Simulation deficit in cardiology training: a missed opportunity for the modern trainee

Abstract

Cardiology training today exists in a paradox. As the specialty becomes more complex, particularly in procedural domains, the time and resources available to train new cardiologists have dwindled. Simulation has become an increasingly important component of modern cardiology training, offering a safe, structured and reproducible environment in which clinical skills can be developed and refined. The term simulation encompasses a broad spectrum of educational approaches, ranging from focused task training to high-fidelity scenario-based learning. Task training is used to develop specific technical skills by breaking down complex procedures into their component partsâ??for example, practising lead manipulation and placement in permanent pacing using a haptic simulator, or employing biological models such as porcine tissue to gain proficiency in venous isolation and generator implantation. At the other end of the spectrum, high-fidelity simulation recreates real-world clinical environments, enabling trainees to manage cardiac arrest scenarios, respond to complications in a mock catheterisation laboratory and address challenges in team-based practice. Importantly, such high-fidelity approaches extend beyond technical competence, emphasising human factors, patient safety and team dynamics. Together, these modalities highlight the evolving role of simulation as a complementary tool that enhances traditional cath lab-based education and prepares trainees for the increasing complexity of contemporary cardiology practice. In this evolving landscape, simulation-based education should serve as a critical pillar. Yet, the 2022 UK Cardiology Curriculum neither defines, embeds nor mandates simulation training in a meaningful way. This gap risks producing consultants who are underprepared to perform procedures safely and confidently in high-pressure clinical environments. Recent evidence has also highlighted the shortfalls in cardiology training under the 2022 curriculum. The Joint British Societiesâ?? position statement on UK cardiology training emphasised concerns regarding training time, procedural exposure and the lack of structured simulation-based education, calling for a re-evaluation of training frameworks to ensure competency and patient safety. Furthermore, the British Junior Cardiologistsâ?? Association surveys have consistently reported reductions in procedural opportunities, increased service pressures from dual accreditation and variability in access to supervised training, with potential implications for workforce readiness.