Mascheroni Jorio, Mont Lluís, Stockburger Martin, Patwala Ashish, Retzlaff Hartwig, Gallagher Anthony G
College of Medicine and Health, University College Cork, Western Road, Cork T12 K8AF, Ireland; Department of Cardiac Rhythm Training & Education, Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland.
Department of Cardiology, Hospital Clinic, Universitat de Barcelona, IDIBAPS, C/Villarroel 170, 08036 Barcelona, Spain.
Int J Cardiol. 2020 May 15;307:48-54. doi: 10.1016/j.ijcard.2020.02.003. Epub 2020 Feb 3.
Pacing/cardiac resynchronization therapy (CRT) implant training currently lacks a common system to objectively assess trainee ability to perform required tasks at predetermined performance levels. The purpose of this study was to primarily examine construct validity and reliability, secondarily discriminative validity of novel intraoperative performance metrics, developed for a reference approach to training novice CRT implanters.
Fifteen novice and eleven experienced CRT implanters performed a 3-lead implant procedure on a virtual reality simulator. Performances were video-recorded, then independently scored using predefined metrics endorsed by an international panel of experts. First, Novice and Experienced group scores were compared for steps completed and errors made. Secondly, each group was split in two around the median score of the group and subgroup scores were compared.
The mean number of scored metrics per performance was 108 and the inter-rater reliability for scoring was 0.947. Compared with novices, experienced implanters completed more procedural Steps correctly (mean 87% vs. 73%, p = 0.001), made fewer procedural Errors (6.3 vs. 11.2, p = 0.005), Critical Errors (1.8 vs. 4.4, p = 0.004), and total errors (8.1 vs. 15.6, p = 0.002). Furthermore, the differences between the two Novice subgroups were 25% for steps completed correctly and 94% for total errors made (p < 0.001); the differences between the two Experienced subgroups were respectively 16% and 191% (p < 0.001).
The procedure metrics used in this study reliably distinguish novice and experienced CRT implanters' performances. The metrics further differentiated performance levels within a group with similar experience. These performance metrics will underpin quality-assured novice implanter training.
目前，起搏/心脏再同步治疗（CRT）植入培训缺乏一个通用系统来客观评估学员在预定表现水平上执行所需任务的能力。本研究的目的主要是检验为培训新手CRT植入者的参考方法所开发的新型术中表现指标的结构效度和信度，其次检验其区分效度。
15名新手和11名经验丰富的CRT植入者在虚拟现实模拟器上进行三导联植入手术。手术过程进行录像，然后使用国际专家小组认可的预定义指标进行独立评分。首先，比较新手组和经验丰富组在完成步骤和出现错误方面的得分。其次，每组围绕该组的中位数得分分为两组，并比较亚组得分。
每次手术的平均评分指标数量为108个，评分者间信度为0.947。与新手相比，经验丰富的植入者正确完成的手术步骤更多（平均87%对73%，p = 0.001），出现的手术错误更少（6.3对11.2，p = 0.005），严重错误更少（1.8对4.4，p = 0.004），总错误更少（8.1对15.6，p = 0.002）。此外，两个新手亚组在正确完成步骤方面的差异为25%，在总错误方面的差异为94%（p < 0.001）；两个经验丰富亚组在正确完成步骤方面的差异分别为16%和191%（p < 0.001）。
本研究中使用的手术指标能够可靠地区分新手和经验丰富的CRT植入者的表现。这些指标进一步区分了经验相似组内的表现水平。这些表现指标将为确保质量的新手植入者培训提供支持。
