High-Fidelity Simulation for Assessing Catheterization-Based Skills Among Trainees

Simulation-based training for coronary angiography has not been widely adopted, and an operator's skillset should be accurately reflected in a simulation-based task. The purpose of this study is to determine whether increasing levels of clinical experience were associated with improved performance and whether trainees' confidence improved with use of a high-fidelity simulator.

Physicians with different catheterization experience (internal medicine residents, first- through third-year cardiology fellows, interventional fellows, and attending interventional cardiologists) performed multiple coronary artery catheter engagements on a high-fidelity endovascular simulator. The primary outcome was coronary engagement time (from the ascending aorta to coronary). Trainees completed presimulation and postsimulation surveys assessing confidence in catheter engagement (10-point Likert scale: 1, no confidence; 10, supreme confidence).

Across 240 catheter engagements by 24 physicians, median coronary engagement time was 37 seconds (IQR, 22-64). Engagement times were longer on the right coronary artery (42 seconds [22-70]) than on the left (34 seconds [21-56]; P = .04). Engagement time decreased with increasing operator experience (P _trend < .001). Baseline confidence increased with training stage (P _trend < .001), and among all trainees combined, confidence in catheter engagement improved after simulation (6 [2-7] vs 7 [5-8]; P = .01).

Using a high-fidelity simulator, increasing operator experience was associated with less time to coronary catheter engagement. Simulation was associated with a significant increase in trainee confidence in performing coronary catheter engagement.