Simulation versus theoretical learning for the transradial approach: a randomized controlled trial in interventional cardiology

Authors

  • Aymen Noamen Hôpital militaire principal d’instruction de Tunis / Université Tunis El Manar / faculté de médecine de Tunis,
  • Ahmed Ben Amara Hôpital militaire principal d’instruction de Tunis / Université Tunis El Manar / faculté de médecine de Tunis,
  • Mokhles Lajmi Hôpital militaire principal d’instruction de Tunis / Université Tunis El Manar / faculté de médecine de Tunis,
  • Nadhem Hajlaoui Hôpital militaire principal d’instruction de Tunis / Université Tunis El Manar / faculté de médecine de Tunis,
  • Wafa Fehri Hôpital militaire principal d’instruction de Tunis / Université Tunis El Manar / faculté de médecine de Tunis,

Keywords:

Simulation, training, learning, teaching, radial artery, vascular access, coronarography, evaluation, stress.

Abstract

Introduction : Simulation-based education (SE) in interventional cardiology improves knowledge acquisition and mastery of procedures
including the conventional radial access (CRA).
Aim: To evaluate the contribution of SE in CRA compared with theoretical learning alone.
Methods : This is a prospective randomized controlled study including cardiology residents and patients with normal radial pulses. Experienced residents as well as patients with contraindications to CRA, requiring urgent intervention, or with hemodynamic instability were not
included. Missing the teaching sessions was the exclusion criteria. Residents were randomized into two groups: simulation versus control.
They attended a theory lecture explaining CRA and were evaluated Only the simulation group attended an SE session with measurement
of heart rate (HR) and stress level. A real application was then performed with measurement of HR and stress level. The primary outcome
was success puncture rate.
Resulats : The success of the puncture was similar between the two groups (p=0.651). In the practical application, the stress level was
significantly different before the procedure but similar after the end of the procedure. The stress level varied significantly within the same
group before and after the procedure The simulation group was significantly less tachycardic both before and during the procedure with a
significant difference between the two groups (p<10-3).
Conclusion: This study demonstrated the interest of SE in novice residents for CRA as a complement to theoretical learning upstream
of the real-life procedure.

Downloads

Download data is not yet available.

References

Pezel T, Coisne A, Picard F, Gueret P, French Commission of Simulation Teaching of the French Society of Cardiology. How simulation teaching is revolutionizing our relationship with cardiology. Arch Cardiovasc Dis. 2020;113(5):297‑302. DOI: 10.1016/j.acvd.2020.03.010

Okuda Y, Bryson EO, DeMaria S, et al. The utility of simulation in medical education: what is the evidence? Mt Sinai J Med N Y. 2009;76(4):330‑43. DOI: 10.1002/msj.20127

Pezel T, Coisne A, Bonnet G, et al. Simulation-based training in cardiology: State-of-the-art review from the French Commission of Simulation Teaching (Commission d’enseignement par simulation-COMSI) of the French Society of Cardiology. Arch Cardiovasc Dis. 2021;114(1):73‑84. DOI: 10.1016/j.acvd.2020.10.004

Gosai J, Purva M, Gunn J. Simulation in cardiology: state of the art. Eur Heart J. 2015;36(13):777‑83. DOI: 10.1093/eurheartj/ehu527

Jp C, H T, E B, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. Eur Heart J; 2021;42(14). DOI: 10.1093/eurheartj/ehaa575

Kolkailah AA, Alreshq RS, Muhammed AM, Zahran ME, El‐Wegoud MA, Nabhan AF. Transradial versus transfemoral approach for diagnostic coronary angiography and percutaneous coronary intervention in people with coronary artery disease. Cochrane Database Syst Rev. John Wiley & Sons, Ltd; 2018;(4). DOI: 10.1002/14651858.CD012318.pub2

Mahmoudi A, Noomen F, Nasr M, Zouari K, Hamdi A. [Evaluation of residency training in general and digestive surgery in Tunisia]. Pan Afr Med J. 2015;21:328. DOI: 10.11604/pamj.2015.21.328.6604

Naouar S, Binous MY, Braiek S, El Kamel R. Training of Tunisian future urologists: how to improve it ? Tunis Med. 2018;96(7):401‑4.

Zairi I, Mzoughi K, Mrad IB, et al. Intérêt de la simulation dans l’apprentissage du raisonnement clinique The value of simulation in learning clinical reasoning. Tunis Med. 2020; 98 (06) : 466-9.

Ahmed HB, Ouanes I, Allouche E, Chetoui A, Ouechtati W, Bazdeh L. Évaluation du stress généré par un exercice de simulation haute-fidélité chez des étudiants en médecine Assessement of stress induced by high-fidelity simulation sessions among medical students. Tunis Med. 2020;98(05) : 363-7.

Ben Amara A, Noamen A, Anouar Y, Chenik S, Hajlaoui N, Fehri W. Evaluation of the Distal Radial Approach in percutaneous coronary interventions. Controlled, randomized non-inferiority trial. Tunis Med. 2022;100(3):192‑202.

