Simulation training best for high-risk procedures

Simulation training prior to carotid stenting procedures could help reduce complication rate.

Training on patient-like medical simulators allows physicians to refine their skills without putting actual patients at risk.

Representatives of courses offered through Medical Simulation Corp. of Denver compare the experience to a pilot training on a flight simulator. Doctors with experience on the system told Cardiology Today that they agree with this analogy.

“Flight simulators mitigate the potentially huge consequence of pilot error. With these medical simulation systems, their highest value is when the risk of the procedure is highest,” said Mark Burket, MD, medical director of the cardiovascular laboratory at Medical University of Ohio.

Burket has directed a medical simulations course at his institution and plans to do these courses four times a year. The company provides the technology and consultants, and the university sets aside a two-day time block for the courses.

“It’s a really nice bridge between lecture format and strictly observation with no hands on and the other end — actually doing a procedure. So this really is a middle ground where there’s no risk to the patient,” Burket said.

SimSuite

The SimSuite Education System is the centerpiece product of Medical Simulation Corp.

The device is designed to provide experience on a simulated patient, which includes a presentation of patient history, a required diagnosis and an opportunity for self-assessment based on procedure outcome and post-procedure care planning.

According to company materials, the system couples advanced fluoroscopic imaging with superior haptics, or the science of touch. The software is based on actual patient scenarios written by medical experts.

“The system has a lot of variability. We had done live cases on pigs several months prior to using this system, and this was much better than the animal model because with the animals you can’t add any variation to the situation,” said Howard Cowen, MD, director of cardiac intervention at Lenox Hill Hospital.

Reducing errors

According to the Joint Commission for the Accreditation of Healthcare Organizations, the top two reasons for medical errors from 1995 to 2002 were lack of communication and lack of training. According to the American College of Cardiology, 50% of interventional cardiologists and 32% of institutions do not meet the minimum guidelines for procedure competency.

“One example of the problem is carotid stenting. This is a stenting procedure for cardiologists that is kind of an extension of what they already do, but the technique and the choice of equipment is very different, and the training issues for these sorts of technologies are very difficult.

I believe that the simulation training prior to doing these sorts of procedures would greatly reduce the complication rate,” Sherman Sorenson, MD, director of the catheterization laboratory at the Utah Heart Clinic, told Cardiology Today.

Sorenson has participated in training courses with the SimSuite system. “With new devices and new technologies there’s not often a training option,” Sorenson said.

“Simulation technology provides an opportunity for physicians who are treating patients and already in practice, because obviously these people can’t go back to a fellowship.” – by Jeremy Moore