Virtual reality simulator training significantly reduced simulator complications compared to conventional training among electrophysiology fellows (25% vs 100%; P=0.02).
RCT (n=8)
Does virtual reality simulator training improve procedural skill competency in transvenous lead extraction among electrophysiology fellows?
Virtual reality simulation training for transvenous lead extraction significantly improves procedural skills, reduces simulated complications, and decreases procedure time compared to conventional training for EP fellows.
Absolute Event Rate: 25% vs 100%
p-value: p=0.02
BACKGROUND: It is estimated that the demand for transvenous lead extraction (TLE) has reached an annual extraction rate of nearly 24,000 patients worldwide. Despite technologic advances, TLE still has the potential for significant morbidity and mortality. Complication rates with TLE directly parallel operator experience. However, obtaining adequate training during and postfellowship can be difficult. Given the potential for catastrophic complications and the steep learning curve (up to 300 cases) associated with this procedure, we sought to validate a virtual reality (VR) lead extraction simulator as an innovative training and evaluation tool for physicians new to TLE. METHODS: We randomized eight electrophysiology fellows to VR simulator versus conventional training. We compared procedural skill competency between the groups using simulator competency, tactile measurements, markers of proficiency and attitudes, and cognitive abilities battery. RESULTS: Practical skills and simulator complications differed significantly between the VR simulator and conventional training groups. The VR simulator group executed patient preparation and procedure performance better than the conventional group (P < 0.01). All four fellows randomized to conventional training experienced a simulator complication (two superior vena cava SVC tears, three right ventricle RV avulsions) versus one fellow in the VR simulator group (one SVC tear) (P = 0.02). Tactile measurements revealed a trend toward excess pushing versus pulling forces among the conventionally trained group. The time for lead removal was also significantly higher in the conventional training group (12.46 minutes vs 5.54 minutes, P = 0.02). There was no significant difference in baseline or posttraining cognitive ability. CONCLUSIONS: We contend that the implementation of alternative training tools such as a VR simulation model will improve physician training and allow for an innovative pathway to assess the achievement of competency.
Maytin et al. (Fri,) conducted a rct in Transvenous lead extraction training (n=8). Virtual reality (VR) lead extraction simulator vs. Conventional training was evaluated on Simulator complications (p=0.02). Virtual reality simulator training significantly reduced simulator complications compared to conventional training among electrophysiology fellows (25% vs 100%; P=0.02).
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