Interactive TEE Review: Self-Assessment Examination (DVD).  By Robert M. Savage, M.D., Solomon Aronson, M.D., and Stanton K. Shernan, M.D. Philadelphia, Lippincott Williams & Wilkins, 2008. Price: $229.00.

The expanding interest of anesthesiologists in perioperative transesophageal echocardiography (TEE) has significantly changed the practice of anesthesia. Once an expensive toy for academic medical institutions, TEE now has achieved “standard of care” status for many cardiothoracic procedures. The Society of Cardiovascular Anesthesiologists initiated formal testing in perioperative TEE in 1998. Ten years later, nearly 3,000 physicians have successfully passed the examination.

Parallel to this rise in interest has been the publishing of a large number of textbooks, atlases, and DVDs on perioperative TEE marketed to cardiovascular anesthesiologists. This year alone, three review books on the perioperative TEE examination have been introduced. Despite a large amount of competition, Interactive TEE Review: Self-Assessment Examination  is the first of its kind.

Most review books are “old school” paper and ink with static TEE images. Other DVDs have been designed as video atlases with a limited number of test questions. This DVD is the first interactive text that allows for extensive test review using “live” TEE loops and referenced answers. The timing of the new text is excellent. For the first time, the Perioperative TEE Exam will be completed at computer testing centers across the country in November 2009. This DVD format allows for an excellent simulation of the real test environment.

Interactive TEE Review  is composed of 420 test questions organized into 32 chapters. More than 600 videos and images are used in the text. The program interface allows the student to personalize the program by selecting the desired subject matter, the number of questions, and how the questions are answered, one by one or as a group.

I found that the program was stable and ran quickly on my laptop. The video images have adequate resolution and can be expanded for closer inspection. I found most of the videos and image diagrams to have excellent quality and help clarify the explanations in the text.

The subject matter is well organized and extensive. The subject chapters progress in complexity and question difficulty. Each group of 10 chapters roughly correlates with novice, intermediate, and advanced levels of expertise. The subject matter and format are well suited to the goal of testing TEE knowledge in preparation for the National Board of Echocardiography Perioperative TEE Exam.

Unfortunately, I found this DVD text to have a few significant problems. Throughout several of the chapters, I encountered a large number of errors in the text and the video links for the questions. A few of the questions were confusing, and I struggled with the appropriate answer. Most of the explanations were excellent, but I noticed a small number of errors in the text of the answers (e.g. , speed of ultrasound in soft tissue was misquoted as 1,740 m/s). One answer merely stated “See Textbook.” A couple of the tables used were very complex and difficult to read.

Some of the links seemed to be crossed with other videos in the same questions, which I found to be frustrating. Although most video loops were excellent, I found a small number of the video loops to be nonfunctional or to have poor resolution.

Several of the advanced questions required a large number of images to complete the answer. One complex question had greater than 20 videos and images referenced in the question. I found my interest waning about halfway though the images, and I had to force myself to push on in the name of journalistic integrity.

Overall, my impression is: Great idea! Great format! Great organization! But the questions and text need editing and proofreading. I was disappointed by the number of errors and would have been more disappointed if I were using the text to prepare for the Perioperative TEE Exam.

Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia.