The Necessity of High-Fidelity Simulation in Cardiology Training Programs.

T he past decade of graduate medical education (GME) has been marked by several major changes, including duty hour restrictions (1) and the Institute of Medicine’s landmark paper “To Err Is Human” (2). The Institute of Medicine’s report suggested that nearly 100,000 patients died annually from preventable mistakes in hospitals, with an additional 1 million who were injured. This report propelled patient safety into the health care spotlight. Simultaneously, technological advancements have outpaced GME curricular innovations. Through medical school, residency, and fellowship, the old adage “see one, do one, teach one” has been recited over and over; yet, at each additional year of training, it is met with more cynicism. As training advances, the procedures become exceedingly more complex with attendant higher risk. Most cardiology fellows remember their first time performing a pericardiocentesis, floating a transvenous pacing wire, and wiring their first stenotic coronary artery. Hopefully, the majority of these events were completed free of complications. However, the level of concern and anxiety experienced by fellows, regarding patient safety and their competence to perform those tasks, are likely as vivid now as they were the day the procedure was performed. It is well documented that procedural risk is reduced with operator experience (3). We believe it is possible to reduce the procedural risk associated with novice operators by first demonstrating competency on high-fidelity simulators (4). Thus, we have begun a comprehensive integration of high-fidelity simulation into our core curriculum that includes both diagnostic and management components.