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Prospective, randomised and blinded comparison of proficiency-based progression full-physics virtual reality simulator training versus invasive vascular experience for learning carotid artery angiography by very experienced operators
  1. Christopher U Cates1,
  2. Lars Lönn2,
  3. Anthony G Gallagher1,3
  1. 1Division of Cardiology, School of Medicine, Vascular Intervention, Emory University Hospital, Atlanta, Georgia, USA
  2. 2Department of Radiology and Vascular Surgery, National Hospital, Copenhagen University, Copenhagen, Denmark
  3. 3ASSERT Centre, School of Medicine, University College Cork, Cork T12 DX01, Ireland
  1. Correspondence to Professor Anthony G Gallagher, ASSERT Centre, School of Medicine, University College Cork, Room 2.103B School of Medicine, Brookfield Health Sciences Complex, Cork, Ireland; ag.gallagher{at}


Introduction We assessed the transfer of training (ToT) of virtual reality simulation training compared to invasive vascular experience training for carotid artery angiography (CA) for highly experienced interventionists but new to carotid procedures.

Methods Prospective, randomised and blinded.

Setting Catheterisation and skills laboratories in the USA.

Participants Experienced (mean volume=15 000 cases) interventional cardiologists (n=12) were randomised to train on virtual reality (VR) simulation to a quantitatively defined level of proficiency or to a traditional supervised in vivo patient case training.

Outcome measures The observed performance differences in performing a CA between two matched groups were then blindly assessed using predefined metrics of performance.

Results Experienced interventional cardiologists trained on the VR simulator performed significantly better than their equally experienced controls showing a significantly lower rate of objectively assessed intraoperative errors in CA. Performance showed 17–49% ToT from the VR to the in vivo index case.

Discussion This is the first prospective, randomised and blinded clinical study to report that VR simulation training transfers improved procedural skills to clinical performance on live patients for experienced interventionists. This study, for the first time, demonstrates that VR simulation offers a powerful, safe and effective platform for training interventional skills for highly experienced interventionists with the greatest impact on procedural error reduction.

  • Simulation
  • virtual reality
  • transfer of training
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