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How Novel Transcatheter Therapies are Transforming Echocardiography

Today, echocardiography is crucial to patient screening and guidance for novel and complex interventional procedures, and this increases the demand...

May 12, 2021

Today, echocardiography is crucial to patient screening and guidance for novel and complex interventional procedures, and this increases the demand for highly skilled operators. However, training opportunities remain limited. There certainly is still no standard certification process for echocardiography, and education continues to be based off an outdated see one, do one, teach one model. How can interventional teams move toward new training techniques that will save both time and costs, as well as improve patient outcomes in echocardiography and echo-guided interventions?

We had the pleasure of interviewing Senior Echocardiographer, Jens Schneider, who for the last 14 years, has been running a company that offers professional echocardiography education using a curriculum that integrates the Mentice VIST TEE Trainer for practical training. In this blog, we take a close look at Jens Schneider’s experiences with our solutions and his suggestions for the future of echocardiography education.

Understanding current needs in Echocardiography, Interventional Cardiology (IC), and beyond...

With the increasing demand and importance for echo in SHD, typically the most experienced echo operator is fundamentally the ‘bottleneck’ of the department - performing all intraoperative procedures, whilst carrying the responsibility to train their team. As hospitals are ramping up their SHD programs, there is a greater need to train more highly skilled echocardiographers. The main challenge is to relieve the pressure and free up resources within the department to further support the interventional teams, whilst producing more independent echo operators.

As Jens highlights, echocardiography is the only technique that lets you visualize the pulsating heart and its tissue, as well as the medical devices in real-time. Therefore, the need is greater for cardiologists and other interventionalists to better understand and interpret echo imaging so that they can ultimately fill knowledge gaps that would improve their own procedural outcomes.

“Time pressure is a substantial factor in the cath lab, as it is shared amongst many different healthcare professionals and time slots are limited.”
Jens Schneider
Sr. Echocardiographer

From Jens’ perspective, one of the biggest challenges for both echocardiographers and ICs is balancing a schedule for the cath lab. Most hospitals must share a cath lab among a variety of departments, so the schedule can be very tight, especially if delays are encountered.

For interventional teams, an even more critical challenge is communication. Good communication, i.e., walking through steps and landmarks, is integral to effective training. Otherwise, you might end up “chasing yourself inside the atrium,” as Jens describes. This can lead to increased procedure times and potentially sub-optimal outcomes, which both increases cost and risks patient safety.

Since Jens especially recognizes the gap that exists between echocardiography and other departments, he believes it is even more important to standardize training utilizing simulators like VIST TEE Trainer. This will ultimately improve training for echocardiographers, leading to better outcomes and reduced procedure costs as they acquire the skill set and confidence required in the interventional setting to produce higher quality echo guidance and reduced procedure times.

How does the VIST TEE Trainer support Echocardiographers, Interventional Cardiologists, and interventional teams?

“Imaging of the right heart today is trial and error… This is where the TEE simulator helps and is doing an outstanding job with the visualization of the probe, and the heart model. The images are simulated; however, they are generated in a similar way to ultrasound, and this is the point when it feels like real TEE.”
Jens Schneider
Sr. Echocardiographer

As a direct solution to these needs, the TEE Trainer enhances learning through hands-on training and visual guidance. This exposes echocardiographers to a variety of complex scenarios that may have taken twice as long to be exposed to otherwise, especially for procedures having to do with tricuspid valves, or as Jens and many others call it, “the forgotten valve.”

The integrated expert guidance allows for independent self-learning away from patients, ultimately relieving the senior echocardiographer from the pressures of having to train the echo team. During simulation, echocardiographers are exposed to rare pathologies and challenging cases, preparing them for stressful circumstances within the clinical setting. Whatever the case, these enhanced insights dramatically shorten their learning curve and decrease the time they need to become independent operators.

