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Aptitude Predicts Endovascular Performance of Inexperienced Individuals Before and After Virtual Reality Training

Isabelle Van Herzeele^1,2, Kevin O'Donoghue¹, Rajesh Aggarwal^1, Frank Vermassen², Ara Darzi¹, HHG Eastcott³, Nicholas Cheshire.^1,3
1Imperial College London, London, United Kingdom;²Ghent University Hospital, Ghent, Belgium;³Regional Vascular Unit, London, United Kingdom.

OBJECTIVES: To evaluate virtual reality simulation for endovascular training of student doctors, to assess if benchmark levels of skill were reached and to determine whether perceptual, visuo-spatial and psychomotor aptitude correlated to technical endovascular performance.

METHODS: Twenty medical students received didactic and simulator training in endovascular treatment of renal artery stenosis (RAS). Each subject treated ten identical RAS. Performance data were recorded by the simulator. An interventionalist rated performance at the first and tenth session using generic and procedure-specific rating scales. Nine interventional radiologists treated the same RAS setting the benchmark level of skill. Organizational aptitude (map-planning), ability for image recall (Rey-Osterrieth), fine motor dexterity (FMD, Pegboard) and general motor ability (MIST-VR) of students were tested. Performance at initial session and plateau phase of their learning curve was correlated to the subjects’ perceptual, visuo-spatial and psychomotor aptitude (VSA).

RESULTS: Medical students exhibited a learning curve from initial to end performance for contrast usage (28 vs. 17 mls, p<0.001), procedure (medians: 2120 vs. 867 seconds, p<0.001) and fluoroscopy time (993 vs. 507 seconds, p<0.001). Both generic and procedure specific rating scales improved significantly (10 vs. 25, p<0.001; 8 vs. 17, p<0.001). End performance remained inferior to benchmark levels of skill (contrast volume 11 mls, p=0.011; procedure time 290 seconds, p<0.001; fluoroscopy time 152 secs, p<0.001). Significant correlations with FMD and initial and plateau session for fluoroscopy time (r=-0.564, p=0.01; r=-0.449, p=0.047) were noted. FMD also correlated with procedure specific scores at the initial session (r=0.607, p=0.006), though image recall correlated with generic skills at the end of training (r=-0.587, p=0.006).

CONCLUSIONS: Simulator-based training in endovascular skills improved performance in naïve individuals. A plateau in the learning process occurred but remained inferior to the performance of experienced interventionalists. However this study has demonstrated a significant correlation between endovascular technical skill and VSA. In addition to current selection mechanisms VSA may be useful to spot future interventionalists.

AUTHOR DISCLOSURES: I. Van Herzeele, Fund for Scientific Research – Flanders (FWO), Belgium; Boston Scientific Corporation, Natick, Nanterre, France; Mentice, Gothenburg, Sweden; Boston Scientific Corporation, Natick, Nanterrre, France; K. O'Donoghue, Mentice, Gothenburg, Sweden; Boston Scientific Corporation, Natick, Nanterre, France; R. Aggarwal, None; F. Vermassen, Boston Scientific Corporation, Natick, Nanterre, France; A. Darzi, None; H. Eastcott, None; N. Cheshire, Boston Scientific Corporation, Natick, Nanterre, France; Mentice, Gothenburg, Sweden.