Centre for Clinical Education, University of Copenhagen and Capital Region, Denmark.
Catheter Cardiovasc Interv. 2011 Sep 1;78(3):387-93. doi: 10.1002/ccd.22812. Epub 2011 Mar 8.
Current guidelines in cardiology training programs recommend 100-300 coronary angiography procedures for certification. We aimed to assess the number of procedures needed to reach sufficient proficiency.
Procedure time, fluoroscopy time, dose area product (DAP), and contrast media volume were used as indicators of quality of performance. We analyzed data from 4,200 coronary angiographies. Performance curves of seven trainees were compared with recommended reference levels and to those of seven interventional cardiologists.
On average, the number of procedures needed for trainees to reach recommended reference levels was estimated as 226 and 353, for DAP and use of contrast media, respectively. After 300 procedures, trainees' procedure time, fluoroscopy time, DAP, and contrast media volume were significantly higher compared with experts' performance, P < 0.001 for all parameters. To approach the experts' level of DAP and contrast media use, trainees need 394 and 588 procedures, respectively. Performance curves showed large individual differences in the development of competence.
On average, trainees needed 300 procedures to reach sufficient level of proficiency, and this is in accordance with current guidelines. However, because of large individual differences, performance curves might be useful in monitoring individual trainees' progress and ensure documentation of sufficient competence when dealing with patients at risk.
心脏病学培训计划中的现行指南建议进行 100-300 次冠状动脉造影术以获得认证。我们旨在评估达到足够熟练程度所需的手术次数。
将手术时间、透视时间、剂量面积乘积 (DAP) 和对比剂用量用作性能质量的指标。我们分析了 4200 例冠状动脉造影术的数据。将七名学员的绩效曲线与推荐的参考水平以及七名介入心脏病专家的绩效曲线进行比较。
平均而言，学员达到推荐的参考水平所需的手术次数估计为 226 和 353，分别为 DAP 和对比剂使用。在进行 300 次手术后，学员的手术时间、透视时间、DAP 和对比剂用量均明显高于专家的表现，所有参数的 P 值均<0.001。为了接近专家的 DAP 和对比剂使用水平，学员分别需要进行 394 和 588 次手术。绩效曲线显示出在能力发展方面存在较大的个体差异。
平均而言，学员需要进行 300 次手术才能达到足够的熟练程度，这与现行指南一致。然而，由于个体差异较大，绩效曲线可能有助于监测个别学员的进展，并在处理高危患者时确保充分能力的记录。
