Endovascular skills training and assessment.

Objective: Evolving endovascular therapies have transformed the management of vascular disease. At the same time, the increasing use of non-invasive vascular imaging techniques has reduced the opportunities to gain the required basic wire and catheter handling skills by performing diagnostic catheterizations. This article reviews the evidence for alternative tools currently available for endovascular skills training and assessment.

Methods: A literature search was performed on PubMed using combinations of the following keywords; endovascular, skills, training, simulation, assessment and learning curve. Additional articles were retrieved from the reference lists of identified papers as well as discussion with experts in the arena of medical education.

Results: Available alternatives to training on patients include synthetic models, anesthetized animals, human cadavers and virtual reality (VR) simulation. VR simulation is a useful tool enabling objective demonstration of improved skills performance both in simulated performance and in subsequent in-vivo performance. Assessment modalities reviewed include time action analysis, error analysis, global rating scales, procedure specific checklists and VR simulators. Assessment in training has been widely validated using VR simulation. Rating scales and checklists are presently the only assessment modalities that have demonstrated utility outside the training lab.

Conclusion: The tools required for a structured proficiency based endovascular training curriculum are already available. Organization of training programs needs to evolve to make full use of modern simulation capability for technical and non-technical skills training.