TEE PALM Training

Research Summary

The TEE PALM significantly improves performance in TEE interpretation and produces long-term retention.

Prior to PALM training, accuracy in interpreting TEE videoclips showed an increasing trend with increased years of training. Fluency (correct answers within 10 seconds) was much lower, and fairly comparable, for all trainee groups relative to that of the faculty. Note that, despite the small numbers (N), Faculty performance was statistically significantly better than the performance of all other groups, for both accuracy and fluency, as indicated in the accompanying table.

Experimental and control groups of PGY-1 residents consisted of 12 subjects each. The experimental group completed the TEE PALM within 30 minutes following the pretest. Delayed tests were administered ~6 months after the pretest. Percentages are mean values of each measurement. Statistically significant differences between pretest and either posttest (for the experimental group) or delayed test values for each group are indicated by asterisks with their values (p) along with their effect sized (d) listed in the accompanying table. Six months following completion of the TEE PALM, the experimental group had scores similar to those of cardiac anesthesiology faculty physicians for both accuracy (p = .31) and fluency (p = 0.72)

Comparison of maintenance of learning for experimental vs. control PGY-1’s

The differences between the pretest and delayed test performances for the experimental group were statistically significantly larger than those for the control group for both accuracy and fluency.


  • Romito B, Krasne S, Kellman PJ, Dhillon A. The Impact of a Perceptual and Adaptive Learning Module on Transesophageal Echocardiography Interpretation in Anesthesiology Residents: A Pilot Study. British Journal of Anaesthesia, 2016;117(4):477–81.