Introduction
The power to carry out and interpret cardiovascular examinations utilizing invasive and non-invasive modalities is likely one of the key competencies of cardiology trainees. The training 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 pictures have an important potential to scale back the misinterpretation of pathological buildings.3 Analysis on medical college students utilizing 3D-printing discovered a big enchancment within the conceptualization of the guts construction.4 3D printing can enhance the spatial orientation of medical college students.5 Visuospatial skill is the power to control or rotate 3D objects as a cognitive course of. This skill has an important function in medical coaching or for individuals in surgical method coaching and primary anatomy training for medical college students.6 Visuospatial skill influences the power to be taught anatomy, and accordingly, educators can develop studying strategies to enhance college students’ visuospatial skills in understanding anatomical buildings and medical coaching7 However, simulation can enhance technical abilities, as discovered within the research the place freshmen who underwent simulations considerably developed technical abilities within the first week. The advance was extra evident in individuals with no expertise than in additional skilled individuals.8
Conventional studying strategies for learning anatomy primarily use pictures from anatomy atlases and textbooks.9 Visualizing the place and the way these buildings run is crucial to the complexity of the coronary arteries. Bodily fashions are confirmed superior to different studying media used for anatomy studying.10 On the College of Drugs, 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 just lately has been revised primarily based on knowledgeable 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 know-how because of the lack of awareness on its effectiveness. For a know-how or methodology to be adopted, proof is required to indicate that the constructive impacts outweigh the detrimental penalties.13 The effectiveness of the instructing 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 utility 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 skill 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 growth (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. Contributors have been taken from your complete inexpensive inhabitants utilizing a purposive sampling methodology with 34 individuals consisting of 28 cardiology residents and 6 inner drugs residents. Inclusion standards embrace (1) Cardiology residents who haven’t undergone medical rotation of the invasive division at Dr. Sardjito Basic Hospital, (2) Inside drugs residents who’re present process medical rotation within the Cardiology Division, and (3) Keen to signal the consent kind to take part. Exclusion standards embrace: (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 College of Drugs, Public Well being and Nursing, Universitas Gadjah Mada, consisting of a 3D coronary mannequin anatomically positioned and paired 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 primary coronary anatomy and identification of 2D fluoroscopy pictures 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 introduced within the type of slides and examples of 2D coronary angiogram pictures). 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 exhibits that the questions are confirmed legitimate. The pretest and post-test questions are about primary coronary anatomy and identification of 2D fluoroscopy pictures 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 outfitted with gentle supply and white display screen. (b) 3D-printed clear coronary heart mannequin with opaque coronary artery. (c) Outcome picture of the coronary angiography simulator. |
Analysis Scheme
Contributors underwent a pretest and have been then randomized into two teams, every consisting of 17 individuals (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, College of Drugs, 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 types earlier than taking part. This research complies with the Declaration of Helsinki.
Outcomes
The analysis was carried out by amassing the information straight from the individuals in July 2022. In the course of the knowledge assortment interval, all individuals may participate within the research to completion.
Fundamental Traits of Contributors
The imply age of the individuals on this research was 29.7 years in each teams. Most individuals have been male in group A (64.7%) and group B (52.9%). Nearly all 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 individuals between the 2 teams primarily based on age, gender, and semester (p > 0.05), whereas primarily based on the division confirmed a big distinction (p = 0.018) (Desk 1).
