Cardiovascular Business - September/October 2008 - (Page 25) become accredited. Programs must first meet standards in one or more of three areas: assessment, research or education, which then allows them to seek additional accreditation in the areas of system integration and patient safety. Simulation is for real Much of the momentum for the acceptance of medical simulation training began in 2004. In that year, representatives from the Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Vascular Medicine and Biology (SVMB) and the Society for Vascular Surgery (SVS) met with the FDA behind closed doors and in public to promote the technique. An FDA panel voted that year to accept a proposal that “virtual reality simulation would be an important component of a training package for carotid stenting” (JAMA 2004;292:3024-3026). The FDA then approved the Cordis carotid stent system, with the proviso that the manufacturer would work with physician trainers to “learn catheter and wire handling skills on a high-fidelity virtual reality simulator.” Also in 2004, SCAI, SVMB and SVS included medical simulation in a joint competency statement and the Centers for Medicare & Medicaid Services elected to reimburse for carotid stenting. Giora Weisz, MD, and colleagues at the Cardiovascular Research Foundation and Columbia University in New York confirmed that simulation could reliably discriminate between different levels of experience. Their stated aim in the study was to provide a mechanism that could assess competency in performing percutaneous endovascular carotid stenting. They tested 34 operators—10 expert, 12 intermediate, and 12 novice— on Simbionix equipment and concluded that simulation training has the potential to be an objective examination tool. They further stated that their results “justify the use of interventional cardiovascular simulation for certification and credentialing” (J Soc Sim Healthcare 2007;2[1]:81). Weisz’s findings, at least on the expert level, were confirmed by Simon Neequaye, MD, and colleagues at Imperial College London. Researchers evaluated 11 experienced endovascular physicians from several medical disciplines with minimal ex- “the skills required for the practice of modern procedurebased medicine are frequently so difficult to learn that traditional training is no longer acceptable, and learning on patients is increasingly suboptimal.” anthony G. Gallagher, PhD; Christopher U. Cates, MD (JaMa 2004;292:3024-3026) perience in carotid artery stenting, using Simbionix simulation equipment. They observed a total procedure time decline from a median of 36 to 20 minutes; a drop in fluoroscopy time from 20 to 11 minutes; and a decrease in delivery-retrieval time of the embolic protection device from 12 to nine minutes. The study was presented at the 2007 European Society for Vascular Surgery meeting in Madrid, Spain. At the 2008 American College of Cardiology conference, 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. “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. CardiovascularBusiness.com Cardiovascular Business 25 http://CardiovascularBusiness.com
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