Gauthier J, Bouchard S. Adaptation canadienne-française de la forme révisée du State–Trait Anxiety Inventory de Spielberger. Can J Behav Sci Rev Can Sci Comport. 1993;25(4):559‑78. DOI: 10.1037/h0078881

Yuan HB, Williams BA, Fang JB, Ye QH. A systematic review of selected evidence on improving knowledge and skills through high-fidelity simulation. Nurse Educ Today. 2012;32(3):294‑8. DOI: 10.1016/j.nedt.2011.07.010

Fischer Q, Sbissa Y, Nhan P, et al. Use of Simulator-Based Teaching to Improve Medical Students’ Knowledge and Competencies: Randomized Controlled Trial. J Med Internet Res. 2018;20(9):e261. DOI: 10.2196/jmir.9634

Henriksen MJV, Wienecke T, Kristiansen J, Park YS, Ringsted C, Konge L. Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety. Neurology. 2018;90(21):981‑7. DOI: 10.1212/WNL.0000000000005556

Bauer C, Rimmelé T, Duclos A, et al. Anxiety and stress among anaesthesiology and critical care residents during high-fidelity simulation sessions. Anaesth Crit Care Pain Med. 2016;35(6):407‑16. DOI: 10.1016/j.accpm.2016.01.004

Gurm HS, Sanz-Guerrero J, Johnson DD, et al. Using simulation for teaching femoral arterial access: A multicentric collaboration. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2016;87(3):376‑80. DOI: 10.1002/ccd.26256

Okano H, Mayumi T, Kataoka Y, et al. Outcomes of Simulation-Based Education for Vascular Access: A Systematic Review and Meta-Analysis. Cureus. 2021;13(8):e17188. DOI: 10.7759/cureus.17188

Oh EJ, Lee J-H, Kwon EJ, Min JJ. Simulation-based training using a vessel phantom effectively improved first attempt success and dynamic needle-tip positioning ability for ultrasound-guided radial artery cannulation in real patients: An assessor-blinded randomized controlled study. PloS One. 2020;15(6):e0234567. DOI: 10.1371/journal.pone.0234567

Harrison CM, Gosai JN. Simulation-based training for cardiology procedures: Are we any further forward in evidencing real-world benefits? Trends Cardiovasc Med. 2017;27(3):163‑70. DOI: 10.1016/j.tcm.2016.08.009

Popovic B, Pinelli S, Albuisson E, et al. The Simulation Training in Coronary Angiography and Its Impact on Real Life Conduct in the Catheterization Laboratory. Am J Cardiol. 2019;123(8):1208‑13. DOI: 10.1016/j.amjcard.2019.01.032

Prenner SB, Wayne DB, Sweis RN, Cohen ER, Feinglass JM, Schimmel DR. Simulation-based education leads to decreased use of fluoroscopy in diagnostic coronary angiography. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2018;91(6):1054‑9. DOI: 10.1002/ccd.27203

Yang L, Li Y, Liu J, Liu Y. Effect of vascular simulation training on practice performance in residents: a retrospective cohort study. BMJ Open. 2020;10(9):e037338. DOI: 10.1136/bmjopen-2020-037338

Hale C, Crocker J, Vanka A, Ricotta DN, McSparron JI, Huang GC. Cohort study of hospitalists’ procedural skills: baseline competence and durability after simulation-based training. BMJ Open. 2021;11(8):e045600. DOI: 10.1136/bmjopen-2020-045600

Joshi A, Wragg A. Simulator Training in Interventional Cardiology. Interv Cardiol Lond Engl. 2016;11(1):70‑3. DOI: 10.15420/icr.2016.11.1.70

Weber U, Zapletal B, Base E, Hambrusch M, Ristl R, Mora B. Resident performance in basic perioperative transesophageal echocardiography: Comparing 3 teaching methods in a randomized controlled trial. Medicine (Baltimore). 2019;98(36):e17072. DOI: 10.1097/MD.0000000000017072

Ferrero NA, Bortsov AV, Arora H, et al. Simulator training enhances resident performance in transesophageal echocardiography. Anesthesiology. 2014;120(1):149‑59. DOI: 10.1097/ALN.0000000000000063

Hernández-Padilla JM, Granero-Molina J, Márquez-Hernández VV, Cortés-Rodríguez AE, Fernández-Sola C. Efeitos de um workshop de simulação sobre a competência em punção arterial de estudantes de enfermagem. Acta Paul Enferm. Escola Paulista de Enfermagem, Universidade Federal de São Paulo; 2016;29:678‑85. DOI: 10.1590/1982-0194201600095

Kikuchi M, Asao T, Tokumine J, et al. A novel system for teaching the in-plane vascular access technique: A simulation study. Medicine (Baltimore). 2021;100(37):e27201. DOI: 10.1097/MD.0000000000027201

Additional Files

Published

2023-06-07

Issue

Section

Original articles