Haptic Simulation in Cerebral Angiography: Establishing New Clinical Competency Targets
Abstract
As medical education and specialty training continues to move in the direction of competency-based training, assisted with the progression of simulation-based modules, the importance of establishing objective assessment parameters and performance metrics is becoming more clear. Currently, interventionalist training focusing on endovascular skills in cerebral angiography (an imaging procedure used to diagnose and treat stroke and vascular disorders), continues to rely on quantity of clinical experience rather than its quality, and has lagged in developing objective performance markers. Immersive, realistic, and haptically-accurate simulators have been developed in this field for the purposes of training future expert interventionalists, however, their utility has been washed out due to a poor understanding of transferrable clinical skills and performance markers to be used in medical fellowship programs.
This dissertation assessed the perceived competencies and operational obstacles observed by neurointerventionalists to inform an assessment of diagnostic and interventional skills which can be developed in simulation-based training. Inquiry into clinically significant steps in cerebral angiography revealed a relationship between clinical procedural tasks which were rated to be highly important and risky, such as those associated with vascular navigation and aneurysm coiling. The results of our studies suggest that navigational skills in simulation-based diagnostic angiography training could be improved with independent practice. Furthermore, navigational competency was strongly linked to mental rotation ability, the lack of which could be supplemented with visual assistance overlay tools. Most importantly, the data suggests that independent training of neurointerventional skills, such as aneurysm coiling, in simulation-based training may be an effective method of complementary training with minimal resources, as improvement in aneurysm coiling quality and pace was observed in simulation.
Using objective assessments of targeted skillsets in simulation-based training can alleviate the training burden in neurointerventional radiology and provide performance metrics to improve training standards while minimizing resource waste, including both attending clinician resources and operating room use for training.