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Desk 1 Fundamental Traits of Contributors |
Outcomes of Pretest, Publish-Take a look at I, Publish-Take a look at II
The outcomes of pretest, post-test I, and post-test II in each teams are introduced 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 Publish Hoc |
The outcomes of the normality take a look at of pretest, post-test I, post-test II, delta post-test I – pretest, and delta post-test II – pretest knowledge obtained p worth >0.05 in every group. This exhibits that the information have been usually distributed. To match the measurement outcomes every so often between the 2 teams, the overall linear mannequin evaluation was introduced with the repeated measure ANOVA take a look at with Bonferroni publish 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, exhibiting 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, greater than group A, which was 12.71, with a big distinction (p < 0.001). The post-test II rating of group B was 17.85, greater than group A, which was 17.15 and not using a vital distinction (p = 0.314). The outcomes of the distinction in values in a single group (with publish hoc Bonferroni), it was discovered that in group A, there was a big 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 big 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 greater than group A (12.71), with a big distinction (p < 0.001). The post-test II rating of group B (17.85) was greater than group A (17.15) however didn’t present a big distinction (p = 0.314). The outcomes of the distinction in values in a single group (with publish hoc Bonferroni), it was discovered that in group A, there was a big 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 big 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 greater than the delta between post-test I and pretest group A, which was 5.21, with a big distinction (p = 0.003). The delta between post-test II and pretest in group A was 9.65. This was greater 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 greater than the delta between post-test I and pretest in group A, which was 5.21, with a big distinction (p < 0.001). In group B, the delta between post-test II and pretest was 8.65. This was greater 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 tackle the potential of its utility. This research confirmed that the simulator is an efficient coronary angiogram instructing methodology. Improve of information and CA interpretation talent was noticed in simulator group confirmed by the numerous enhance of post-test rating. Earlier comparable research decided the effectiveness of incorporating simulator into medical studying by the enhancements of information, abilities and satisfaction.14 Within the eleven research evaluating simulated coaching with no simulation, simulated coaching was related to average 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 extra medium for learning cardiac anatomy in comparison with learning utilizing a cadaver.16
When in comparison with current standard coronary angiogram studying media, our simulator studying mannequin acquire greater enhance of information. The delta between post-test I and pretest in group B (3D-printing-based fluoroscopic coronary angiography simulator) is greater 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 be efficient as complementary to the present 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 greater 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 provided with a 3D bodily construction as a substitute of a 2D. 3D know-how has the benefit of presenting 2D pictures in a kind 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 buildings.17 The fast progress of 3D printing created a brand new manner of medical training.18
3D-printing-based fluoroscopic coronary angiography simulator additionally has the potential to boost visuospatial skills. Vandenberg and Kuse outline visuospatial skill as the power to mentally manipulate or rotate 3D objects within the thoughts.19 This skill has an important function in medical coaching or for individuals in surgical method coaching and primary anatomy training for medical college students.6,20 Excessive visuospatial skill is related to an individual’s excellence in science, know-how, arithmetic, chemistry, physics, anatomy, and psychology.21 In a fluoroscopy process, the coronary arteries can rotate relative to different buildings making identification troublesome. To grasp the complexity of the situation being handled, a heart specialist or interventional specialist depends on psychological skills to compile the guts’s anatomical topology from 2D to 3D pictures.22,23 Utilizing buildings that may be studied from varied factors of view, equivalent to cadavers, plastics, or laptop fashions, a studying methodology might be developed to extend spatial skill.6 That is according to the research by Lufler et al, which states that pedagogical methods by incorporating a rotatable anatomical mannequin or construction can enhance visuospatial skills.7
One other good thing about the simulator is that it improves comprehension and reminiscence. Referring to Dale’s cone expertise or studying pyramid, a better degree of understanding and reminiscence might be achieved by simulating studying actions or doing one thing straight (studying by doing) as a result of it entails extra senses.24 Sturdy proof exhibits that simulation is an efficient instructional technique to assist well being career learners purchase primary data, medical abilities and acumen, and communication abilities.25
Effectiveness evaluation of the 3D-printing-based fluoroscopic coronary angiography simulator (Desk 2) exhibits that the delta between post-test II and pretest group A (9.65), is greater than the delta between post-test II and pretest group B (8.65) with no vital distinction (p = 0.368). This exhibits that the individuals in group A who had been uncovered to standard studying media plus publicity to a 3D-printing fluoroscopic coronary angiography simulator had virtually equivalent post-test scores as individuals 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 knowledge (Desk 2), in group B, the delta between post-test II and pretest (8.65), was greater than the delta between post-test I and pretest (8.53) with no vital distinction (p = 0.774). This exhibits that in group B, individuals who solely obtained publicity to 3D-printing-based fluoroscopic coronary angiography simulators had post-test scores virtually the identical as post-test scores of individuals uncovered to 3D-printing-based fluoroscopic coronary angiography simulators plus publicity to standard 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 greater and statistically vital (p < 0.001) than the delta between post-test I and pretest. This means that individuals who obtained standard studying plus 3D-printing-based fluoroscopic coronary angiography simulator publicity had greater post-test scores than those that solely obtained publicity to standard 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 individuals might be included to additional enhance the research. The individuals on this research have been solely from one establishment, thus a wider variation inside the inhabitants may not be mirrored on this research.
Conclusion
A 3D-printing-based fluoroscopic coronary angiography simulator improves the educational functionality of cardiology trainees, particularly in coronary angiogram diagnostics. Subsequent trials of this simulator might be carried out in a number of instructional establishments apart from the College of Drugs, Public Well being, and Nursing, Universitas Gadjah Mada.
Abbreviations
CA, coronary angiography; GLM, common 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, College of Drugs, 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 Know-how 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 stories grants from Ministry of Training, Tradition, Analysis, and Know-how of Republic Indonesia, grants from Gadjah Mada College, through 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 stories grants from Ministry of Training, Tradition, Analysis and Know-how of Republic Indonesia, grants from Universitas Gadjah Mada, through the conduct of the research. The writer stories no different conflicts of curiosity on this work.
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