Open Access Research article

The role of a simulator-based course in coronary angiography on performance in real life cath lab

Ulf J Jensen16*, Jens Jensen2, Göran Olivecrona3, Gunnar Ahlberg4, Bo Lagerquist5 and Per Tornvall1

Author Affiliations

1 Cardiology Unit, Karolinska Institutet, Department of Clinical Research and Education Södersjukhuset, Stockholm, Sweden

2 Department of Medicine, Sundsvall-Härnösand County Hospital, Karolinska Institutet, Stockholm, Sweden

3 Department of Coronary Heart Disease, Skåne University Hospital, Lund University, Lund, Sweden

4 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

5 Uppsala Clinical Research Centre, Department of Medical Sciences, Uppsala University, Sweden

6 Department of Cardiology, Södersjukhuset, Stockholm 118 83, Sweden

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BMC Medical Education 2014, 14:49  doi:10.1186/1472-6920-14-49

Published: 12 March 2014



The aim of this study was to explore if a course consisting of lectures combined with simulator training in coronary angiography (CA) could accelerate the early learning curve when performing CA on patients.

Knowledge in performing CA is included in the curriculum for the general cardiologist. The method, according to American College of Cardiology and European Society of Cardiology guidelines, for this training is not well defined but simulator training is proposed to be an option. However, the transfer effect from a CA simulator to performance in real world cath lab is not validated.


Fifty-four residents without practical skills in CA completed the course and 12 continued to training in invasive cardiology. These residents were tracked in the Swedish Coronary Angiography and Angioplasty Registry and compared to a control group of 46 novel operators for evaluation of performance metrics. A total of 4472 CAs were analyzed.


Course participants demonstrated no consistent acceleration in the early learning curve in real world cath lab. They had longer fluoroscopy time compared to controls (median 360 seconds (IQR 245–557) vs. 289 seconds (IQR 179–468), p < 0.001). Safety measures also indicated more complications appearing at the ward, in particular when using the femoral approach (6.25% vs. 2.53%, p < 0.001).


Since the results of this retrospective non-randomized study were negative, the role of a structured course including simulator training for skills acquisition in CA is still uncertain. Randomized transfer studies are warranted to justify further use of simulators for training in CA

Learning curve; Simulator; Performance; Coronary angiography