Device Training & Medical Education from Volcano Peripheral Vascular

Neil Hattangadi MD (Executive VP/General Manager, Peripheral Vascular & Global Clinical Affairs)
David Goodman (Associate Director, Global PV Market Development)
Paul Khait (Senior Director, Clinical Sales Training & Medical Education)

The medical device industry plays an important role in the ongoing education of physicians, nurses, and clinical staff. At Volcano Corporation, we have invested significant resources into medical education, employing many of our best people to think about how to most efficiently deliver appropriate and actionable content to our customers.

Almost three years ago, Volcano created a dedicated Peripheral Vascular business unit. Our goal was to expand use of our diagnostic technologies in Peripheral procedures—principally with Intravascular Ultrasound (IVUS).  IVUS penetration is estimated today to be only ~5% of Peripheral procedures globally.  We have targeted applications where IVUS has demonstrated clinical utility, such as aortic dissection/aneurysm repair[1], peripheral arterial disease stenting[2]/atherectomy, and deep venous intervention[3]. We have also moved into selected therapeutic categories where close coupling of image guidance can improve the workflow. For example, the Pioneer Plus™ Re-Entry catheter utilizes IVUS to more precisely enter the true lumen from the subintimal space, beyond a stenotic lesion[4]. Also, we have recently received regulatory approval to commence the IDE trial of Lumifi™, which will investigate the use of on-board IVUS visualization to place the Crux™ Vena Cava Filter without the need for adjunctive fluoroscopy[5].

Volcano has focused on three pillars to grow our Peripheral franchise: innovative product development, new data generation through clinical trials, and best-in-class device training and medical education. In each application we target, training of both the physician and associated staff is critical, as multiple individuals are simultaneously involved in performing IVUS during a case. There are several areas of complexity, including the IVUS image (what am I seeing?), the console (how do the buttons work? how do I use the software features?), and the overall procedure workflow (how does the information provided by IVUS change my decision making?).

When formulating our medical education strategy at Volcano, we think carefully about the learning curve.  The goal is to bring a customer from initial point of interest to a level of competence and confidence where they can deliver safe and quality care. For each indication, we call this the “Clinical Pathway,” drawing from the same term used to describe the standardization of a patient’s clinical course to improve consistency of outcomes[6]. Depending on where our customers are on the Clinical Pathway for a particular indication, we have created a variety of programs to address varying levels of understanding, as well as different channels to deliver content. Many interventionalists are seeing IVUS content on their Board examinations/recertifications, driving interest in our programs.

We have launched the Volcano Academy as our medical education brand that focuses on the following five areas:

  1. Establish Volcano Centers of Excellence to create partnerships with key healthcare facilities, interventionalists, and their staff. Programs include didactic lectures and dinner programs, live case observation, and peer-to-peer preceptorship programs.

A recent program focused on Office Based Venous and Arterial Interventions with the following learning objectives:

  • Understanding the feasibility and the economics of performing office based interventions for both arterial and venous interventions
  • Understanding the role of IVUS in iliac venous compression and chronic venous insufficiency
  • Understanding IVUS utilization in peripheral arterial interventions
  • Observing 2 – 4 office-based cases

The goal of this type of program is to provide an opportunity for attendee physicians to interact with their peers and see how they successfully manage patients with our technologies, in this case in the Physician Office Lab.

  1. Invest in E-learning programs to give our customers the flexibility to learn about our products when it’s convenient for them. Examples include online training modules, archived cases on websites such as www.beyondangio.com, IVUS image atlases, and interactive iPad apps (IVUS in EVAR/TEVAR launched in 2012, app for deep venous intervention coming soon).
  1. Expand our ability to provide web-based or telemedicine educational opportunities. These limit the need for travel and increase the frequency and reach of our educational programs. We conduct multiple live webinars each year, allowing an interventionalist to present cases and solicit questions from a global audience. We are also developing ways to broadcast live from OR’s and cath labs, to do live case presentations easily and inexpensively relative to what is done at the major conferences.
  1. Invest in simulation technologies to provide hands-on experiences. We use benchtop training models to simulate real IVUS usage. We also utilize computer simulation technologies that replicate the tactile feedback of actual human use.
  1. Establish nurse/technologist “super users.” To reduce the dependence on our sales reps, we have established dedicated training programs for the laboratory technical staff. They learn the console “buttonology” and use of more advanced software features. Feedback from this program has shown significant reduction in time and anxiety from IVUS use during a case.

In the area of deep venous intervention, our educational efforts have gone beyond skill set training and clinical workflows to more general disease awareness, as most of the pathology goes undiagnosed. We have created Practice Development resources for education of patients, referring physicians, and wound care centers. In addition, while the role of IVUS in diagnosing iliac venous compression has been well accepted, raising awareness around this data has been a priority for us.

Alongside our own programs, we take advantage of educational opportunities in conjunction with conferences/tradeshows, including symposia, hands-on workshops and Fellows programs.  These are efficient uses of resources delivered to highly motivated customers who are actively seeking out this type of education.

Volcano has trained over a thousand physicians, nurses and technologists since the inception of its Peripheral business unit.  We constantly seek feedback to improve and refine our programs to provide the best possible educational experience for our customers.  Please feel free to reach out to us with any comments or suggestions (Dgoodman@volcanocorp.com).  To participate in one of Volcano’s educational program please contact your local Volcano sales representative.

 

[1] Pearce BJ, Jordan WD Jr. Using IVUS during EVAR and TEVAR: improving patient outcomes. Semin Vasc Surg 2009;22(3):172-80. Hoshina K, Kato M, Miyahara T, Mikuriya A, Ohkubo N, Miyata T. A retrospective study of intravascular ultrasound use in patients undergoing endovascular aneurysm repair: its usefulness and a description of the procedure. Eur J Vasc Endovasc Surg 2010;40(5):559-63.

[2] Iida O, Takahara M, Soga Y, Suzuki K, Hirano K, Kawasaki D, Shintani Y, Suematsu N, Yamaoka T, Nanto S, Uematsu M. Efficacy of intravascular ultrasound in femoropopliteal stenting for peripheral artery disease with TASC II class A to C lesions. J Endovasc Ther 2014;21(4):485-92.

[3] McLafferty RB. The role of intravascular ultrasound in venous thromboembolism. Semin Intervent Radiol 2012;29(1):10-5.

[4] Liang GZ, Zhang FX. Novel devices and specialized techniques in recanalization of peripheral artery chronic total occlusions (CTOs)--a literature review. Int J Cardiol. 2013;165(3):423-9.

[5] Lumifi™ is not commercially available, and is under investigational study only.

[6] Panella, M. "Reducing clinical variations with clinical pathways: do pathways work?". Int J Qual Health Care 2003; 15 (6): 509–21.

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