Subjects
Very experienced (or senior) interventional cardiologists (SICs) and mid-level experienced (or Trainee) interventional cardiologists participated in this study. Demographic profiles are reported in Table 1.
Table 1.
The study apparatus comprised of, 1) a full-physics high-fidelity simulator (Mentice VIST-Lab 11 with VIST G5 software) to simulate angiography patient cases; 2) an additional LCD display screen which facilitated the secondary task which was used to assess attentional capacity of subjects during procedural performance, and 3) eye tracking glasses (SMI) to measure eye gaze behavior during the additional stimulus task (to compute latencies between the stimulus appearing and the subject’s gaze towards it and identifying the stimulus) and previously described in detail (Figure 1).15
The Phases of the interventional cardiology procedure (i.e., coronary angiography) were, i.e., 1) advancing the catheter and wire toward the Right Coronary Artery (RCA), 2) engaging with the ostium of the RCA and then 3) Imaging the RCA;4) advancing the catheter and wire toward the Left Anterior Descending (LAD), 5) engaging with the ostium of the LAD and then 6) Imaging the LAD.
Figure 1 A & B.
Informed and consented Senior and senior Trainee (from the Irish national training program) interventional cardiologists recruited at the ASSERT Centre, University College Cork. Data were collected at ASSERT and Ethical approval was granted at both University College Cork and Ulster University (FCEEFC20160630). All methods were carried out in accordance with relevant guidelines and regulations of University College Cork and Ulster University. Informed consent was obtained from all participants
Participants completed the same VR simulated coronary angiographic procedure twice. During the first procedure, the subjects performed a secondary task and verbally acknowledge the appearance of an ‘Ace of Spades’ playing card when it appeared on the LCD screen by saying the word ‘card’. The Ace of Spades card was displayed for 2s in 20 seconds window however, the position of the card in each presentation was randomly assigned using a random number generator.
During the second procedure, the subjects were asked to verbally acknowledge the appearance of a ‘Queen of Hearts’ (QH) card when it appeared on the LCD screen by saying the word ‘heart’. However, in this condition a different playing card appeared every 2s. A QH playing card was guaranteed to appear once in each 20 second window (Figure 1A & B.)
The secondary playing card identification task used to measure attentional capacity was based on the works of Shannon and Weaver 16 and Smith.17 According to Smith,17 a playing card elicits a total of 5.7 bits of information processing. Hence, given that the first stimulus task displays one card every 20 seconds, this task elicited 17.1 bits of information per minute. In contrast, given that the second stimulus task comprises of 20 cards per minute, it elicited 171 bits per minute providing 10 times more information compared to the first task. More details about the experimental setup can be found in our previous publication.18