Association between endovascular performance in a simulated setting and in the catheterization laboratory

Area of Science:

• Cardiovascular Interventions
• Medical Simulation
• Performance Assessment

Background:

• Existing simulation studies link simulator performance to clinical experience, not actual clinical outcomes.
• This research validates a new rating scale for coronary angiography (CA) performance.
• It also investigates the relationship between simulated and real-world CA performance.

Purpose of the Study:

• To validate a novel rating scale for coronary angiography (CA) performance.
• To explore the association between CA performance in a simulated environment and in the catheterization laboratory.
• To assess the predictive value of simulator performance for clinical competence.

Main Methods:

• Ten cardiologists and cardiology residents performed CA in both clinical and simulated settings.
• Video recordings of procedures were assessed by two raters using the novel CA rating scale (CARS).
• Operators' prior clinical experience in CA was also recorded.

Main Results:

• The correlation between CARS scores in the catheterization laboratory and the simulated setting was weak (R = 0.20, P = 0.195).
• Residents scored higher in the simulated setting compared to the clinical environment.
• A strong correlation was found between clinical experience and CARS scores in the lab (R = 0.65, P = 0.005), but not in simulation (R = 0.11, P = 0.353).

Conclusions:

• The link between simulated and actual CA performance is not linear.
• The novel CA rating scale (CARS) appears to be a valid tool for assessing proficiency in the catheterization laboratory.
• Simulator familiarity may lead to an overestimation of proficiency, warranting cautious interpretation of simulator performance as a predictor of clinical skill.