Surgical skill simulation training to proficiency reduces procedural errors among novice cardiac device implanters: a randomized study

Abstract Aims In cardiac device implantation, having both surgical skills and ability to manipulate catheter/lead/wire is crucial. Few cardiologists, however, receive formal surgical training prior to implanting. Skills are mostly acquired directly on-the-job and surgical technique varies across ins...

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Published in	Europace (London, England) Vol. 26; no. 9
Main Authors	Mascheroni, Jorio, Stockburger, Martin, Patwala, Ashish, Mont, Lluís, Rao, Archana, Retzlaff, Hartwig, Garweg, Christophe, Gallagher, Anthony G, Verbelen, Tom
Format	Journal Article
Language	English
Published	UK Oxford University Press 30.08.2024 Oxford Publishing Limited (England)
Subjects	Adult Animals Cardiologists - education Clinical Competence Curriculum Defibrillators, Implantable Education, Medical, Graduate - methods Female Heart Humans Learning Curve Male Medical Errors - prevention & control Models, Animal Prospective Studies Prosthesis Implantation - education Simulation Simulation Training Skills Swine Task Performance and Analysis Training Translational Research Training Surgical skill Pacing CIED implant Proficiency-based progression Cardiac resynchronization therapy
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ISSN	1099-5129 1532-2092 1532-2092
DOI	10.1093/europace/euae229

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Summary:	Abstract Aims In cardiac device implantation, having both surgical skills and ability to manipulate catheter/lead/wire is crucial. Few cardiologists, however, receive formal surgical training prior to implanting. Skills are mostly acquired directly on-the-job and surgical technique varies across institutions; suboptimal approaches may increase complications. We investigated how novel proficiency-based progression (PBP) simulation training impacts the surgical quality of implantations, compared to traditional simulation (SIM) training. Methods and results In this international prospective study, novice implanters were randomized (blinded) 1:1 to participate in a simulation-based procedure training curriculum, with proficiency demonstration requirements for advancing (PBP approach) or without (SIM). Ultimately, trainees performed the surgical tasks of an implant on a porcine tissue that was video-recorded and then scored by two independent assessors (blinded to group), using previously validated performance metrics. Primary outcomes were the number of procedural Steps Completed, Critical Errors, Errors (non-critical), and All Errors Combined. Thirty novice implanters from 10 countries participated. Baseline experiences were similar between groups. Compared to SIM-trained, the PBP-trained group completed on average 11% more procedural Steps (P < 0.001) and made 61.2% fewer Critical Errors (P < 0.001), 57.1% fewer Errors (P = 0.140), and 60.7% fewer All Errors Combined (P = 0.001); 11/15 (73%) PBP trainees demonstrated the predefined target performance level vs. 3/15 SIM trainees (20%) in the video-recorded performance. Conclusion Proficiency-based progression training produces superior objectively assessed novice operators’ surgical performance in device implantation compared with traditional (simulation) training. Systematic PBP incorporation into formal academic surgical skills training is recommended before in vivo device practice. Future studies will quantify PBP training’s effect on surgery-related device complications. Graphical Abstract Graphical Abstract
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Conflict of interest: J.M. conducted the present research project as part of his PhD studies at KU Leuven, Belgium. J.M. is also an employee of Medtronic. M.S. reports personal fees (honoraria for educational activity) from Medtronic during the conduct of the project and personal fees from Biotronik outside the submitted work; A.P. reports personal fees (honoraria for educational activity) from Medtronic during the conduct of the project; L.M. reports grants and personal fees (support for Fellowship programme, research grants, consulting honoraria) from Medtronic, Abbott, and Boston Scientific during the conduct of the project; A.R. reports teaching honoraria from Medtronic outside the submitted work; H.R. reports personal fees (honoraria for educational activity) from Medtronic during the conduct of the project and outside the submitted work; C.G. reports research funding from Abbott, Biotronik, and Medtronic, and speaker/consultancy fees from Medtronic, Biotronik, and Abbott outside the submitted work; A.G.G. reports personal fees (consulting) from Medtronic during the conduct of the project; T.V. reports personal fees (lectures honoraria) from Medtronic outside the submitted work.
ISSN:	1099-5129 1532-2092 1532-2092
DOI:	10.1093/europace/euae229