JMIR Publications

ABSTRACT

Background:

Post-mortem removal of cardiac implantable electronic devices, primarily pacemakers, is legally required before cremation in France and is frequently performed by geriatric medicine residents. Although technically straightforward, the procedure involves specific steps, dedicated equipment, and regulatory obligations that are not covered by any published guidelines; nor has it ever been the subject of formal training, meaning residents typically perform it alone for the first time without prior training.

Objective:

To assess the feasibility and acceptability of a low-fidelity simulation-based training program for post-mortem pacemaker removal, and its short-term and three-month association with residents’ knowledge and self-reported procedural confidence.

Methods:

A single-arm pre-post study was conducted in February 2026 at a university hospital simulation center. All geriatric medicine residents from two university hospital faculties attended as part of a mandatory monthly seminar. The two-hour session combined a briefing, hands-on practice on a purpose-built procedural manikin, structured debriefing, and theoretical teaching. Anonymous pre- and post-tests (Wooclap®) assessed four self-rated domains (five-point Likert scales) and five knowledge domains (percentage of correct answers); a shortened questionnaire was administered at three months.

Results:

Forty-two of 45 enrolled residents (93%) participated; 30 (71%) had prior experience of the procedure. All four self-assessed domains improved (p < .001; Wilcoxon r 0.64 – 0.76), with the largest gain for self-assessed knowledge of risks to the operator (+1.7 on a 1 – 5 scale). Knowledge scores improved in four of five domains: regulatory authorization (69% to 91%; p < .001; Hake g = 0.71), device identification (55% to 84%; p < .001), infectious risk awareness (29% to 61%; p < .001), and procedural technique (66% to 85%; p = .013); cremation-related explosion risk showed a pre-test ceiling effect (88% to 100%; p = .063). Residents without prior experience showed greater gains and reached post-training self-assessment levels comparable to experienced peers (between-group post-test p = .089 – .983). Satisfaction was high (4.83/5 ± 0.5). At three-month follow-up (response rate 86%), 44% of respondents had performed the procedure and reported high confidence (4.75/5 ± 0.45).

Conclusions:

A low-fidelity simulation session focused on the post-mortem removal of pacemakers proved feasible for geriatric medicine residents; it was associated with improved knowledge regarding the procedure and regulations, as well as increased confidence in performing the task correctly. These effects were sustained at the three-month mark. Larger-scale controlled studies, including objective competency assessments are still needed. This program offers an initial, pragmatic and low-cost model for the first exposure to this procedure. Clinical Trial: Ethical approval was not required as this study involved an educational intervention with fully anonymized data collection.