Chapter 77: Medical Simulation in Interventional Cardiology

INTRODUCTION

Medical simulation comprises the artificial representation of a real-world medical environment with sufficient realism to facilitate learning through immersion, reflection, feedback, and practice without the risks inherent to a similar real-life experience.¹ As a result, simulation’s re-creation of a real-world process/system permits operators to practice/rehearse various scenarios that may range from routine practice to rare events including complications. One central purpose of simulation is for “safe learning,” ie, learning without a real-world consequence if errors occur. As such, simulation has a long history of use in professions that require the execution of precise physical and neurocognitive tasks in high-risk environments. For example, simulation has been used to train pilots and other professions where mistakes can have disastrous consequences. We know from the aviation industry as well as other nonmedical fields that simulators are effective teaching tools, improve learner success, enable repetitive practice of tasks in a range of conditions, and enhance task safety.^2-7 Despite the ability of simulators to recreate numerous high-risk and complex environments, the uptake of simulation for the training and assessment of interventional cardiologists has lagged. This chapter will review the use of medical simulation in the realm of interventional cardiology as it stands today in hopes that it will continue to grow and be integrated more effectively into training and practice.

Interventional cardiology is a relatively new field, having only been in existence for just over 3 decades. Many current operators have been practicing since its inception and have vast experience, essentially precluding a need for simulation prior to the turn of this century. Previously, coronary interventions were only being performed in high-volume centers by high-volume operators. However, since Andreas Gruentzig’s first foray into the heart in September 1977, there have been many changes in the landscape of interventional cardiology. No longer are we as a profession performing only coronary interventions. Where previously invasive surgery represented the only option for patients, thanks to countless technologic advancements and the pioneering nature of numerous physicians/scientists/industry partners, patients with structural heart disease, peripheral arterial disease, and coronary disease now have minimally invasive options. However, with the expansion of interventional cardiology beyond the coronary vessels has come the challenge/inability of most interventionalists to practice all 3 subsets of interventional cardiology, ie, coronary, structural, and peripheral. This fact, coupled with demands for “centers of excellence,” along with an ever competitive market further underscore the need for an environment where the interventional cardiologist can assimilate new skills, rehearse rare emergency procedures, and perhaps provide evidence of their own. Simulation can provide such an environment.

In fact, interventional cardiology is a field well suited for simulation.⁸ Simulation can be used to both educate and improve performance by enabling repetitive practice of tasks in a range of difficult clinical conditions.^9-11 Education in an era where work hour restrictions are a reality has also proven challenging. This, in addition to the well-publicized decrease in coronary percutaneous ...