A technical and cognitive skills evaluation of performance in interventional cardiology procedures using medical simulation

Introduction: Interventional cardiology, with large numbers of complex procedures and potentially serious complications, stands out as an obvious discipline in which to apply simulation to help prevent medical errors. The objective of the study was to determine whether it is feasible to develop a valid and reliable evaluation approach using medical simulation to assess technical and cognitive skills of physicians performing coronary interventions. Methods: Clinical case scenarios were developed by a committee of subject matter experts, who defined key decision nodes, such as stent positioning, and introduced unanticipated complications, such as coronary perforation. Subjects were 115 physicians from 10 U.S. healthcare institutions at three levels of expertise: novice, skilled, or expert. Subjects completed a questionnaire, one practice case and six test cases on a SimSuite simulator (Medical Simulation Corporation, Denver, CO), and an opinion survey. Clinical specialists rated subjects' procedural skills. Results: A technical and cognitive skills evaluation of performance in interventional cardiology procedures using medical simulation yielded results that distinguished between a novice group and skilled or expert groups (P < 0.001) and scores correlated moderately with clinical specialist ratings of subjects' procedural skills and with number and complexity of procedures performed in practice during the previous year. Approximately 90% of subjects generally thought that the cases were well simulated and presented situations encountered in practice. Conclusions: This study suggests that an evaluation approach using high-fidelity medical simulation to assess technical and cognitive skills of physicians performing interventional cardiology procedures can be used to identify physicians who are extremely poor performers and not likely to be providing appropriate patient care. We believe that use of a high-fidelity simulator incorporating situations with multiple events, immediate feedback, and high sensory load would complement the results of traditional written examinations of medical knowledge to provide a more comprehensive assessment of physician ability in interventional cardiology.