63 Prospective observational study of the use of simulation for the assessment of competence for percutaneous coronary intervention

Introduction Current interventional cardiology training in the United Kingdom is based on direct observed procedures and maintenance of a logbook of cases performed by each interventional trainee. Whilst this may provide some evidence of an operators experience in terms of number of cases performed, it provides little evidence as to the operator's independence, decision making and level of procedural skill in performing percutaneous coronary intervention (PCI). Simulation based training is being increasingly utilized for the assessment of procedural skills across a range of specialties. It provides a safe environment for the practice and assessment of procedural knowledge and hands-on skills. The The Mentice VIST® G7+ simulator (Mentice, Göteborg, Sweden) is a high-fidelity interface that mimics the latest generation of cardiac catheterizations laboratories. It has the capability of simulating real life case scenarios with a verity of clinical presentations and coronary anatomy and collects important procedural metrics. The aim of this pilot study is to assess the utility and feasibility of high-fidelity coronary intervention simulation as a form of objective assessment of competence for interventional cardiology trainees. Methods Six volunteers were divided into 2 groups. The control group consisted of 3 experienced consultant interventional cardiologists, whilst the trainee group consisted of 3 senior interventional cardiology trainees (within 12 months of completion of training). Each participant was given a case scenario with diagnostic angiogram images and were asked to plan and proceed with coronary intervention. Each subject was assisted by a competent second operator with knowledge of the The Mentice VIST® G7+ simulator. Each group was compared and evaluated for procedure metrics including;total procedure time, total screening time and radiation dose, total contrast use, number of coronary guide catheters, wires, balloons and stents used. Independent assessment of each case was also performed by a blinded adjudicator to assess final PCI result. Results Each participant was presented with a case of severe stenosis in a proximal LAD involving the bifurcation with a diagonal branch (Medina 1,1,0). All participants across both groups opted for an upfront provisional stent strategy. Whilst 100% of participants in the control group proceeded to perform PCI as per their original stent strategy, 67% (n=2) of participants in the trainee group chose to change their stenting strategy following initial lesion preparation. Both groups achieved a satisfactory stent result in the main vessel with 0% residual stenosis. The maximum residual side branch stenosis in the trainee group was 50% compared with 5% in the control group. There was no difference in the total number of guide catheters, guidewires and stents used between the two groups. Total procedure time was greater in the trainee group (mean 18.7 vs 13.5 mins). Mean fluoroscopy time was 6 times greater in the trainee group as compared to the control (13.8 vs 2.2 mins) and radiation dose was concurrently higher in the trainee group (mean difference of 31Gycm2). Contrast volume was also greater in the trainee group as compared to the control (mean difference of 44 mls). Conclusion Simulation based platforms are an excellent tool to aid training in interventional cardiology that has thus far, not been tested in a systematic way. The results of this initial observational study showed that whilst procedure time and contrast use were expectedly higher amongst the interventional trainee group, PCI strategy, quantity of equipment used and final stent result achieved were comparable between the two groups. These early data suggest that simulation based assessment is a practical tool that can be used to assess procedural skills in interventional cardiology in an objective and reproducible manner. Conflict of Interest None