US_cardio_Herzeele.qxp 17/7/08 09:42 Page 42
Interventional Cardiology
Figure 1: The Angio Mentor™ Ultimate and a Trainee Report Table 1: Qualities of the Ideal Surgical Assessment Tool
43
Recorded by the Simulator
Feasibility A measure of whether something is capable of
being done or carried out.
Validity Face validity The extent to which the examination resembles
real-life situations.
Content validity The extent to which the domain that is being
measured is measured by the assessment tool—
for example, while trying to assess technical
skills we may actually be testing knowledge.
Construct validity The extent to which a test measures the trait
that it purports to measure. One inference of
construct validity is the extent to which a test
discriminates between various levels of expertise.
Concurrent validity The extent to which the results of the
assessment tool correlate with the gold
standard for that domain.
Predictive validity The ability of the examination to predict future
performance.
Reliability Test–re-test A measure of a test’s ability to generate similar
results when applied at two different points.
Inter-rater A measure of the extent of agreement between
two or more observers when rating the
performance of an individual.
of VR simulation, a demonstration of reliability, feasibility, and validity is
necessary (see Table 1).
So far, most papers have sought to demonstrate the face and construct
available: the Angio Mentor Express and the Angio Mentor Mini (see Figure 1). validity of renal and carotid modules of the VIST simulator (see Table 2).
The SimSuite
®
(Medical Simulation Corporation, Colorado, US) is the largest The assessment studies carried out by the EVEREST members differed
simulator, with up to six interactive screens to facilitate multidisciplinary team from other studies as they did not include medical students but only
training. Similarly to the Angio Mentor, adverse events and response to physicians with the appropriate medical background in treating these
physiology feature substantially in the simulation. Additionally, the full process lesions.
19,20
Furthermore, in the CAS assessment study, only experienced
of patient care, patient history, physical assessment, and other diagnostic tests interventionalists were included in order to respect the guidelines of
is presented, allowing the clinician to formulate a diagnosis and treatment international societies who stated that CAS should be performed only by
plan. The treatment of SFA occlusions and placement of cardiac valves are now physicians who have at least acquired basic endovascular skills.
simulated by this system in addition to the existing modules. Nevertheless, our study, similar to other papers, has shown that more
experienced interventionalists perform a CAS procedure more quickly,
The CathLabVR™ Surgical Simulator (formerly the Endovascular press the fluoroscopy pedal less often, and perform fewer angiograms to
AccuTouch
®
System, Immersion Medical, Maryland, US) not only boasts complete the intervention.
19–24
Thus, the VIST simulator can objectively
peripheral and coronary simulation modules with metrically based differentiate between levels of CAS experience in experienced
assessments, but also allows you to manage cardiac rhythm diseases, interventionalists based on these automatically recorded quantitative
replace cardiac valves, and implant cardiac pacemaker leads. assessment parameters.
Validation of the Virtual Reality Simulators The difficulty is that a therapist who performs a procedure quickly and uses
The first flight simulator, invented in 1929 by Edward Link, was not fully little radiation is not always a good interventionalist.
25,26
To overcome this
adopted until nearly 15 years after it was developed. During the last 75 criticism, simulator companies assess technical performance not only using
years, substantial amounts of money have been invested, ensuring that it quantitative assessment parameters, but also using more clinically relevant
became as effective and sophisticated as it is today. No controlled trials parameters (endovascular tools, residual stenosis, stent/vessel ratio, etc.) and
were required to prove the effectiveness of these simulators. Pioneered in error scoring (movement of embolic protection device after deployment). To
the 1980s, surgical simulation is still not widely accepted, principally our knowledge, only the study from the EVEREST members has attempted to
because of scepticism within the medical community and the lack prove the construct validity of these metrics of quality of performance.
20
of validation studies. Prior to assessment or training of physicians, the
validity of these simulators needs to be demonstrated. It is incorrect to Although most would agree that efficiency, precision, and avoidance of
assume that a realistic simulation (face validity) equates to an effective errors are qualities that reflect technical skill in the interventional suite,
training or assessment model.
18
In addition to developments in the realism few have attempted to develop reliable and valid measurements of these
42 US CARDIOLOGY
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84