From simulator to patient: transfer of procedural skills to practice in cardiac device implantation

Cardiac implantable electronic devices (CIED) training for novice implanters typically occurs in vivo, varies across countries/institutions, and results in inconsistent skill levels. Proficiency-based progression (PBP) simulation training-requiring attainment of expert-derived performance benchmarks before clinical practice-reduced procedural errors by 61-77% compared with traditional simulation-based training (SBT) in randomized simulation trials. This study aimed to quantify clinical skill transfer in CIED implantation for the first time, comparing in vivo deviations from expert-agreed optimal technique in early-career implanters previously randomized to PBP vs. SBT.

Prospective observational cohort study following participants from a prior multinational randomized simulation trial to assess transfer of training to clinical practice. Early-career implanters (≥20 prior pacemaker/defibrillator cases; limited CRT first-operator experience) reported the implant technique they applied in their first two routine clinical cases within 30 days of training, using a validated standardized performance metrics form assessing surgical and lead implantation steps. The primary outcome was the mean percentage of deviations from optimal technique per participant.Of 30 randomized participants, 21 (70%) submitted 42 case reports (10 PBP, 11 SBT). Baseline characteristics were similar, and case complexity did not differ between groups (P = 0.43). PBP trainees demonstrated 60% fewer procedural deviations than SBT trainees (mean [SD], 5.8% [3.8%] vs. 14.4% [9.1%]; P = 0.013).

Metrics-based PBP training was associated with significantly fewer procedural deviations from optimal CIED implant technique during early clinical practice compared with traditional simulation. These findings support benchmark-based simulation as a strategy to improve early clinical skill transfer in cardiac electrophysiology.