Using simulation for teaching femoral arterial access: A multicentric collaboration.
OBJECTIVE
To assess the impact of simulation training on complications associated with femoral arterial access obtained by first year cardiology fellows.


BACKGROUND
Prior studies demonstrate a higher incidence of arterial access related complications among patients undergoing invasive cardiac procedures.


METHODS
First year cardiology fellows at four teaching hospitals in Michigan tracked their femoral access experience and any associated complications between July 2011 and June 2013. Fellows starting their academic training in July 2012 were first trained on a specially developed simulator before starting their rotation in the catheterization laboratory. The primary outcome was access proficiency, defined as five successful femoral access attempts without any complication or need to seek help from a more experienced team member.


RESULTS
A total of 1,278 femoral access attempts were made by 21 fellows in 2011-2012 compared with 869 femoral access attempts made by 21 fellows in 2012-2013. There was a lower rate of access related complications in patients undergoing access attempts by first year fellows in year 2 compared with year 1 (2.1% versus 4.5%, P = 0.003). The number of procedures to achieve procedural proficiency was significantly higher in year 1 compared with year 2 (median 20 versus 10, P = 0.007).


CONCLUSIONS
Incorporation of simulation in the training of first year fellows was associated with an improvement in proficiency and a clinically meaningful reduction in vascular complications.
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Hitinder S
HS
Gurm
Facultades De Ingenieria Medicina Y Ciencias Biologicas, Instituto De Ingenieria Biologica Y Medica, Pontificia Universidad Catolica De Chile, Santiago, Chile.|Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan.
Jorge
J
Sanz-Guerrero
Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan.
Daniel D
DD
Johnson
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Andrea
A
Jensen
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Milan
M
Seth
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Stanley J
SJ
Chetcuti
Department of Cardiovascular Medicine, St. John Hospital, Detroit, Michigan.
Thomas
T
Lalonde
Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
Adam
A
Greenbaum
Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Michigan.
Simon R
SR
Dixon
Department of Mechanical Engineering, Wu Manufacturing Research Center University of Michigan, Ann Arbor, Michigan.|Biomedical Engineering, University of Michigan, Ann Arbor.
Albert
A
Shih
D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005263:Femoral Artery; D006784:Hospitals, Teaching; D006801:Humans; D059032:Learning Curve; D008824:Michigan; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D000066908:Simulation Training / Q000379:methods*
Fellow training; Medical education; Simulation; femoral access