Interventional cardiology sits at a unique intersection of cognitive mastery and manual precision. Unlike most medical disciplines, its procedures,  percutaneous coronary intervention, complex bifurcation stenting, chronic total occlusion recanalization, demand both the accumulated clinical judgment that only years of practice can build, and the fine motor dexterity that physiologically peaks early in a career.

This creates a structural paradox that has received surprisingly little systematic attention: by the time an interventional cardiologist has the experience, credentialing, and independent authority to perform the most complex procedures, some of the very physical attributes that make those procedures safer may have already begun to decline. Conversely, trainees and junior fellows, at their manual and cognitive peak, are appropriately restricted from independent practice precisely because experience-dependent judgment has not yet matured.

We are calling this the experience-dexterity paradox, and we believe it deserves rigorous examination.

This scoping review will map the global literature on how operator career stage, defined across dimensions of age, training level, years in practice, and procedural volume, shapes outcomes in interventional cardiology. We will draw from cardiology outcomes research, cognitive aging literature, and medical education scholarship to build a comprehensive picture of what is known, what is contested, and where the critical gaps lie.

Findings will carry direct implications for how training pipelines are structured, how credentialing thresholds are set, how emerging technologies like robotic-assisted PCI should be integrated, and ultimately how patients are protected across the full arc of an operator's career.

The review will follow JBI scoping review methodology and PRISMA-ScR reporting guidelines, with pre-registration on OSF. We are targeting a high-impact cardiology or medical education journal.

We are recruiting volunteers for:

• Title and abstract screening
• Full-text review and data extraction
• Data charting and synthesis
• Manuscript writing and editing

Estimated commitment: 3–5 hours per week over 3–4 months. Fully remote. Authorship offered to all contributors meeting ICMJE criteria.