Computer simulation as a component of catheter-based training.
BACKGROUND
Computer simulation has been used in a variety of training programs, ranging from airline piloting to general surgery. In this study we evaluate the use of simulation to train novice and advanced interventionalists in catheter-based techniques.


METHODS
Twenty-one physicians underwent evaluation in a simulator training program that involved placement of a carotid stent. Five participants were highly experienced in catheter-based techniques (>300 percutaneous cases), including carotid angioplasty and stenting (CAS); the remaining 16 participants were interventional novices (<5 percutaneous cases). The Procedicus VIST simulator, composed of real-time vascular imaging simulation software and a tactile interface coupled to angiographic catheters and guide wires, was used. After didactic instruction regarding CAS and use of the simulator, each participant performed a simulated CAS procedure. The participant's performance was supervised and evaluated by an expert interventionalist on the basis of 50 specific procedural steps with a maximal score of 100. Specific techniques of guide wire and catheter manipulation were subjectively assessed on a scale of 0 to 5 points based on ability. After evaluation of the initial simulated CAS procedure, each participant received a minimum of 2 hours of individualized training by the expert interventionalist, with the VIST simulator. Each participant then performed a second simulated CAS procedure, which was graded with the same scale. After completion, participants assessed the training program and its utility via survey questionnaire.


RESULTS
The average simulated score for novice participants after the training program improved significantly from 17.8 +/- 15.6 to 69.8 +/- 9.8 (P < .01), time to complete simulation decreased from 44 +/- 10 minutes to 30 +/- 8 minutes (P < .01), and fluoroscopy time decreased from 31 +/- 7 minutes to 23 +/- 7 minutes ( P < .01). No statistically significant difference in score, total time, or fluoroscopy time was noted for experienced interventionalists. Improvement was noted in guide wire and catheter manipulation skills in novices. Analysis of survey data from experienced interventionalists indicated that the simulated clinical scenarios were realistic and that the simulator could be a valuable tool if clinical and tactile feedback were improved. Novices also thought the simulated training was a valuable experience, and desired further training time.


CONCLUSIONS
An endovascular training program using the Procedicus VIST haptic simulator resulted in significant improvement in trainee facility with catheter-based techniques in a simulated clinical setting. Novice participants derived the greatest benefit from simulator training in a mentored program, whereas experienced interventionalists did not seem to derive significant benefit.
Dayal
Rajeev
R
Department of Surgery, The New York-Presbyterian Hospital, Weill Medical College of Cornell University and Columbia College of Physicians and Surgeons, New York, NY 10021, USA.
Faries
Peter L
PL
Lin
Stephanie C
SC
Bernheim
Joshua
J
Hollenbeck
Scott
S
DeRubertis
Brian
B
Trocciola
Susan
S
Rhee
Jason
J
McKinsey
James
J
Morrissey
Nicholas J
NJ
Kent
K Craig
KC
D019917:Blood Vessel Prosthesis Implantation / Q000193:education*; D002339:Carotid Arteries; D002404:Catheterization; D002983:Clinical Competence; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods; D004521:Educational Measurement; D013502:General Surgery; D006801:Humans; D007396:Internship and Residency; D008955:Models, Cardiovascular; D017063:Outcome Assessment, Health Care; D015607:Stents; D013663:Teaching / Q000379:methods*