Simulation training in cardiology: a systematic review

Introduction Simulation-based training (SBT) in cardiology has emerged as a popular adjunct to traditional teaching to develop clinical and procedural skills within a controlled environment. In this systematic review, we aim to evaluate the evidence for SBT in cardiology with a focus on real-world outcomes. Methods This systematic review was designed following the PRISMA guidelines. The literature search was performed using MEDLINE, Cochrane and EMBASE by two independent reviewers. Studies utilising SBT to teach medical professionals skills pertaining to cardiology were included, with a particular emphasis on factors linked to SBT that may result in positive outcomes. Results A total of 3014 studies between January 2000 to December 2023 were obtained. After critical review, 33 studies (2061 participants) were included. Fourteen studies evaluated in-vivo procedure-based outcomes. 4 of these showed significant reductions in fluoroscopy time, 3 showed reductions in radiation dose, 4 showed improved procedural proficiency, and 2 showed reductions in real-world complication rates. Conversely, one study (12 participants) found increased real-world complication rates associated with SBT. Nineteen studies evaluated knowledge-based outcomes, seventeen of which showed significant improvements in test scores following SBT. Conclusion SBT in cardiology, particularly when structured and supervised, improves patient outcomes, procedural skill and knowledge acquisition. However, the indiscriminate use of SBT, particularly when unsupervised, does not appear to be beneficial. Significance/Impact: Current evidence does suggest that the indiscriminate use of high-fidelity simulation training alone is not superior to conventional training. There is a need for a more nuanced approach to integrate SBT within cardiology training.