Introduction
The flexibility to carry out and interpret cardiovascular examinations utilizing invasive and non-invasive modalities is likely one of the key competencies of cardiology trainees. The educational goal is for college kids to have the ability to carry out coronary angiography (CA) with good projection and consider regular and pathological coronary angiography.1 Coronary angiography is an X-ray process aiming to visualise the arteries within the coronary heart.2 3D printing fashions created from actual affected person photographs have a terrific potential to scale back the misinterpretation of pathological constructions.3 Analysis on medical college students utilizing 3D-printing discovered a major enchancment within the conceptualization of the guts construction.4 3D printing can enhance the spatial orientation of medical college students.5 Visuospatial potential is the flexibility to govern or rotate 3D objects as a cognitive course of. This potential has an important function in medical coaching or for members in surgical approach coaching and fundamental anatomy schooling for medical college students.6 Visuospatial potential influences the flexibility to study anatomy, and accordingly, educators can develop studying strategies to enhance college students’ visuospatial talents in understanding anatomical constructions and medical coaching7 However, simulation can enhance technical abilities, as discovered within the research the place newcomers who underwent simulations considerably developed technical abilities within the first week. The advance was extra evident in members with no expertise than in additional skilled members.8
Conventional studying strategies for finding out anatomy primarily use photographs from anatomy atlases and textbooks.9 Visualizing the place and the way these constructions run is essential to the complexity of the coronary arteries. Bodily fashions are confirmed superior to different studying media used for anatomy studying.10 On the School of Medication, Public Well being, and Nursing, Universitas Gadjah Mada, a brand new studying mannequin for 3D-printing coronary arteries has been developed.11 A 3D-printing-based fluoroscopic coronary angiography simulator has been developed,12 and not too long ago has been revised based mostly on professional validation. The brand new state of utilizing 3D-printing-based coronary artery studying fashions presents a dilemma of whether or not one ought to undertake the expertise as a result of lack of know-how on its effectiveness. For a expertise or methodology to be adopted, proof is required to indicate that the optimistic impacts outweigh the unfavorable penalties.13 The effectiveness of the educating methodology utilizing a 3D-printing-based fluoroscopic coronary angiography simulator as a coronary angiogram diagnostic studying medium and its affect on the cardiology trainee’s understanding of coronary anatomy and its software in coronary angiography procedures have by no means been evaluated.
The contributions of this research space are described beneath:
- 3D-printing-based fluoroscopic coronary angiography simulator enhances the diagnostic potential of coronary angiograms for college kids.
- College students will enhance their curiosity and motivation in studying coronary angiography utilizing a 3D-printing-based fluoroscopic coronary angiography simulator.
Supplies and Strategies
Design and Topic
This analysis used a analysis and improvement (R&D) design to judge the effectiveness of a 3D-printing-based fluoroscopic coronary angiography simulator as a coronary angiogram diagnostic studying medium with quantitative and qualitative strategies. The research was carried out at Dr. Sardjito Basic Hospital, Yogyakarta, Indonesia. Members have been taken from the complete reasonably priced inhabitants utilizing a purposive sampling methodology with 34 members consisting of 28 cardiology residents and 6 inner drugs residents. Inclusion standards embody (1) Cardiology residents who haven’t undergone medical rotation of the invasive division at Dr. Sardjito Basic Hospital, (2) Inner drugs residents who’re present process medical rotation within the Cardiology Division, and (3) Prepared to signal the consent type to take part. Exclusion standards embody: (1) Having undergone coaching or simulation utilizing 3D-printing coronary fashions or 3D-printing-based fluoroscopic coronary angiography simulator.
Devices
This research makes use of three devices: a 3D-printing-based fluoroscopic coronary angiography simulator, standard studying media, and pretest and post-test questions. The primary instrument is a 3D-printing-based fluoroscopic coronary angiography simulator owned by the School of Medication, Public Well being and Nursing, Universitas Gadjah Mada, consisting of a 3D coronary mannequin anatomically positioned and matched with a light-weight supply to resemble the precise coronary angiography course of as proven by Determine 1. The second instrument is standard studying media, together with materials on fundamental coronary anatomy and identification of 2D fluoroscopy photographs from varied commonplace projections utilized in coronary angiography, which refers back to the textbook The Cardiac Catheterization Handbook delivered by an teacher utilizing standard studying media (textbooks offered within the type of slides and examples of 2D coronary angiogram photographs). The third instrument is the pretest and post-test questions. The questions are crafted referring to the competency commonplace offered by Indonesian Coronary heart Affiliation and have been validated by three cardiology specialists. Aiken’s content material validity of V=0.91 and Lawshe’s content material validity of CVR = 1 was acquired, which reveals that the questions are confirmed legitimate. The pretest and post-test questions are about fundamental coronary anatomy and identification of 2D fluoroscopy photographs from varied projections, together with 17 a number of selection questions and three essay questions within the type of studying regular coronary angiography movies.
