Abstract
PurposeSimulators are increasingly used in the training of endovascular procedures; however, for the use of the Mentice vascular interventional system trainer (VIST) simulator in neuroradiology, the validity of the method has not yet been proven. The study was carried out to test the construct validity of such a simulator by demonstrating differences between beginner and expert neurointerventionalists and to evaluate whether a training effect can be demonstrated in repeated cases for different levels of experience.MethodsIn this study 4 experts and 6 beginners performed 10 diagnostic angiographies on the VIST simulator (Mentice AB, Gothenburg, Sweden). Of the cases four were non-recurring, whereas three were repeated once and ten subjects performed all tasks. Additionally, another expert performed only five non-recurring cases. The simulator recorded total time, fluoroscopy time, amount of contrast medium and number of material changes. Furthermore, gaze direction and heart rate were recorded, and subjects completed a questionnaire on workload.ResultsBeginners and experts showed significant differences in total duration time, fluoroscopy time and amount of contrast agent (all p < 0.05). Gaze direction, dwell time and heart rate were similar between both groups. Only beginners improved during training with respect to total duration time, fluoroscopy time and amount of contrast agent. If a case was previously known to them, the total duration and fluoroscopy time were significantly shortened (p < 0.001).ConclusionThis study demonstrated both the construct validity of a diagnostic neuroangiography simulator as well as a significant training effect for beginners. Therefore, in particular beginner neurointerventionalists should use such simulation tools more extensively in their initial training.
Highlights
Heart rate and viewing direction did not differ between experts and beginners in the cases
We were able to show the effectiveness of such a simulator by directly measuring significant improvements in psychomotor skills of beginners in cases derived from real patient anatomy. This is in line with previous studies on different scenarios, such as carotid artery stenting [13, 18] and several infra-aortic applications [9, 17] and addresses one major concern regarding neuroangiographic simulations: In 2008, Carroll and Messenger stated that “medical simulation has made the transition from an experimental technology to the clinical world”, and that “perhaps the most pressing issue [...] regarding medical simulation is validation” [27]
Construct validity of a high-tech simulator could be demonstrated for diagnostic neuroangiography and especially beginners showed a measurable training effect through repeated practice
Summary
The second aim of the study was to quantify improvements of different quality measures of a diagnostic neuroangiography, resulting from repeated simulator training
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