Qianqi Qiu

Transesophageal echocardiography (TEE) is indispensable for intraoperative guidance and evaluation in pediatric cardiac surgery. While simulation-based medical education offers a promising alternative to the traditional apprenticeship model, evidence directly comparing its efficacy in improving live pediatric TEE performance remains limited. This study aimed to evaluate whether simulation-based training using a 3D pediatric TEE simulator is superior to traditional apprenticeship training for enhancing clinical TEE proficiency among anesthesia residents. First- through third-year anesthesia resident physicians without prior echocardiography experience were randomized into two groups. All participants first completed a standardized 2-hour web-based foundational course. Subsequently, the intervention group (Simulation group, Group S; n = 22) received 1 h of supervised hands-on practice using the BabyWorks^® simulator, while the control group (Traditional group, Group T; n = 22) received 1 h of bedside apprenticeship training on live patients. One week later, all participants were assessed on their ability to independently acquire 11 standardized TEE views in pediatric patients. Performance was scored across three dimensions (imaging angle, anatomical structure, and image clarity), with a maximum total score of 110 points. The total examination duration (time) was also recorded. Baseline knowledge scores were comparable between groups. In the clinical assessment, Group S achieved significantly higher total performance scores than Group T (Group S: 88.60 ± 15.60 vs. Group T: 64.70 ± 16.70; p < 0.001). Group S also demonstrated shorter examination durations (Group S: 447.60s vs. Group T: 584.50s; p = 0.007). Specifically, Group S significantly outperformed Group T in 7 of the 11 anatomical landmarks (p < 0.05), primarily in the technically demanding transgastric and advanced mid-esophageal views. Regarding dimensions, Group S scored higher in angle (p = 0.031), clarity (p < 0.001), and structures (p < 0.001). In summary, this trial provides robust evidence that 3D simulation training significantly improves live TEE performance among novice operators compared to conventional training, contributing valuable insights toward optimizing echocardiography education and enhancing perioperative safety in pediatric cardiac care. Chinese Clinical Trial Registry (ChiCTR.org.cn). Registration number: ChiCTR2500105325. Date of the study first posted on ChiCTR.org.cn: 2025-07-02. Date of the enrolment of the first research participant: 202507-03. The online version contains supplementary material available at 10.1186/s12871-026-03769-0.

Background: Unintended postoperative hypothermia in infants is associated with increased mortality and morbidity. We noted consistent hypothermia postoperatively in more than 60% of our neonatal intensive care (NICU) babies. Therefore, we set out to determine whether a targeted quality improvement (QI) project could decrease postoperative hypothermia rates in infants.Objectives: Our SMART aim was to reduce postoperative hypothermia (37.5°C). Data collected was analyzed using control charts. The factors associated with a reduction in hypothermia were explored using regression analysis.Results: There were 295 infants in the project. The percentage of postoperative hypothermia decreased from 60% to 37% over 26 weeks, a special cause variation below the mean on the statistical process control chart. Reduction in hypothermia was associated with an odds of 0.17 (95% CI: 0.06–0.46; p <.001) for compliance with the transport incubator and 0.24 (95% CI: 0.1–0.58; p =.002) for prewarming the OR ambient temperature to 26°C. Two infants had hyperthermia.Conclusions: Our QI project reduced postoperative hypothermia without incurring hyperthermia through multidisciplinary team collaboration with the guidance of QI experts from the USA.