Author + information
- Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions⁎ ()
- ↵⁎Address for correspondence to:
Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions, Saint Joseph's Heart and Vascular Institute, 5665 Peachtree Dunwoody Road, NE, Atlanta, Georgia 30342
In this issue of the journal, we feature 7 papers addressing one of the most talked about developments in interventional cardiology. Although Andreas Gruentzig performed the fourth angioplasty on a patient with left main stenosis, this lesion remained outside the purview of interventional procedures for most physicians. The guidelines recommended against it. Now that has changed and important trials and observations suggest that left main intervention is acceptable and even preferred in certain situations. Two questions are pertinent. Which patients should be done, and who should do them? Most of the 7,000+ interventional cardiologists in the U.S. have limited or no experience treating this lesion. How will they be trained?
Yesterday I was invited to a private tour of the Delta Airlines Operations Control Center and the flight simulators used to train and maintain competence of pilots, and evacuation simulators for replicating cabin emergency conditions for training flight attendants. The invitation apparently came because much of my misspent adulthood has been in the fuselage of an airplane. Five million miles earns you this “honor.” I succeeded in landing a simulated MD-88 and a 767 (on my second try). The experience was thrilling but I am clearly not ready to be your pilot.
Efforts are underway to replicate the flight simulation experience in cath lab situations. Several of us collaborated with the American Board of Internal Medicine and The Simulation Company to design a simulation of interventional cardiology procedures and the report of this effort was just published (1). The cases were tested on 120 cardiologists of varying experience levels and did show discrimination between novice operators (think of me flying the airplane) and those more experienced. Interestingly, we could not discriminate between cardiology fellows and operators with years of experience, a fact not lost on the fellows who took the test. However, we know intuitively that this is not correct as the ways to avoid cath lab disasters and the tricks to get out of them come with increasing experience. Some of you have taken this simulated exam as part of your maintenance of certification process of the American Board of Internal Medicine.
The efforts to create medical simulation have had varying success with some of the leaders being anesthesiology and trauma, championed by the armed services. Nonetheless, should we not press on to develop ways to change the steep learning curve in interventional cardiology with virtual patients so that procedures can be more safely performed on real patients? Even though medical simulation lags far behind aerospace simulation, I was once reminded that the airplane simulators have been evolving over 50 years, and after all, their machines are more predictable than ours (patients). We will never replace carefully mentored training and large patient experience. Nonetheless, as we introduce new procedures and new indications, the chance to practice on virtual patients may improve our outcomes on real ones. In that way, I look forward to the day when we can all avoid that emergency of rushing the patient off to the operating suite with an acutely dissected artery that cannot be reopened. I had flashbacks of those experiences yesterday as I left the “smoke-filled” cabin and hurled myself onto the evacuation slide.
- American College of Cardiology Foundation