INTRODUCTION: Simulation-based assessment studies have related simulator performance to clinical experience instead of actual clinical performance. This study validates a novel rating scale for coronary angiography (CA) performance and at the same time explores the association between CA performance in a simulated setting and in the catheterization laboratory.

METHODS: Ten cardiologists and cardiology residents with varying degrees of CA experience performed 2 CAs in the catheterization laboratory and 2 CAs in a simulated setting. The residents had prior simulator experience opposite cardiologists. Two raters assessed the operators' video-recorded performances using the novel CA rating scale (CARS).

RESULTS: The correlation between CARS scores in the catheterization laboratory and the simulated setting was R = 0.20 (P = 0.195). Residents' scores were higher in the simulated setting than in the catheterization laboratory. The correlation between operators' previous clinical experience in CA and CARS scores was R = 0.65 (P = 0.005) in the catheterization laboratory and R = 0.11 (P = 0.353) in the simulated setting.

CONCLUSIONS: The association between CA performance in a simulated setting and actual performance in the catheterization laboratory is not linear. The novel rating scale for CA (CARS) seems to be a valid proficiency assessment instrument in the catheterization laboratory. Familiarity with the simulator may overestimate proficiency, which means that simulator performance as a predictor of clinical performance should be interpreted with caution.