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Determine 1 (a) Coronary angiography simulator geared up with gentle supply and white display. (b) 3D-printed clear coronary heart mannequin with opaque coronary artery. (c) Outcome picture of the coronary angiography simulator. |
Analysis Scheme
Members underwent a pretest and have been then randomized into two teams, every consisting of 17 members (Determine 2).
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Determine 2 Analysis scheme. |
Information Evaluation
The statistical evaluation was carried out utilizing the IBM SPSS model 26 software program. The effectiveness of the 3D-printing-based fluoroscopic coronary angiography simulator as a coronary angiogram diagnostic studying medium is analyzed by calculating the distinction (delta values) of the pretest, post-test I, and post-test II utilizing the t-test.
Moral Points
This analysis was carried out with the approval of Medical and Well being Analysis Ethics Committee, School of Medication, Public Well being and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia with reference quantity KE/FK/0890/EC/2021. Topics have been defined concerning the analysis procedures and signed the knowledgeable consent varieties earlier than taking part. This research complies with the Declaration of Helsinki.
Outcomes
The analysis was carried out by accumulating the information immediately from the members in July 2022. Through the information assortment interval, all members may participate within the research to completion.
Fundamental Traits of Members
The imply age of the members on this research was 29.7 years in each teams. Most members have been male in group A (64.7%) and group B (52.9%). The vast majority of the semester degree is the semester I (35.3%) in group A and semester III (52.95%) in group B. There was no distinction within the traits of the members between the 2 teams based mostly on age, gender, and semester (p > 0.05), whereas based mostly on the division confirmed a major distinction (p = 0.018) (Desk 1).
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Desk 1 Fundamental Traits of Members |
Outcomes of Pretest, Submit-Take a look at I, Submit-Take a look at II
The outcomes of pretest, post-test I, and post-test II in each teams are offered within the following desk (Desk 2).
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Desk 2 Evaluation of Basic Linear Mannequin (GLM) with Repeated Measure ANOVA Take a look at with Bonferroni Submit Hoc |
The outcomes of the normality check of pretest, post-test I, post-test II, delta post-test I – pretest, and delta post-test II – pretest information obtained p worth >0.05 in every group. This reveals that the information have been usually distributed. To match the measurement outcomes occasionally between the 2 teams, the overall linear mannequin evaluation was offered with the repeated measure ANOVA check with Bonferroni put up hoc.
The distinction scores between the 2 teams confirmed that the imply pretest rating for group A was 7.50 and group B was 9.21, displaying no vital distinction (p = 0.108). This discovering signifies that the pretest rating between the 2 teams is homogeneous. The imply rating of post-test I in group B was 17.74, increased than group A, which was 12.71, with a major distinction (p < 0.001). The post-test II rating of group B was 17.85, increased than group A, which was 17.15 with out a vital distinction (p = 0.314). The outcomes of the distinction in values in a single group (with put up hoc Bonferroni), it was discovered that in group A, there was a major enhance within the worth of the pretest to post-test I, from 7.50 to 12.71 (p < 0.001) and elevated considerably once more from the post-test I to post-test II, from 12.71 to 17.15 (p < 0.001).
Likewise, in group B, there was a major enhance within the worth of the pretest to post-test I, from 9.21 to 17.74 (p < 0.001), however from post-test I to post-test II, there was a non-significant enhance in scores from 17.74 to 17.85 (p = 1).
The imply pretest scores between the 2 teams confirmed no vital distinction (p = 0.108). The imply rating of post-test I in group B (17.74) was increased than group A (12.71), with a major distinction (p < 0.001). The post-test II rating of group B (17.85) was increased than group A (17.15) however didn’t present a major distinction (p = 0.314). The outcomes of the distinction in values in a single group (with put up hoc Bonferroni), it was discovered that in group A, there was a major enhance within the worth of the pretest to post-test I, from 7.50 to 12.71 (p < 0.001) and elevated considerably once more from the post-test I to post-test II, from 12.71 to 17.15 (p < 0.001). In group B there was a major enhance within the worth of pretest to post-test I, from 9.21 to 17.74 (p < 0.001), however from post-test I to post-test II, there was a non-significant enhance in scores from 17.74 to 17.85 (p = 1).
