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Rigor of cardiac device implant training affects performance outcome.

Jorio Mascheroni1, Martin Stockburger2, Ashish Patwala3

  • 1Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Cardiac Rhythm Management Training & Education, Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland.

International Journal of Cardiology
|March 29, 2025
PubMed
Summary

Proficiency-Based Progression (PBP) training for cardiac device implants showed initial execution flaws. After improvements, PBP training significantly enhanced trainee performance and benchmark achievement in a subsequent trial.

Keywords:
CIED implantCardiac resynchronization therapyMetricsPacingProficiency-based progressionTraining

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Area of Science:

  • Medical Education
  • Surgical Simulation
  • Cardiac Implantable Electronic Devices (CIED)

Background:

  • Current Cardiac Implantable Electronic Devices (CIED) training for novice implanters is inconsistent and institution-dependent.
  • Proficiency-Based Progression (PBP) training demonstrated superior effects in a prior randomized controlled trial (RCT).
  • A pilot study was conducted to assess the robustness of PBP training before a larger RCT.

Purpose of the Study:

  • To evaluate the effectiveness and robustness of a metrics-based simulation training curriculum for novice CIED implanters.
  • To identify deficiencies in PBP training execution and implement corrective actions.
  • To compare the performance of trainees from the pilot study (PBP-PILOT) with those from a subsequent RCT (PBP-RCT).

Main Methods:

  • Novice implanters underwent a simulation-based PBP curriculum, requiring benchmark proficiency at each stage.
  • Trainees performed a virtual reality cardiac resynchronization therapy implant, video-recorded and scored on Steps, Critical Errors, and Non-critical Errors.
  • The primary outcome was the number of trainees achieving the proficiency benchmark; performance was compared between PBP-PILOT and PBP-RCT groups.

Main Results:

  • Only 17% of trainees in the pilot phase achieved the proficiency benchmark due to insufficient faculty adherence.
  • Corrective actions led to significant improvements in the subsequent RCT.
  • PBP-RCT trainees completed 15% more Steps, made 69% fewer All Errors, and 93% achieved the benchmark compared to PBP-PILOT (p < 0.001).

Conclusions:

  • Pilot testing highlighted critical deficiencies in PBP training execution, emphasizing the need for strict adherence and faculty compliance.
  • Rigorous verification of novel curricula is essential before large-scale implementation to ensure effective training outcomes.
  • The study underscores the importance of simulation-based PBP training for improving CIED implantation skills.