Immersive clinical simulation for assessment of ultrasound-guided pericardiocentesis procedures for trainees

Mbonye, K. A.; Mills, H.; Barakat, K.

Introduction It is well documented that part-task trainers are highly effective in practical skills training, including pericardiocentesis. 1 2 However, the use of immersive simulation to create high-fidelity clinical scenarios for summative assessment of pericardiocentesis is a novel approach. Cardiology trainees in the UK are expected to demonstrate Level 3 competency (perform the procedure unsupervised and deal with complications) in pericardiocentesis in order to meet the curriculum requirements to achieve their Certificate of Completion of Training (CCT). Given the high risk of complications associated with pericardiocentesis, it is now increasingly performed by interventional cardiologists in specialist centres, resulting in fewer opportunities for trainees to observe and practice this procedure during their training. This has become more apparent during the COVID-19 pandemic when normal clinical activities were largely put on hold, resulting in an increase in demand for simulation-based training and assessment of practical procedures. Methods Four cardiology trainees attended a series of two teaching sessions held 1 month apart which involved an immersive simulated scenario on the management of a patient with life-threatening cardiac tamponade. This included a period of teaching from a qualified trainer, followed by an observed assessment whereby trainees attended to a simulated patient and initiated relevant treatment, including successfully performing pericardiocentesis whilst interacting with colleagues and the patient. The procedure was performed using an 'Ultrasound Guided Pericardiocentesis Simulator' and a patient actor. Trainees were assessed using the Joint Royal Colleges Physician Training Board (JRCPTB) Directly Observed Procedures (DOPS) proforma for pericardiocentesis. The assessment comprised of 9 different domains graded (A-F), and a point score (1-6) was assigned according to their level of competency, generating an overall assessment score out of 54 points and mean score out of 6 points. Results Three out of the 4 trainees improved their mean assessment scores by an average of 22% in subsequent sessions (figure 1). Trainee 1 was already fully competent on initial assessment (initial mean score 6/6), demonstrated sustained competency throughout subsequent assessments and consequently fulfilled their training requirements for pericardiocentesis. Conclusion Immersive simulation is an effective, low-risk and high-fidelity method of training and assessment of pericardiocentesis for cardiology trainees. Although additional trainee data will be required to comprehensively validate it as an effective assessment tool for pericardiocentesis, during times where clinical experience is limited, immersive simulation can be an essential alternative training tool to allow trainees to meet requirements for their training and maintain clinical competencies.