title: Targeting clinical outcomes: Endovascular simulation improves diagnostic coronary angiography skills.
abstract: OBJECTIVE
  The purpose of this study is to determine the effects of simulation-based medical education (SBME) on the skills required to perform coronary angiography in the cardiac catheterization laboratory.
  
  
  BACKGROUND
  Cardiovascular fellows commonly learn invasive procedures on patients. Because this approach is not standardized, it can result in inconsistent skill acquisition through exclusion of concepts and skills. Also, the learning curve varies between trainees yielding variability in skill acquisition. Therefore, coronary angiography skills are an excellent target for SBME in an environment in which direct patient care is not jeopardized.
  
  
  METHODS
  From January 2013 to June 2013, 14 cardiovascular fellows entering the cardiac catheterization laboratory at a tertiary care teaching hospital were tested on an endovascular simulator to assess baseline skills. All fellows subsequently underwent didactic teaching and preceptor-lead training on the endovascular simulator. Topics included basic catheterization skills and a review of catheterization laboratory systems. Following training, all fellows underwent a post-training assessment on the endovascular simulator. Paired t tests were used to compare items on the skills checklist and simulator defined variables.
  
  
  RESULTS
  Cardiovascular fellows scored significantly higher on a diagnostic coronary angiography skills checklist following SBME using an endovascular simulator. The mean pretest score was 66.6% (SD = 9.7%) compared to 86.0% (SD = 6.3%) following simulator training (P < 0.001). Additional findings include significant reduction in procedure time and use of cine-fluoroscopy at posttest.
  
  
  CONCLUSIONS
  SBME significantly improved cardiovascular fellows' performance of simulated coronary angiography skills. Standardized simulation-based education is a valuable adjunct to traditional clinical education for cardiovascular fellows.
authors.affiliation: Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Daniel R
authors.identifier: http://orcid.org/0000-0001-6035-7317
authors.initials: DR
authors.lastname: Schimmel
authors.affiliation: Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ranya
authors.initials: R
authors.lastname: Sweis
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.affiliation: Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Charles
authors.initials: C
authors.lastname: Davidson
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D006328:Cardiac Catheterization; D002309:Cardiology / Q000193:education*; D057189:Checklist; D002983:Clinical Competence; D017023:Coronary Angiography; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D057510:Endovascular Procedures / Q000193:education*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D059032:Learning Curve; D008297:Male; D011237:Predictive Value of Tests; D000066908:Simulation Training / Q000379:methods*; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D062606:Tertiary Care Centers
keywords: cardiac catheterization; clinical skills assessment; medical education; simulation-based education training