『From Impression to Evidence: Proficiency-Based Progression for Cardiac Device Implanters | E11 Dr Jorio Mascheroni』のカバーアート

From Impression to Evidence: Proficiency-Based Progression for Cardiac Device Implanters | E11 Dr Jorio Mascheroni

From Impression to Evidence: Proficiency-Based Progression for Cardiac Device Implanters | E11 Dr Jorio Mascheroni

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Guest: Dr Jorio Mascheroni, biomedical engineer, with a Master's in Technology Enhanced Learning and a PhD on how best to implant cardiac resynchronisation therapy (CRT) devices. Jorio has spent his career in the medical device industry, where he develops and validates training for cardiac device implanters. Interviewed by: Professor Anthony G. Gallagher Topic: Moving the Learning Curve Away from the Patient: Proficiency-Based Progression for Cardiac Device Implantation Episode Summary Professor Tony Gallagher talks with Dr Jorio Mascheroni, a friend and collaborator of around 20 years, about a career spent trying to make device training safer and more effective. Jorio was there when cardiac resynchronisation therapy was introduced and saw early on that getting specific steps right, and avoiding specific mistakes, decided whether a procedure went well. The conversation traces how training moved from knowledge-based courses and "learning on patients", through the early days of virtual reality simulators, to a proficiency-based progression (PBP) programme with validated metrics and a benchmark that every trainee must reach before moving on. Jorio shares what his randomised trials found, why the approach does not take longer or cost more over time, and why he would change one thing above all: everyone should start in a protected environment and only then move to the operating room. Key Topics Covered Introducing Dr Jorio Mascheroni (0:00) An engineer who moved into education, with a Master's in Technology Enhanced Learning and a PhD on optimal CRT implantationTwenty years of working togetherFrom Engineer to Educator: The Arrival of CRT (0:34) Witnessing the introduction of cardiac resynchronisation therapy, a completely new type of procedureWorking with the pioneers and realising that performing certain steps properly and avoiding mistakes determined successEarly involvement in building a virtual reality simulator for CRT, and the chance to move training away from the patientTraining 25 Years Ago: Impression, Not Data (2:55) Training was mostly knowledge-based and theoreticalPhysicians learning a new procedure were, and still often are, learning on patientsDifferent experts taught different content and techniques for the same procedureNobody measured what trainees had actually learned: "we had an impression that people were getting better"Simulators: From Room Decoration to a Standard Workflow (6:51)Early simulators were often "the attraction of the training event"Use ranged from decoration to the first attempts at standardising a procedural workflowBringing the pioneers together to agree an optimal approach, and why a group of experts beats a single speaker telling their own storyWas Simulation Seen as a Magic Bullet? (10:04)Industry valued simulation for demonstrating product workflow in a safe settingEffectiveness depended on the faculty delivering the training"Simulators by themselves don't teach much if there is no solid curriculum around"Shared Shortcomings Across Industry and Medicine (11:54)Underestimating the size of skill gaps and taking foundational skills for grantedTraining differed from one hospital to the next, even for the same therapySpeaker-centred training: "listening to an expert does not mean that you become an expert"Learning curves happening on patients in the clinical environmentAn Accumulation of Evidence (15:04)No single turning point: evidence built up that different techniques produced different patient outcomesThe way you teach someone to do something may determine the outcome for the patientReading Tony's work on minimally invasive surgery and realising the approach could apply to device implantationThe aggregation of marginal gains, and why it sits at the core of proficiency-based progressionRelated reading: Gallagher AG, Ritter EM, Champion H, et al. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Annals of Surgery, 2005; 241(2): 364 to 372 What Pacing and CRT Are (21:22)Treatments for selected patients with cardiac rhythm abnormalitiesA generator placed under the skin of the chest, connected to the heart through implanted leadsPermanent pacing has been around for about 70 years; CRT for 25 to 30 yearsWhere Device Training Fell Short (23:41)Challenge one: training or coaching in the cath lab is too late, and it is not fair for the learning curve to happen on a patientChallenge two: many interpretations of optimal implantation, never compared, varying between countries and even neighbouring hospitalsLicensed physicians finishing training with wide variability in performanceComplications that looked like technology problems were often a suboptimal use of the technologyTony on the surgical side of device procedures: femoral access complications in carotid stenting at Emory in 2003, and the same complications two decades later with TAVRPublication: Mascheroni J, Stockburger M, Patwala A, ...
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