Simulation-based training in cardiovascular intervention and cardiac surgery: bridging skill, safety, and innovation

The increasing complexity of cardiovascular procedures, regulatory constraints, and heightened patient safety requirements have necessitated a fundamental transformation in medical education of interventional cardiology and cardiac surgery beyond traditional apprenticeship models. A comprehensive review of simulation-based training (SBT) in cardiovascular medicine and surgery was conducted, analysing evidence from 2020 to 2025 across multiple databases and incorporating data from systematic reviews, randomized controlled trials, and international surveys. SBT demonstrates significant educational benefits with moderate to large effect sizes across all training domains. Meta-analyses of over 6000 participants show technical skill improvements of 20%-40%, medical error reduction of 51%, and large effect sizes for skill acquisition (Cohen's d = 0.85-2.2). Contemporary platforms, including virtual reality, haptic feedback systems, and artificial intelligence-powered adaptive, learning achieve high simulation accuracy for complex procedures. Despite proven efficacy, implementation of SBT faces barriers including cost ($50 000-$200 000 per high-fidelity system) and limited access, with 71% of practitioners reporting insufficient simulation exposure. SBT represents a paradigm shift in cardiovascular education, offering standardized, patient risk-free environments for technical skill development. While evidence demonstrates improved procedural competency and knowledge acquisition with SBT, the critical gap remains in demonstrating direct patient outcome improvements. Future integration of artificial intelligence, digital twins, and personalized learning platforms promises to further transform training in interventional cardiology and cardiothoracic surgery.