出現(xiàn)在TEE視頻中每個未標記的心臟解剖結(jié)構(gòu),。然后，正確標記的TEE視頻剪輯給GR組觀看5秒以上,。 SP組看到與GR組相同的TEE視頻剪輯但沒有要求SP組給出心臟解剖結(jié)構(gòu)答案;SP組,，每個TEE視頻圖像被標記了正確的解剖結(jié)構(gòu)并給觀看15秒。所有參與者在中間（1周）和最后（1個月）時間段接受了正常TEE心血管解剖的測試,。使用具有隨機截距和隨機斜率的線性混合效應(yīng)模型評估這兩個時間段記憶TEE心血管解剖的提高,。

GR（49％±11）和SP（50％±12）基線評分差異無統(tǒng)計學(xué)意義，平均差異（95％CI）-1.1％（-9.5,，7.3％）,。培訓(xùn) 1周后，GR組（90％±5）表現(xiàn)明顯優(yōu)于SP組（82％±11）,，平均差異（95％CI）為8.1％（1.9％,，14.2％）; P = 0.012。一個月的后期測試中兩組得分持續(xù)顯著增加（GR：83％±12; SP：72％±12）,，平均差異（95％CI）10.2％（1.3?19.1％）; P = 0.026,。混合效應(yīng)分析顯示隨著時間的推移TEE心血管解剖的學(xué)習顯著改善,， GR和SP組每周分別為5.9%和3.5%（P = 0.0003）,，且GR組比SP組略有增長（P = 0.065）。

醫(yī)學(xué)生和麻醉醫(yī)生在使用TEE方面的不足經(jīng)驗表明生成檢索提高學(xué)習和記憶心血管超聲解剖并納入教育經(jīng)驗,。

原始文獻摘要

Amanda M. Kleiman, MD,Katherine T. Forkin, MD,Allison J. Bechtel, MD,Stephen R. Collins, MD,Jennie Z. Ma, PhD,? Edward C. Nemergut, MD, and Julie L. Huffmyer, MD.Generative Retrieval Improves Learning andRetention of Cardiac Anatomy Using Transesophageal Echocardiography.Anesth Analg 2017;124:1440–4.

BACKGROUND: Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromisein the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy.

METHODS: Fifteen fourth-year medical students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents without prior training in cardiac anesthesia or TEE viewed normal cardiovascular anatomy TEE video clips; participants were randomized to learning cardiac anatomy in generative retrieval (GR) and standard practice (SP) groups. GR participants were required

to verbally identify each unlabeled cardiac anatomical structure within 10 seconds of the TEE video appearing on the screen. Then a correctly labeled TEE video clip was shown to the GR participant for 5 more seconds. SP participants viewed the same TEE video clips as GR but there was no requirement for SP participants to generate an answer; for the SP group, each TEE video image was labeled with the correctly identified anatomical structure for the 15 second period. All participants were tested for intermediate (1 week) and late (1 month) retention of normal TEE cardiovascular anatomy. Improvement of intermediate and late retention of TEE cardiovascular anatomy was evaluated using a linear mixed effects model with random intercepts and random slopes.

RESULTS: There was no statistically significant difference in baseline score between GR (49%± 11) and SP (50% ± 12), with mean difference (95% CI) -1.1% (-9.5, 7.3%). At 1 week following the educational intervention, GR (90% ± 5) performed significantly better than SP (82%± 11), with mean difference (95% CI) 8.1% (1.9, 14.2%); P = .012. This significant increase in scores persisted in the late posttest session at one month (GR: 83% ± 12; SP: 72% ±12), with mean difference (95% CI) 10.2% (1.3 to 19.1%); P = .026. Mixed effects analysis showed significant improvements in TEE cardiovascular anatomy over time, at 5.9% and 3.5%per week for GR and SP groups respectively (P = .0003), and GR improved marginally faster than SP (P = .065).

CONCLUSIONS: Medical students and anesthesiology residents inexperienced in the use of TEE showed both improved learning and retention of basic cardiovascular ultrasound anatomy with the incorporation of GR into the educational experience.