As co-founders of UKETS (www.ukets.org), this blog entry highlights our experiences over the past 12 months. Endovascular simulation remains an exciting and evolving field yet its implementation globally is highly varied.  

We hope this blog encourages dialogue internationally on the needs of early stage endovascular practitioners and how simulation can more effectively be integrated into training.

UKETS stands for U.K Endovascular Trainees. We’re a new cross specialty (radiology, vascular surgery, cardiology) training group that focuses on the basics of safe endovascular practice. Our mantra is “safe access, safe navigation, safe closure”. We believe the fundamental principles of endovascular intervention are the same no matter what your chosen specialty. Our mission is to ensure every trainee learns these basic skills on a simulator before practicing on real patients.

Our journey over the past 12 months has been exciting and enlightening and we wanted to share some of our experiences – in particular the challenges to endovascular simulation.

As residents in radiology and vascular surgery, we initially intended to create a small local group of trainees interested in endovascular intervention. We advertised a free meeting which focused on endovascular simulation. We were astounded by the level of interest. Residents around the country are hungry for basic endovascular training. Unlike other specialities that cater specifically to early stage learning e.g The Royal College of Surgeons of England: “Basic Surgical Skills”, the choices for people interested in endovascular practice are limited and the traditional apprenticeship style of learning prevails. Many endovascular simulation-based courses exist across Europe, but all assume these basic skills have already been established.

Responding to the overwhelming interest for our group, we piloted a cross specialty endovascular training course using high fidelity simulation. We restricted our intake to just 35 residents from radiology, vascular surgery or cardiology. A series of short introductory lectures were quickly followed by hands-on, expert led simulation training, in small groups, centred on the fundamental principles of endovascular practice: “safe access, safe navigation, safe closure”! Feedback was overwhelmingly positive and a sample video of the event can be seen at: http://vimeo.com/54162246

UKETS are running two further basic skills training events in March 2013 (http://ukets.org/events/)

Our experience so far has highlighted two key practical challenges to endovascular simulation. We believe addressing these are essential to maintaining safe endovascular practice.

Simulator availability – 74% of our trainees had never used an endovascular simulator. Yet the majority came from renowned vascular centres that have their own endovascular simulators. On further inspection we have established that very few centres have dedicated 24 hour access to a simulator. Instead, the majority of these simulators remain locked up in a cupboard.

While we understand the need to protect simulators and the logistical challenges to running a dedicated 24 hour simulation facility, the nature of resident working hours is such that access to simulation availability needs to be flexible. Examples where this is already happening e.g The University of Michigan, Clinical Simulation Centre (http://www.med.umich.edu/umcsc/services/facilities.html) is a testament to the fact 24 hour access is possible.

Curriculum Integration – Where does simulation fit into endovascular training? While the evidence for this type of simulation is growing, its official integration into training program curricula is lacking. More lessons can be learned from the aviation industry, where simulation is an integral part of training – pilots can’t fly without meeting specific simulator requirements. Trainees are required to show evidence of their competences which is traditionally done by logging cases on real patients. We suggest trainees should also be integrating their endovascular simulation experience as evidence of career progression. Pilots talk about their number of simulator and flight hours, why don’t interventionalists do the same?

Dr. Sebastian Mafeld
Mr. Craig Nesbitt

The UKETS