Dayal Rajeev, Faries Peter L, Lin Stephanie C, Bernheim Joshua, Hollenbeck Scott, DeRubertis Brian, Trocciola Susan, Rhee Jason, McKinsey James, Morrissey Nicholas J, Kent K Craig
Department of Surgery, The New York-Presbyterian Hospital, Weill Medical College of Cornell University and Columbia College of Physicians and Surgeons, New York, NY 10021, USA.
J Vasc Surg. 2004 Dec;40(6):1112-7. doi: 10.1016/j.jvs.2004.09.028.
Computer simulation has been used in a variety of training programs, ranging from airline piloting to general surgery. In this study we evaluate the use of simulation to train novice and advanced interventionalists in catheter-based techniques.
Twenty-one physicians underwent evaluation in a simulator training program that involved placement of a carotid stent. Five participants were highly experienced in catheter-based techniques (>300 percutaneous cases), including carotid angioplasty and stenting (CAS); the remaining 16 participants were interventional novices (<5 percutaneous cases). The Procedicus VIST simulator, composed of real-time vascular imaging simulation software and a tactile interface coupled to angiographic catheters and guide wires, was used. After didactic instruction regarding CAS and use of the simulator, each participant performed a simulated CAS procedure. The participant's performance was supervised and evaluated by an expert interventionalist on the basis of 50 specific procedural steps with a maximal score of 100. Specific techniques of guide wire and catheter manipulation were subjectively assessed on a scale of 0 to 5 points based on ability. After evaluation of the initial simulated CAS procedure, each participant received a minimum of 2 hours of individualized training by the expert interventionalist, with the VIST simulator. Each participant then performed a second simulated CAS procedure, which was graded with the same scale. After completion, participants assessed the training program and its utility via survey questionnaire.
The average simulated score for novice participants after the training program improved significantly from 17.8 +/- 15.6 to 69.8 +/- 9.8 (P < .01), time to complete simulation decreased from 44 +/- 10 minutes to 30 +/- 8 minutes (P < .01), and fluoroscopy time decreased from 31 +/- 7 minutes to 23 +/- 7 minutes ( P < .01). No statistically significant difference in score, total time, or fluoroscopy time was noted for experienced interventionalists. Improvement was noted in guide wire and catheter manipulation skills in novices. Analysis of survey data from experienced interventionalists indicated that the simulated clinical scenarios were realistic and that the simulator could be a valuable tool if clinical and tactile feedback were improved. Novices also thought the simulated training was a valuable experience, and desired further training time.
An endovascular training program using the Procedicus VIST haptic simulator resulted in significant improvement in trainee facility with catheter-based techniques in a simulated clinical setting. Novice participants derived the greatest benefit from simulator training in a mentored program, whereas experienced interventionalists did not seem to derive significant benefit.
计算机模拟已被应用于从航空驾驶到普通外科手术等各种培训项目中。在本研究中，我们评估了使用模拟技术对新手和经验丰富的介入医师进行基于导管技术培训的效果。
21名医生参加了一个涉及颈动脉支架置入的模拟器培训项目评估。5名参与者在基于导管的技术方面经验丰富（>300例经皮手术），包括颈动脉血管成形术和支架置入术（CAS）；其余16名参与者为介入新手（<5例经皮手术）。使用了由实时血管成像模拟软件和与血管造影导管及导丝相连的触觉界面组成的Procedicus VIST模拟器。在接受关于CAS和模拟器使用的理论指导后，每位参与者进行了一次模拟CAS手术。专家介入医师根据50个具体的手术步骤对参与者的表现进行监督和评估，满分100分。根据能力，对导丝和导管操作的具体技术进行主观评分，范围为0至5分。在对初始模拟CAS手术进行评估后，每位参与者在专家介入医师的指导下，使用VIST模拟器接受至少2小时的个性化培训。然后每位参与者进行第二次模拟CAS手术，并使用相同的评分标准进行评分。完成后，参与者通过调查问卷评估培训项目及其实用性。
培训项目后，新手参与者的模拟平均得分从17.8±15.6显著提高到69.8±9.8（P<.01），完成模拟的时间从44±10分钟减少到30±8分钟（P<.01），透视时间从31±7分钟减少到23±7分钟（P<.01）。经验丰富的介入医师在得分、总时间或透视时间方面未发现统计学上的显著差异。新手在导丝和导管操作技能方面有改进。对经验丰富的介入医师的调查数据分析表明，模拟临床场景是真实的，如果改进临床和触觉反馈，模拟器可能是一个有价值的工具。新手也认为模拟培训是一次有价值的经历，并希望有更多的培训时间。
使用Procedicus VIST触觉模拟器的血管内培训项目在模拟临床环境中显著提高了学员使用基于导管技术的熟练程度。在有指导的项目中，新手参与者从模拟器培训中获益最大，而经验丰富的介入医师似乎没有获得显著益处。