“In an interventional setting, being faster, with better quality is the point.”
Jens Schneider
Sr. Echocardiographer
Mentice Scrubs tool

The TEE trainer provides echocardiographers the skill set and confidence within the interventional setting. This optimally supports Interventional Cardiologists during procedures by producing higher quality echo guidance, shortened procedure times that ultimately result in better outcomes and reduced costs. The TEE Trainer also allows ICs to improve their ability to interpret echo imaging, enabling them to gain new insights into anatomical aspects crucial for deploying novel devices.  

Mentice also offers the only solution combining intraoperative TEE with real-time device manipulation across all modalities. This allows ICs to train on transcatheter therapies, such as MVR, TVR, LAAO, etc – all whilst simultaneously improving interdisciplinary teamwork and communication with the echocardiographer and their interventional team.

How does Jens Schneider use the TEE Trainer to support his hospital’s Echocardiography department?

Jens spends a lot of his time developing courses specifically around the VIST TEE Trainer, for both beginners to advanced echocardiographers. With TEE simulation, there is a greater understanding of complex techniques and more opportunities to learn new ones.

Even Jens himself, who has completed 65k echo examinations so far, says he is still learning and believes that even advanced echocardiographers that have been doing TEE procedures for years, can still learn something new with this kind of insight.

“Even I, as an echo operator with over 19 years of experience, can learn something from the VIST TEE trainer… Certain steps I carried out correctly, but I was doing them based on my training, yet I never fully understood why I was carrying out those steps. The enhanced visualizations of the TEE trainer helped me understand the ‘why’ and even though they may only be small things, in daily life, it is often the small things that cause big troubles.” 
Jens Schneider
Sr. Echocardiographer

How effective is simulation training for echocardiographers?

Several studies have shown the benefits of simulation training for TEE. In one study, TEE simulation has shown to improve residents’ practical test scores in addition to achieving shorter examination times after each training session:

Weber, et al, showed that simulation-based TEE training provides more effective training than other teaching methods. It is therefore especially suitable for the initial stages of TEE training to acquire psychomotor skills and knowledge of echo-anatomy.
Read the full research article here.

In another study conducted by Dayton, et al, 100% of trainees reported that the simulator improved both their knowledge and ability to diagnose CHD.
Abstract available here.

In his Hospital, Jens set up two different groups of echocardiographer trainees. The first group trained traditionally, and the second group trained using the VIST TEE Trainer. While the traditionally trained group gained independence to perform basic TEE examinations after 4-5 weeks on average, the TEE Trainer group was almost twice as fast, averaging 2-3 weeks until independence.

   Click to play the full video

What are your recommendations for setting up an effective curriculum?

For expert echocardiographer Jens Schneider, the two most important aspects to consider as he develops his own curriculum, are the key needs and desired outcomes for your course. He explains how it is important to ensure clear & concise planning, otherwise, you will overwhelm your curriculum. Once you have your needs and outcomes defined, you can structure the setting of the course around those goals:

“I strongly recommend incorporating VIST TEE Trainer for the vital hands-on training; it is the only way to train these skills away from real patients. I also plan to incorporate hybrid courses that involve remote participation. The VIST TEE Trainer would be a perfect added component and help to cut back on travel costs for physicians and medical device companies. Because of its high portability and easy set-up and maintenance, it would easily provide echocardiographers the platform they need to apply their learnings as they are taught.”
Jens Schneider
Sr Echocardiographer
VIST One TEE Web Image


The Takeaway

Continuous training with a simulator like VIST® TEE will lead to improved outcomes over time for your patients, skillset, department, and hospital.

Based on real patients’ anatomies, the solution offers the most sophisticated real-time ultrasound simulation in the market. Users can practice hands-on under expert guidance and test their TEE skills both in obtaining and interpreting views and investigating pathologies. To meet the increasing need for echocardiography, Mentice offers you a highly realistic environment that is cost-effective and a lightweight solution for echocardiographers, interventional teams, and industry field staff.

Want to learn more? 

Alternatively, learn more about our VIST® TEE Trainer and how you can get started on more effective training with your interventional teams.

Any further questions? You can get in touch with us straight from contacting us.

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