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Although there has been rapid adoption of simulators by numerous teaching consortiums, the use of simulator-based teaching in cardiology has unfortunately lagged behind other procedural specialties. This study investigates the utility of a simulator-based training program for fellows in cardiovascular disease with no prior experience in diagnostic coronary angiography.
First-year cardiology fellows at University of Illinois-Chicago (UIC) with no prior exposure to diagnostic coronary angiography completed benchmark cases requiring basic coronary engagement with catheters and angiography in multiple views using AngioMentor™ simulators (Simbionix. Cleveland, Ohio). Subsequently, benchmark cases were completed one day later and at 9 months following 2-3 months of training in the cardiac catheterization lab. In addition, 1st year cardiology fellows were compared to 3rd year fellows. Objective measures assessed from benchmark cases were total procedural time, total contrast used, and total fluoroscopy time.
All fellows improved their total time to complete the benchmark case from initial to second attempt one day later (initial 15.5 min, second 10 min, P=0.004). Importantly, total contrast used (60 ml initial, 43 ml second, P=0.02) and total fluoroscopic time (7 min initial and 5 min second, P=0.01) also both decreased. Overall procedure time and contrast use was similar among 1st and 3rd year fellows after simulation training. Total procedure time was 10 min (± 69 seconds) for the 1st years versus 9.5 min (± 53 seconds) for the 3rd years. Total contrast used was 43 ml (± 6 mL) for the 1st years versus 47 mL (± 7 mL) for the 3rd years. Decreases in procedure and fluoroscopy time were maintained in 1st year fellows after 2-3 months of training in the cardiovascular catheterization laboratory.
Fellows displayed technical and procedural improvement at diagnostic coronary angiography in a short period of time with procedural and fluoroscopic time showing lasting improvements after 9 months. In this study, a computer-based simulator was successfully incorporated into a first year cardiovascular fellowship curriculum and represents a contemporary means to assess the effectiveness of simulation and non-simulation training in cardiology.