Abstract
BackgroundSimulation-based medical education (SBME) is growing as a powerful aid in delivering proficient skills training in many specialties. Cerebral angiography (CA), a spatially and navigationally challenging endovascular procedure, can benefit from SBME by training targetable skills outside of the Angiosuite. In order to standardize and specify training requirements, navigational challenges and needs have to be identified. Furthermore, to enable successful adoption of these strategies, simulation adoption barriers, such as necessity of supervisory resources, must be reduced. In this study, we assessed the navigational challenges in simulated CA through a self-guided novice training program.MethodsNovice participants (n = 14) received virtual reality (ANGIO Mentor, Simbionix) diagnostic cerebral angiography training and were tested on a right middle cerebral artery aneurysm case over 8 sessions with a reference instructional outline. The navigational trajectories for the guidewire and catheter were analyzed and rates in erroneous vessel access were analyzed. Participants were given a Mental Rotations Test (MRT) and were analyzed based on MRT performance.ResultsAfter 8 sessions, there was a significant (p < 0.05) reduction on navigational error prevalence. The L-SUB and L-CCA saw the biggest drop in erroneous access, whereas the R-ECA, the biggest consumer of error time, saw no changes in access frequency. Individuals with high MRT score performed much better (p < 0.05) than those with low MRT score.ConclusionsThrough self-guided simulation training, we demonstrated the navigational challenges encountered in simulated CA. To establish better assessments and standards in medical training, we can create self-guided training curricula aimed at correcting errors, enabling repetitive practice, and reducing human resource needs.
Highlights
Simulation-based medical education (SBME) is growing as a powerful aid in delivering proficient skills training in many specialties
Time spent in incorrect vessels All participants had significantly improved performance over 8 sessions by reducing their time spent in incorrect vessels (p < 0.05) while navigating through a diagnostic right middle cerebral artery (R-MCA) cerebral angiography case with both guidewire and catheter (Fig. 3)
Based on the participants’ first-session performance, accidentally entering the right external carotid (R-ECA) resulted in the highest amount of time wasted, compared to lower duration in left common carotid (L-CCA), L-SUB, and right vertebral (R-VERT)
Summary
Simulation-based medical education (SBME) is growing as a powerful aid in delivering proficient skills training in many specialties. One of the arguable strengths of SBME lies in creating a safe environment for trainees to make and learn from mistakes that would otherwise have been harmful for patients [1] This is Development of endovascular proficiency in CA requires multimodal acuity due to the limited visuospatial feedback—a distal guidewire tip is hard to navigate through the lumen of 3-dimensional vascular anatomy using temporally constrained 2-dimensional fluoroscopic imaging. One of the most established high-fidelity simulators available is the ANGIO Mentor from Simbionix This task-trainer has been shown to have construct validity [2], improve psychomotor learning [3], reduce procedure and fluoroscopy time [3,4,5], and enhance resident performance [6]. Introduction of SBME is generally limited by scarcity of human resources, logistical barriers, and laborious coordination [7], its lagging implementation in CA may be attributed to insufficient identification and standardization of targetable skills
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