Virtual vs. Hands-On Simulation: Room For Cohabitation?

Simulation is key for the development of technical skills among medical students and doctors during their educational career. This is particularly relevant for interventional procedures where it allows experience of potential scenarios without concern for adverse outcomes and the support of a tutoring trainer. Growing interest has been dedicated in recent years to the world of virtual simulation, supported by an escalation in technological achievements, including humanoid dummies, software and dedicated tools.


Successful and often greatly participated in "hands-on" sessions have progressively complemented theoretical courses and congresses, representing a great opportunity during the early career phases, when young cardiologists are already prepared with the fundamental concepts but need to develop practical skills in order to conduct their daily activity autonomously. However, such educational events require dedicated and generally large spaces, the presence of well-trained educators who could work side by side with the trainees, and the availability of the simulation devices, which are often busy and very expensive to rent or buy. With the financial strain on health care systems and universities, simulation programs have been partially shifted to totally virtual programs, which have become the only possibility of training and education within the last year of the COVID-19 pandemic.

Indeed, there are several important differences between in-person training and online learning that should be acknowledged.  

First, for very practical skills as interventional procedures, there is a certain procedural knowledge that can be offered only with a real hands-on experience. Moreover, greater interaction with the tutor and other trainees can offer pertinent discussions, which cannot be offered at the same level even with live chats and other types of online interaction.

Have a pressing question? You'll most likely have to wait to get it answered. Did the instructor misinterpret your question? You'll have to send another message and wait again for a response.


On the other hand, online training offers more flexibility without the need for days off or long travels. In addition, several people can take advantage of the course at the same time, with a lower cost for institutions.

While the world of virtual medicine is clearly expanding, allowing the simulation of more and more realistic scenarios and even the most complex interventions, it is crucial that both online learning and hands-on simulation coexist in the educational program of early career cardiologists. In-person courses should hopefully restart as soon as possible after the resolution of the pandemic and should not be completely replaced by the webinar format for the future. Nevertheless, the experience with online education acquired within the last months of the pandemic has demonstrated that many theoretical concepts and skills can achieve an effective and even larger diffusion with totally virtual simulation.

Therefore, a better clarification of the criteria that should lead to the selection of in-person or online simulation, when both will be available, and a redefinition of the educational programs in cardiology, accounting for these new tools of training, should be advocated in the next years by cardiological societies.

ACC Members, discuss
this on Member Hub.

The article was authored by Monica Verdoia, MD, PhD, interventional cardiologist, Ospedale degli Infermi, ASL Biella, Università del Piemonte Orientale.

This content was developed independently from the content developed for This content was not reviewed by the American College of Cardiology (ACC) for medical accuracy and the content is provided on an "as is" basis. Inclusion on does not constitute a guarantee or endorsement by the ACC and ACC makes no warranty that the content is accurate, complete or error-free. The content is not a substitute for personalized medical advice and is not intended to be used as the sole basis for making individualized medical or health-related decisions. Statements or opinions expressed in this content reflect the views of the authors and do not reflect the official policy of ACC.