The CIRSE Simulator Task Force (CSTF) and the SIR Medical Simulation Task Force have issued a position statement in the January 2006 editions of CardioVascular and Interventional Radiology and Journal of Vascular and Interventional Radiology on the future of simulation devices in interventional radiology.
Dr Derek A Gould, Liverpool, UK, of the CIRSE Task Force, believes that emerging shortcomings in traditional apprenticeship training are reducing the opportunities for trainees in interventional radiology to acquire core catheter and guidewire skills.
The Cardiovascular and Interventional Radiological Society of Europe (CIRSE), the Society of Interventional Radiology (SIR) and the Radiological Society of North America (RSNA) have therefore established individual medical simulation task forces, as well as a joint task force. They have set out joint recommendations, also supported by the British Society of Interventional Radiologists (BSIR), on the development and use of medical simulation to train and assess IR:
1) Current generation simulator models may be suitable for gaining certain aspects of procedural experience, such as learning the correct sequence of procedural steps and selection of appropriate tools. Such learning may well be beneficial prior to performing procedures on patients. While there is growing evidence for their effectiveness in some areas, the utility of simulators for other aspects of training is currently unproven. In particular there is no existing evidence that catheter manipulation skills acquired on the simulator are transferable to actual clinical practice.
Therefore experience on a simulator cannot yet be regarded as equivalent to training involving performance of actual endovascular procedures in patients. Moreover, it should be self-evident that even a valid simulation that predicts transfer of a specific skill to the procedural setting has limits. It cannot supplant the experience, judgment and wisdom gained by managing real patients with serious conditions through their diagnoses, treatments and longitudinal follow-up. Therefore, we should remember that as training hours shorten, diagnostic workups become increasingly non-invasive, and trainees are exposed to dwindling numbers of actual clinical cases, we still must resist the temptation to consider procedural simulations and clinical experiences interchangeable. They are not. Simulation training may become a prerequisite for certification or credentialing, but it can never be a sufficient condition for either.
2) Training and assessment methods that use simulation should be developed and validated in close association with the statutory authorities responsible for certification:
a) Procedural tasks that require simulation should be carefully analysed by psychologists working with acknowledged subject matter experts in order to define metrics and critical performance indicators. The statutory bodies will ensure that these are relevant to their curricula and practice. These data should be made freely available as open source.
b) Test validation should include content, construct, concurrent and predictive validation with the objective of demonstrating transfer of trained skills to procedures in patients.
c) As the advancement in technology has the potential to outpace the validation effort, validation may have to be performed in a staggered parallel fashion.
There is the potential for simulation to
provide robust, high-quality training, and to represent a component of the objective certification of skills by statutory bodies. In this way, the patient can be assured of the interventional radiologist's proficiency and spared the early learning curve of novices. To achieve this will require
collaboration between the statutory organisations and the simulation industry. The named task forces aim to facilitate this process and to continue to stimulate informed discussion regarding the role of simulators, and standards for their use, in interventional radiology training.
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