Virtual reality training in coronary angiography and its transfer effect to real-life catheterisation lab

Selected in EuroIntervention by S. Brugaletta



Jensen UJ, Jensen J, Ahlberg G, Tornvall P


EuroIntervention. 2016 Apr 20;11(13):1503-10


20 April 2016


Read the abstract

My Comment

What is known

Mentor-based training on patients is the gold standard for skills acquisition in coronary angiography (CA). Stepwise progression from a standby operator to a solo CA interventionalist takes a long time and is associated with an increased number of complications for the patient and radiation exposure for the patient and the cath-lab staff. Simulators are proposed as being of value in skills acquisition in the present European Society of Cardiology (ESC) guidelines. Despite the presence of simulators for training in coronary interventions for a decade, none has demonstrated transferability from virtual reality (VR) to the real world in a randomised setting in beginners. The present study evaluated if proficiency-guided simulator-based training would accelerate learning when starting real-world CA.

Major findings 

  • Sixteen senior cardiology residents were randomised to proficiency-based VR training or control. Two consecutive CAs were performed on patients.
  • Skills metrics and errors were compared between the groups.
  • Thirty-two CAs were performed under the supervision of an experienced interventionalist. VR-trained residents practised for a mean of 10 hours in a CA simulator.
  • In real life, the VR-trained group had shorter fluoroscopy and total procedure times than the controls (median 558 vs. 842 seconds, p=0.003 and 1,356 vs. 1,623 seconds, p=0.032, respectively). The controls had a higher error score (median 27 vs. 15, p=0.002) and a lower performance score (median 47 vs. 68, p=0.006) than the VR-trained residents.

My comment

The present paper, which does not show any scientific data on patients, is of particular interest for the young community and for their mentors, showing that preparatory proficiency-based CA training in VR resulted in a superior real-life performance when added to conventional mentor-based training regarding quality and safety. Unfortunately, VR training is not much accessible not only in hospitals, due to its high cost, but even in cardiology congresses, where a long queue does not allow every fellow a training. This paper, showing the potential benefits of VR training, suggests incorporating it in the core curriculum for interventional cardiologists. In the technological era of virtual reality where we are living, we should think about it.

What is your experience about simulators? What do you think about its routinely use for fellows?

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