Rigor of cardiac device implant training affects performance outcome

Abstract

Background

Cardiac Implantable Electronic Devices (CIED) training for novice implanters typically occurs in vivo, varies across institutions, and results in inconsistent skill levels. We previously demonstrated the superior effects of Proficiency-Based Progression (PBP) training on implanters' performance in a randomized controlled trial (RCT). Beforehand, we conducted a ‘pilot’ study to evaluate the robustness of PBP training, hypothesizing that a substantial majority of trainees would achieve the target proficiency after training.

Methods

In this international, prospective, single-arm study, novice implanters completed a metrics-based simulation training curriculum, requiring proficiency benchmark demonstration at each stage to advance. Trainees ultimately performed a cardiac resynchronization therapy implant on virtual reality simulation which was video-recorded and then scored using validated Metrics (Steps, Critical Errors, Errors non-critical) by independent assessors. The primary outcome was the number of trainees meeting the benchmark. Findings informed corrective actions for the subsequent RCT training, whose effectiveness was verified by comparing PBP-trained participants from the pilot study (PBP-PILOT) and the RCT (PBP-RCT) on Steps completed, All Errors, and benchmark achievement.

Results

Only 17 % achieved the proficiency benchmark. Investigations revealed insufficient faculty adherence to the PBP methodology resulting in premature trainee advancement. Corrective actions improved the subsequent RCT training: compared to the PBP-PILOT group, PBP-RCT trainees completed 15 % more Steps (p = .014), made 69 % fewer All Errors (p = .015), and 93 % met the benchmark (p < .001).

Conclusions

Pilot testing revealed deficiencies in PBP training execution, highlighting the importance of rigor and faculty compliance. Verifying novel curricula before large-scale implementation is crucial to ensuring robust training outcomes.