Online Training for Carotid Stenting Professionals

This online Carotid Education and Stenting Course was developed with four key physician consultants — an interventional cardiologist, a neurosurgeon, an interventional radiologist and a vascular surgeon. Why was it important to take a cross-specialty approach in developing the modules in this program?

Carotid artery stenting is unique in that it is a procedure performed by multiple specialties, each bringing a specific skill set and cognitive features into play. The challenge is to funnel these varying areas of expertise down to a common entry point and provide a pathway for CAS training and credentialing. The goal is to have all physicians approach the procedure with a similar set of skills, cognitive abilities and understanding of procedural issues. Without input from multiple societies and multiple specialties, it would be difficult to understand the strengths and weaknesses for the requirements of each specialty.

What was your role in developing the modules, and what is Swedish Heart Institute's role as the CME provider?

My primary role as a trainer with Boston Scientific has been to serve as the author of many of the modules and to review content. In addition to my work on these online modules, I oversee coursework for physicians who come to Swedish Heart Institute for specific didactic training and hands-on training, as well as simulation training. Our simulation training, sponsored by Boston Scientific, is a foundation course for many people who are interested in CAS but are still in the early stages of expertise. The provision of CME is critically important to the overall process of credentialing for a hospital because many of the requirements, at least societal documents, will stipulate a number of CME hours required, in addition to other specific hands-on training.

What components are included in the online training modules?

The modules include all the key components of CAS including anatomy, case reviews, imaging and diagnostic skills, patient selection, understanding and managing complications, technology and more. Because of the multiple specialties performing CAS, it is not enough to train on just the anatomy and the technology. Why is it important to bring all of those components together in online training? Again, it has to do with the various entry points of the different specialties. For example, it may be redundant for a surgeon to hear about the disease process of carotid stenosis, but for an interventional cardiologist it may be relatively new territory or territory that needs to be refreshed. Alternatively, for an interventional radiologist the tools and skills sections may be redundant, but for a vascular surgeon it may be new ground. In order to homogenize the entry point for various specialties, it is important that all these elements are included.

For whom were the modules designed, and what is the value for each type of audience?

The Boston Scientific training modules were created for two audiences. The modules were primarily created for the physician at a level that would be appropriate for credentialing and training. However, they were also designed with lab staff personnel in mind so that they would have a better understanding of the procedure and an enhanced knowledge of the carotid anatomy and the tools used to treat carotid disease. They are an important part of any successful procedure.

Would referring physicians benefit from this online training program?

Yes. I think there are certain components of the training program that would be very interesting for referring physicians, specifically the background information about carotid clinical studies, both surgical and stenting, the prevention and management of carotid disease and imaging. Information about these topics would be very useful to many referring physicians because it would make their referrals more appropriate and their testing more efficient.

Where do you see this fitting into a physicians’ CAS training regimen? For example, would it follow PVD training but precede a simulation training program?

If a physician is already an interventionalist in surgery, radiology or cardiology and they have the requisite skill set, the first step would be to acquire peripheral endovascular credentialing and privileging within their institution. They should have some level of competence and some standard volume of interventions that is reasonably met, that is, a practice in peripheral vascular care. Second, the physician must have a pathway to CAS credentialing within their institution, which would probably include some sort of certification from the manufacturers and some didactic CME accreditation, which is where these modules fit in nicely. Therefore, the modules are a second tier of specific CAS training for physicians who already have expertise in peripheral endovascular intervention. The third step would be to gain simulation experience. Simulation provides an opportunity that has not existed as broadly before in new-device training. It allows new operators to learn about anatomy, tools and some of the complications that might be encountered prior to doing live cases. A major benefit of simulation is that a procedure can be halted without any downside to a patient, and a mentor can discuss various options within the procedure.

How can participants gain access to the modules and start using them?

Participants can gain access to the modules by going directly to Swedish Medical Center’s website (www.swedish.org) or through a link to Swedish Medical Center’s website via Boston Scientific’s website, www.bostonscientific.com.

Online Carotid Education and Stenting Course

1. Introduction to Carotid Artery Disease and Stroke 2. Diagnosis of Carotid Artery Disease 3. Treatment of Carotid Artery Disease 4. CAS Patient Selection 5. Carotid Stenting Procedure 6. CAS Procedure “Online Simulation” 7. Carotid Angiography Case Review

Online Training Module Content Development Team

William Gray, MD, Interventional Cardiologist, Director of Endovascular Care, Swedish Heart Institute/Swedish Medical Center, Seattle, Washington Nicholas Hopkins, MD , Professor of Neurosurgery, Chair, Department of Neurosurgery, State University of New York in Buffalo, New York Barry Katzen, MD, Founder and Medical Director of Miami Cardiac & Vascular Institute, Voluntary Professor of Radiology, University of Miami Baptist Health Systems of South Florida, Miami, Florida Michael Silva, MD, Professor and Chief of Vascular Surgery and Vascular Interventional Radiology, Texas Tech University Health Sciences Center, Lubbock, Texas