title: Association between endovascular performance in a simulated setting and in the catheterization laboratory.
abstract: BACKGROUND
  Simulation-based assessment studies have related simulator performance to clinical experience instead of actual clinical performance. This study validates a novel rating scale for coronary angiography (CA) performance and at the same time explores the association between CA performance in a simulated setting and in the catheterization laboratory.
  
  
  METHODS
  Ten cardiologists and cardiology residents with varying degrees of CA experience performed 2 CAs in the catheterization laboratory and 2 CAs in a simulated setting. The residents had prior simulator experience opposite cardiologists. Two raters assessed the operators' video-recorded performances using the novel CA rating scale (CARS).
  
  
  RESULTS
  The correlation between CARS scores in the catheterization laboratory and the simulated setting was R = 0.20 (P = 0.195). Residents' scores were higher in the simulated setting than in the catheterization laboratory. The correlation between operators' previous clinical experience in CA and CARS scores was R = 0.65 (P = 0.005) in the catheterization laboratory and R = 0.11 (P = 0.353) in the simulated setting.
  
  
  CONCLUSIONS
  The association between CA performance in a simulated setting and actual performance in the catheterization laboratory is not linear. The novel rating scale for CA (CARS) seems to be a valid proficiency assessment instrument in the catheterization laboratory. Familiarity with the simulator may overestimate proficiency, which means that simulator performance as a predictor of clinical performance should be interpreted with caution.
authors.affiliation: From the Centre for Clinical Education (S.B.E.W.R.,B.B.), University of Copenhagen and Capital Region; and Cardiac Catheterization Laboratory (E.J.), Department of Cardiology, Department of Vascular Surgery (B.B., L.L.), and Department of Cardiovascular Radiology (L.L.), University Hospital Rigshospitalet, Copenhagen; and Department of Cardiology (U.A.), Gentofte University Hospital, Hellerup, Denmark; and Department of Anesthesia (C.V.R.), and The Wilson Centre (C.V.R.), University of Toronto and University Health Network, Toronto, Canada.
authors.forename: Sune B E W
authors.initials: SB
authors.lastname: Räder
authors.forename: Ulrik
authors.initials: U
authors.lastname: Abildgaard
authors.forename: Erik
authors.initials: E
authors.lastname: Jørgensen
authors.forename: Bo
authors.initials: B
authors.lastname: Bech
authors.forename: Lars
authors.initials: L
authors.lastname: Lönn
authors.forename: Charlotte V
authors.initials: CV
authors.lastname: Ringsted
mesh_terms: D006328:Cardiac Catheterization / Q000592:standards*; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D003198:Computer Simulation; D017023:Coronary Angiography / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D014741:Video Recording