Use of medical simulation has grown considerably over the past decade because it helps physicians overcome many training challenges, such as work-hour restrictions and the pace at which technology is evolving. According to John C. Messenger, MD, FSCAI, interventional cardiology is particularly well-suited for simulation. “These procedures are often complex,” he says. “The learning curves can be steep, and complications can be life-threatening. Simulation provides a safe arena to develop and refine skills that improve overall patient care. It’s especially helpful in interventional cardiology because of the field’s ever-changing technological and procedural environment.”
A Call to Action
In Catheterization and Cardiovascular Interventions, the Society for Cardiovascular Angiography and Interventions (SCAI) examined the current state of medical simulation in interventional cardiology. SCAI also issued recommendations for expanding and standardizing the use of this training technology by interventional cardiologists and fellows-in-training. “We need to increase use of medical simulation and accessibility to this training for highly complex procedures, such as structural heart interventions,” says Dr. Messenger, who chairs SCAI’s Simulation Committee. “Simulation can also improve training in areas where procedural volumes are low.”
A key recommendation from SCAI is to integrate formal simulation programs into annual meetings and other training programs for fellows and practicing physicians. However, one of the major issues with integrating simulation is the high cost of simulators. “The key is for clinicians and simulation vendors to collaborate and find ways to alleviate the financial burden associated with simulation,” says Dr. Messenger. “Using simulation at annual meetings and establishing regional or central simulation centers could ease this burden.”
The key is for clinicians and simulation vendors to collaborate and find ways to alleviate the financial burden associated with simulation.”
SCAI also recommends that standardized cases be developed to include simulation training programs that encompass essential psychomotor and knowledge-based skill sets that are required of interventional cardiologists. It is also paramount to integrate a standardized didactic curriculum that meets current evidenced-based learning standards. Additionally, large-scale studies are needed to further evaluate the efficacy of simulation training for learning new procedures and for maintaining competency with other procedures for fellows and experienced clinicians.
Hope for the Future
The Accreditation Council for Graduate Medical Education now mandates that cardiovascular and interventional cardiology fellowship training programs have some component of simulation as a part of training. This is one example of how regulatory bodies are adopting simulation as a valid method for training and certification, Dr. Messenger says. “Our hope is that the SCAI recommendations will encourage the expansion of simulation training programs for both fellows and experienced clinicians. It will require working with vendors and other clinicians to make the technology more affordable and available. Such efforts, however, are worthwhile because they may enhance the quality of care we provide to patients.”
Readings & Resources (click to view)
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 Jun 4 [Epub ahead of print]. Available at: http://www.scai.org/Assets/0da6e150-489b-4557-bc04-0d2789636c35/635176155740670000/2013oct17corecurriculumsimulation-pdf.
Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: Results of a randomized, double-blinded study. Ann Surg. 2002;236:458-463.
Dawson DL, Lee ES, Hedayati N, Pevec WC. Four-year experience with a regional program providing simulation-based endovascular training for vascular surgery fellows. J Surg Educ. 2009;66:330-335.
Chaer RA, Derubertis BG, Lin SC, et al. Simulation improves resident performance in catheter-based intervention: results of a randomized, controlled study. Ann Surg. 2006;244:343-352.