Jorio Mascheroni1, Lluís Mont2, Martin Stockburger3, Ashish Patwala4, Hartwig Retzlaff5, Anthony G Gallagher6. 1. College of Medicine and Health, University College Cork, Western Road, Cork T12 K8AF, Ireland; Department of Cardiac Rhythm Training & Education, Medtronic International Trading Sàrl, Route du Molliau 31, 1131 Tolochenaz, Switzerland. 2. Department of Cardiology, Hospital Clinic, Universitat de Barcelona, IDIBAPS, C/Villarroel 170, 08036 Barcelona, Spain. 3. Department of Cardiology and Internal Medicine, Havelland Kliniken, Ketziner Straße 21, 14641 Nauen, Germany; Department of Cardiology and Angiology, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10255 Berlin, Germany. 4. Department of Cardiology, University Hospital of North Midlands, Newcastle Road, Stoke-on-Trent ST4 6QG, United Kingdom. 5. Alpenstrasse 14a, D-82194 Groebenzell, Germany. 6. Faculty of Life and Health Sciences, Ulster University, Magee Campus, Northland Rd, Londonderry BT48 7JL, United Kingdom; ASSERT Centre, College of Medicine and Health, Brookfield Health Sciences Complex, College Rd., University College Cork, Cork T12 K8AF, Ireland. Electronic address: anthonyg.gallagher@btinternet.com.
Abstract
AIMS: Pacing and Cardiac Resynchronization Therapy (CRT) procedural training for novice operators usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee ability to perform required tasks at predetermined performance levels prior to in-vivo practice. We sought to characterize and validate with experts a reference approach to pacing/CRT implants based on objective and explicit performance quality metrics, for the development of a reproducible, simulation-based, training curriculum aiming to operator proficiency. METHODS: Three experienced CRT implanters, a behavioural scientist and two engineers performed a detailed task deconstruction of the pacing/CRT procedure and identified the performance metrics (phases, steps, errors, critical errors) that constitute an optimal CRT implant for training purposes. The metrics were stress tested to determine reliability and score-ability and then subjected to detailed systematic review by an international panel of 15 expert implanters in a modified Delphi process. RESULTS: Thirteen procedure phases were identified, consisting of 196 steps, 122 errors, 50 critical errors. The expert panel deliberation added 16 metrics, deleted 12, and modified 43. Unanimous panel consensus on the resulting CRT procedure metrics was obtained, which verified face and content validity. CONCLUSION: A reference pacing/CRT procedure and metrics created by a core group of experts accurately characterize the essential components of performance and were endorsed by an international panel of experienced peers. The metrics will underpin quality-assured novice implanter training.
AIMS: Pacing and Cardiac Resynchronization Therapy (CRT) procedural training for novice operators usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee ability to perform required tasks at predetermined performance levels prior to in-vivo practice. We sought to characterize and validate with experts a reference approach to pacing/CRT implants based on objective and explicit performance quality metrics, for the development of a reproducible, simulation-based, training curriculum aiming to operator proficiency. METHODS: Three experienced CRT implanters, a behavioural scientist and two engineers performed a detailed task deconstruction of the pacing/CRT procedure and identified the performance metrics (phases, steps, errors, critical errors) that constitute an optimal CRT implant for training purposes. The metrics were stress tested to determine reliability and score-ability and then subjected to detailed systematic review by an international panel of 15 expert implanters in a modified Delphi process. RESULTS: Thirteen procedure phases were identified, consisting of 196 steps, 122 errors, 50 critical errors. The expert panel deliberation added 16 metrics, deleted 12, and modified 43. Unanimous panel consensus on the resulting CRT procedure metrics was obtained, which verified face and content validity. CONCLUSION: A reference pacing/CRT procedure and metrics created by a core group of experts accurately characterize the essential components of performance and were endorsed by an international panel of experienced peers. The metrics will underpin quality-assured novice implanter training.
Authors: Alexandre Mottrie; Elio Mazzone; Peter Wiklund; Markus Graefen; Justin W Collins; Ruben De Groote; Paolo Dell'Oglio; Stefano Puliatti; Anthony G Gallagher Journal: BJU Int Date: 2020-12-20 Impact factor: 5.588