SCAI Survey: Medical Simulation Use Growing in Interventional Cardiology Programs

The use of medical simulation in the field of interventional cardiology is not only vital to the training of new practitioners, but will likely take on a larger role in the maintenance of certification for experienced physicians, according to a white paper published online October 17, 2013, ahead of print in Catheterization and Cardiovascular Interventions. To standardize the training process and reduce costs, the authors recommend establishing guidelines as well as setting up regional simulation centers.

Sandy M. Green, MD, of Geisinger Medical Center (Danville, PA), and colleagues from the Society for Cardiovascular Angiography and Intervention (SCAI), the American Board of Internal Medicine (ABIM), and the American College of Cardiology (ACC) conducted a survey of 14 Accreditation Council for Graduate Medical Education (ACGME)-accredited interventional cardiology programs in the United States that utilized medical simulation in their curricula. The responses suggested that simulators:

• Allow trainees to identify areas of improvement
• Are beneficial for learning low-volume procedures
• Provide an objective assessment of technical competence
• Raise financial concerns, which could be eased by having regional or central simulation centers

The authors report that simulated procedures are most often used in endovascular cases, but structural heart intervention holds “the greatest potential for simulation-based training” because of the lack of formalized training programs and the low procedure volume. Simulation in procedures like coronary intervention is more advanced and includes real-life clinical complications including MI, multivessel disease, and CTO. Additionally, with the increase of transradial procedures, the authors predict simulation will continue to grow in this field.

Based on the survey’s findings, Dr. Green and colleagues recommend:

• Developing standardized cases “that embody the essential psychomotor and knowledge base skill sets required to be an interventional cardiologist”
• Integrating a “standardized didactic curriculum that meets current evidence-based learning standards” with the simulation protocol
• Conducting “large scale studies to evaluate the impact of simulation in a number of key areas” including feasibility and efficacy of training and reliability and validation of maintenance education
• Including “formal simulation programs . . . in the annual [SCAI] scientific sessions”

To ease the economic burden on some programs, the authors also suggest that “sending trainees to regional simulation centers, which has been shown to be cost-effective in 1 study, is the most cost-effective approach.”

SCAI Taking a Leadership Role

The fact that no formal recommendations on medical simulation have been published by any society was one of the motives in writing the white paper, noted committee chair John C. Messenger, MD, of University of Colorado School of Medicine (Aurora, CO).

Since the ACGME recently introduced a mandate for simulation-based training in all interventional cardiology fellowship programs, “we wanted to discuss the fact that SCAI as a society could play a role in providing simulation training for training programs that don’t have access to this,” he told TCTMD in a telephone interview.

SCAI’s autumn fellows course began integrating simulation training into its curriculum last year, and it will be expanded this December “so that all fellows can at least get some exposure. SCAI can be the leader in providing simulation education in the cardiology community,” Dr. Messenger explained. “We’re trying to standardize simulation training across educational platforms.”

Several Uses for Simulators

Also in a telephone interview with TCTMD, Giora Weisz, MD, of Columbia University Medical Center (New York, NY), said medical simulation in interventional cardiology is “different than other types of simulation in other fields of medicine in that it is much more high-tech and especially challenging and sophisticated. . . . The simulators that we have are very reliable and as close as we can get to the real experience.”

He praised SCAI for “bringing the importance of interventional cardiology simulation to the forefront” and for explaining how simulation can be used in many different circumstances. Dr. Weisz especially highlighted patient-based simulation, where the specific anatomy of a patient obtained by CT or MRI can be loaded into the simulator so an operator can train and perform the procedure “when he knows the anatomy of the patient better and he can select better tools and make the procedure more successful, shorter, and with less complications.”

He also recommended using simulators as part of the fellowship exam since the current multiple-choice test does not assess technical and procedural proficiency. “We can use the simulator as an objective exam machine,” Dr. Weisz commented.

 

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Source:
Green SM, Klein AJ, Pancholy S, et al. The current state of medical simulation in interventional cardiology: A clinical document from the Society for Cardiovascular Angiography and Intervention’s (SCAI) simulation committee. Cath Cardiovasc Interv. 2013;Epub ahead of print.

 

 

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