Prospective, randomised and blinded comparison of proficiency-based progression full-physics virtual reality simulator training versus invasive vascular experience for learning carotid artery angiography by very experienced operators

Christopher U Cates, Lars Lönn, Anthony G Gallagher, Christopher U Cates, Lars Lönn, Anthony G Gallagher

Abstract

Introduction: We assessed the transfer of training (ToT) of virtual reality simulation training compared to invasive vascular experience training for carotid artery angiography (CA) for highly experienced interventionists but new to carotid procedures.

Methods: Prospective, randomised and blinded.

Setting: Catheterisation and skills laboratories in the USA.

Participants: Experienced (mean volume=15 000 cases) interventional cardiologists (n=12) were randomised to train on virtual reality (VR) simulation to a quantitatively defined level of proficiency or to a traditional supervised in vivo patient case training.

Outcome measures: The observed performance differences in performing a CA between two matched groups were then blindly assessed using predefined metrics of performance.

Results: Experienced interventional cardiologists trained on the VR simulator performed significantly better than their equally experienced controls showing a significantly lower rate of objectively assessed intraoperative errors in CA. Performance showed 17-49% ToT from the VR to the in vivo index case.

Discussion: This is the first prospective, randomised and blinded clinical study to report that VR simulation training transfers improved procedural skills to clinical performance on live patients for experienced interventionists. This study, for the first time, demonstrates that VR simulation offers a powerful, safe and effective platform for training interventional skills for highly experienced interventionists with the greatest impact on procedural error reduction.

Keywords: Simulation; transfer of training; virtual reality.

Conflict of interest statement

Competing interests: LL has served as a consultant for Mentice AB, the manufacturer of the simulator used in the study. AGG is a member of the Editorial Board of BMJ Simulation and Technology Enhanced Learning.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Study design and flow of trainees through the trial.
Figures 2
Figures 2
The Vascular Interventional Training System (or VIST) full physics virtual reality simulation of the cardiovascular anatomy (A); the VIST simulator set-up in the skills laboratory (B) (courtesy of Mentice AB, Gothenburg, Sweden) and the fluoroscopic image of the aortic arch (with catheter handling error in situ) (C) and the VR simulated aortic arch (with catheter handling error in situ) (D).
Figure 3
Figure 3
The mean and SE time that it took to perform the carotid angiography, amount of fluoroscopy used and number of objectively assessed intra-operative errors made by the standard trained cardiologists (n=6) and the VR trained interventional cardiologists (n=6).

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