Effectiveness Evaluation of 3D-Printing-Based mostly Fluoroscopic Coronary Angiography Simulator
Effectiveness evaluation of the 3D-printing-based fluoroscopic coronary angiography simulator as a coronary angiogram diagnostic studying medium was outlined by calculating the worth of the distinction (delta) of pretest, post-test I, and post-test II. The evaluation used the t-test with the next outcomes (Determine 3).
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Determine 3 Effectiveness evaluation of 3D-printing-based fluoroscopic coronary angiography simulator. |
The delta between post-test I and pretest in group B was 8.53. This was increased than the delta between post-test I and pretest group A, which was 5.21, with a major distinction (p = 0.003). The delta between post-test II and pretest in group A was 9.65. This was increased than the delta between post-test II and pretest group B, which was 8.65, with no vital distinction (p = 0.368). In group A, the delta between post-test II and pretest was 9.65. This was increased than the delta between post-test I and pretest in group A, which was 5.21, with a major distinction (p < 0.001). In group B, the delta between post-test II and pretest was 8.65. This was increased than the delta between post-test I and pretest, which was 8.53, with no vital distinction (p = 0.774). These outcomes present that the 3D-printing-based fluoroscopic coronary angiography simulator is efficient as a coronary angiogram diagnostic studying medium.
Dialogue
The principal purpose of our research was to find out the effectiveness of 3D-printing-based fluoroscopic as a coronary angiogram diagnostic studying methodology and deal with the potential of its software. This research confirmed that the simulator is an efficient coronary angiogram educating methodology. Enhance of data and CA interpretation talent was noticed in simulator group confirmed by the numerous enhance of post-test rating. Earlier related research decided the effectiveness of incorporating simulator into medical studying by the enhancements of data, abilities and satisfaction.14 Within the eleven research evaluating simulated coaching with no simulation, simulated coaching was related to reasonable enhancements in abilities and satisfaction in comparison with non-simulation coaching.14 The results of our research additionally helps earlier research carried out by Wong and colleagues demonstrating the advance in CA interpretation abilities by digital 3D CA simulator implementation to trainees.15 One other research held by Canty et al confirmed that an ultrasound simulator is a possible and equal further medium for finding out cardiac anatomy in comparison with finding out utilizing a cadaver.16
When in comparison with present standard coronary angiogram studying media, our simulator studying mannequin acquire increased enhance of data. The delta between post-test I and pretest in group B (3D-printing-based fluoroscopic coronary angiography simulator) is increased and statistically vital than the delta between post-test I and pretest in group A (standard studying media). Furthermore, the research confirmed that the simulator studying mannequin can also be efficient as complementary to the prevailing standard studying methodology. The delta between post-test II and pretest in group A (standard studying media adopted by 3D-printing-based fluoroscopic coronary angiography simulator) was increased and statistically vital than the delta between post-test I and pretest group A (standard studying media solely).
There are a number of options that assist our simulator studying mannequin as an efficient coronary angiogram diagnostic studying medium. This simulator is supplied with a 3D bodily construction as an alternative of a 2D. 3D expertise has the benefit of presenting 2D photographs in a type that permits a extra profound understanding of the human anatomy construction.3 3D rendering has proven an elevated understanding by medical college students and clinicians of complicated anatomical constructions.17 The fast development of 3D printing created a brand new approach of medical schooling.18
3D-printing-based fluoroscopic coronary angiography simulator additionally has the potential to boost visuospatial talents. Vandenberg and Kuse outline visuospatial potential as the flexibility to mentally manipulate or rotate 3D objects within the thoughts.19 This potential has an important function in medical coaching or for members in surgical approach coaching and fundamental anatomy schooling for medical college students.6,20 Excessive visuospatial potential is related to an individual’s excellence in science, expertise, arithmetic, chemistry, physics, anatomy, and psychology.21 In a fluoroscopy process, the coronary arteries can rotate relative to different constructions making identification tough. To grasp the complexity of the situation being handled, a heart specialist or interventional specialist depends on psychological talents to compile the guts’s anatomical topology from 2D to 3D photographs.22,23 Utilizing constructions that may be studied from varied factors of view, reminiscent of cadavers, plastics, or pc fashions, a studying methodology may be developed to extend spatial potential.6 That is in step with the research by Lufler et al, which states that pedagogical strategies by incorporating a rotatable anatomical mannequin or construction can enhance visuospatial talents.7
