Internal medicine board to evaluate competency through virtual reality
For the first time in its history, the American Board of Internal Medicine (ABIM) is incorporating medical simulation technology into its Maintenance of Certification program for interventional cardiologists.

The ABIM has teamed with Medical Simulation Corporation (MSC) of Denver, whose SimSuite technology replicates a real-life catheterization lab suite. The ABIM has developed five case scenarios that include common problems faced by interventional cardiologists. Physicians complete the interventional cardiology simulations on-site at one of MSC’s six SimSuite education centers or at conferences throughout the year.

In 2002, the ABIM realized that the method of testing in the future would involve some type of simulation, according to Amy Ketron, manager of clinical development for MSC. They evaluated several simulation companies and chose MSC, which then conducted a feasibility study with 120 interventional cardiologists to determine if simulation training would provide a valid method of measuring the differences in skill levels among cardiologists.

“We showed it could,” Ketron said.

At the recent American College of Cardiology conference in Chicago, MSC presented a simulated scenario that followed a patient suffering from an acute myocardial infarction from the onset of symptoms, through the EMS and ER process of care, and then to the cath lab for a cardiovascular intervention.

To simulate a patient in the field experiencing an AMI, presenters used SimMan, a human patient simulator from Laerdal Medical in Wappingers Falls, N.Y.

“A primary initiative in improving care of AMI patients is finding ways to speed the door-to-cath lab time with the overall goal of saving more heart muscle. Simulation training provides the ideal platform to address these challenges in a realistic environment,” said moderator Mark A. Turco, MD, director of the Center for Cardiac and Vascular Research at Washington Adventist Hospital in Takoma Park, Md.

A study by David L. Dawson, MD, and colleagues from the division of vascular and endovascular surgery at the University of California, Davis, found significant benefits to simulation training (J Vasc Surg 2007;45:149-54). Researchers trained nine vascular surgery residents over three days using simulation technology from MSC. Trainees also underwent didactic instruction, computer-based training and tabletop procedure demonstrations.

The curriculum covered arteriography and intervention for treatment of aortoiliac, renal and carotid artery disease. Each resident completed an average of 9.5 simulated endovascular cases.

Compared with performance early on day one, residents improved significantly in three categories:
  • total procedure time decreased 54 percent;
  • volume of contrast decreased 44 percent; and
  • fluoroscopy time decreased 48 percent.
The selection of catheters and stents also improved, and the average number of catheters used and stents deployed decreased, but this did not reach statistical significance.

Dawson and colleagues found that close faculty observation allowed identification of knowledge and skill shortcomings, including common problems with the selection of catheter, balloon and stent sizes; correct positioning of the sheath; and introprocedural monitoring.