Development and validation of a proficiency-based progression simulation training curriculum for novice cardiac device implanters

Cardiac Implantable Electronic Device (CIED) procedural training for novice operators usually happens in-vivo from the very first attempts. Curriculum structure and implant techniques often differ among teaching centres. Competence level is classically associated to number of cases performed and time spent in training. Furthermore, skill assessment relies on supervisors’ individual judgement. Patients should be assured of a verified and measurable quality of treatment that should not vary greatly as a function of physician experience. To ensure an objective, predetermined proficiency level is reached prior to in-vivo practice, training requires a specific system of measurement for performance to be developed and adopted as a standard. Such training approach is known as Proficiency-based progression (PBP). Published results have shown that PBP trainees perform ~60% better than their conventionally trained peers in various domains of procedural medicine (Mazzone et al, Annals of Surgery. 2021;274(2):281–9). The PBP method has never been applied to cardiac interventions. The general hypothesis of this project is that a PBP approach to novice cardiac device implanter simulation training results in superior operator performance compared to traditional simulation training. The characterization of a reference device implant procedure, the intraoperative performance metrics definitions and their validation were performed by the PhD candidate earlier, in preparation of this project. This project aims to 1) develop a PBP (simulation) training curriculum to supplement institutional training for novice pacemaker/defibrillator/CRT implanters, and 2) demonstrate the superior implant performances of PBP-trained vs traditionally trained operators in a simulated environment prior to in-vivo practice.