One other good thing about the simulator is that it improves comprehension and reminiscence. Referring to Dale’s cone expertise or studying pyramid, the next degree of understanding and reminiscence may be achieved by simulating studying actions or doing one thing immediately (studying by doing) as a result of it includes extra senses.24 Robust proof reveals that simulation is an efficient academic technique to assist well being career learners purchase fundamental data, medical abilities and acumen, and communication abilities.25
Effectiveness evaluation of the 3D-printing-based fluoroscopic coronary angiography simulator (Desk 2) reveals that the delta between post-test II and pretest group A (9.65), is increased than the delta between post-test II and pretest group B (8.65) with no vital distinction (p = 0.368). This reveals that the members in group A who had been uncovered to traditional studying media plus publicity to a 3D-printing fluoroscopic coronary angiography simulator had virtually equivalent post-test scores as members in group B who had been uncovered to a 3D-printing-based fluoroscopic coronary angiography simulator plus publicity standard studying media. That is attainable as a result of each teams have obtained the identical publicity.26
Evaluation of different information (Desk 2), in group B, the delta between post-test II and pretest (8.65), was increased than the delta between post-test I and pretest (8.53) with no vital distinction (p = 0.774). This reveals that in group B, members who solely obtained publicity to 3D-printing-based fluoroscopic coronary angiography simulators had post-test scores virtually the identical as post-test scores of members uncovered to 3D-printing-based fluoroscopic coronary angiography simulators plus publicity to traditional studying media. This confirms the effectiveness of the 3D-printing-based fluoroscopic coronary angiography simulator as a coronary angiogram diagnostic studying medium. In group A, the delta between post-test II and pretest was increased and statistically vital (p < 0.001) than the delta between post-test I and pretest. This means that members who obtained standard studying plus 3D-printing-based fluoroscopic coronary angiography simulator publicity had increased post-test scores than those that solely obtained publicity to traditional studying media, so this additional helps the effectiveness of 3D-printing-based fluoroscopic coronary angiography simulators as a coronary angiogram diagnostic studying medium.26
There are, nonetheless, some limitations of this research. A bigger variety of members may very well be included to additional enhance the research. The members on this research have been solely from one establishment, thus a wider variation throughout the inhabitants may not be mirrored on this research.
Conclusion
A 3D-printing-based fluoroscopic coronary angiography simulator improves the training functionality of cardiology trainees, particularly in coronary angiogram diagnostics. Subsequent trials of this simulator may very well be carried out in a number of academic establishments apart from the School of Medication, Public Well being, and Nursing, Universitas Gadjah Mada.
Abbreviations
CA, coronary angiography; GLM, normal linear mannequin.
Acknowledgments
The authors are grateful to all cardiologists: Budi Yuli Setianto, Hariadi Hariawan, Nahar Taufiq, Muhammad Taufik Ismail, Hendry Purnasidha Bagaswoto, Firandi Saputra; Prattama Santoso Utomo from Division of Medical Training and Bioethics, School of Medication, Public Well being, and Nursing, Universitas Gadjah Mada; Execute 3D Printing Workshop (Yogyakarta, Indonesia) for simulator manufacturing, and all radiographers and nurses from the Catheterization Laboratory at Dr. Sardjito Basic Hospital, Yogyakarta for his or her effort to assist in the analysis. The authors thank to all who assist this research.
Funding
This analysis was funded by “Penelitian Pengembangan Unggulan Perguruan Tinggi (PPUPT)” quantity 7288/UN1/DITLIT/DIT-LIT/PT/2021 from the Ministry of Training, Tradition, Analysis and Expertise of Republic Indonesia and “Rekognisi Tugas Akhir (RTA)” Program Batch I quantity 3550/UN1.P.III/Dit-Lit/PT.01.05/2022 from Universitas Gadjah Mada, Yogyakarta, Indonesia.
Disclosure
Dr Ganda Wibowo reviews grants from Ministry of Training, Tradition, Analysis, and Expertise of Republic Indonesia, grants from Gadjah Mada College, in the course of the conduct of the research. Dr Dyah Wulan Anggrahini, Ms Vita Arfiana Nurul Fatimah and Dr Putrika Prastuti Ratna Gharini report a patent P00202205092 pending for 3D-printing-based fluoroscopic coronary angiography simulator issued by Indonesia Directorate Basic of Mental Property. Ms Vita Arfiana Nurul Fatimah reviews grants from Ministry of Training, Tradition, Analysis and Expertise of Republic Indonesia, grants from Universitas Gadjah Mada, in the course of the conduct of the research. The writer reviews no different conflicts of curiosity on this work.
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