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As clinical educators, we train medical and veterinary students and residents in basic and advanced clinical procedures. The educational dilemma that exists for medical educators is how do we train students to attain competency in high-risk procedures? Traditionally the training model has been a mentor – trainee relationship with students progressively learning and then mastering more complex clinical techniques through observation and under direct supervision in clinical patients over time.
Clinical education standards are evolving and there are requirements to document clinical competency through objective assessment rather than the demonstration of a prescribed number of cases in a case log. This is a positive and long overdue evolution.
Training of medical or veterinary students on animals or humans for higher-risk procedures poses a potential risk to patients through longer procedure times and causes anxiety for students.
Access to animals and cadaveric materials for use in teaching is increasingly difficult, due to ethical and cultural controversies, expense, and health and safety considerations.
An example of a higher risk advanced procedure is performing a bronchoscopy. Bronchoscopy involves placing a flexible endoscope into the airways to allow direct visualization and systematic investigation of the airway and sample collection. During this procedure, adverse effects on breathing and oxygenation can occur, so the procedure must be completed in a timely manner which means limited opportunity for residents to develop the skills required to become competent. In small animals or pediatric patients, small airway diameter and pre-existing pathology can result in rapid desaturation.
Training using physical models allows students to do practiced, repetitive-training of specific clinical skills with real-time guided direct mentor input and feedback in a safe learning environment. Lower-fidelity models are suitable for the development of basic motor and procedural skills. The ideal clinical procedural trainer should affordable, realistic, easily stored, reusable, without the biohazard risks of animal parts, and as technically challenging as real patients.
More advanced or higher-risk procedures require higher-fidelity models, such as virtual reality simulation, may more closely replicate the patient anatomy and clinical scenario, but are significantly more expensive.
Using 3D printed training models, technical skills can be acquired, practiced, and improved before procedures are done in people or animals. 3D models can be produced to have normal and pathological simulation scenarios to encompass the full range of procedural practice and intended learning objectives.
We have created a 3D printed canine bronchoscopy training model at the Austin Hospitals 3DMed Lab from a thoracic CT scan of a dog. The airway was segmented from these scans via 3D Slicer and then uploaded to Meshmixer, where further manual adjustments were made. The resultant STL was uploaded to Cura and printed with an Ultimaker S5 with white poly-lactic acid and poly-vinyl acetate support. An iterative feedback process from clinical educators and students was used to refine the model. Features included from this feedback included: dyeing the model with red synthetic fabric dye to better replicate mucosa, including a dorsal tracheal membrane for orientation and making slight adjustments to the angle of the airways to facilitate navigation. Face and content validation of the model was conducted with 7 participants of varying experience.
The model will be introduced into clinical teaching for veterinary medicine residents in 2020. Residents will be able to practice endoscope manipulations required to perform a standardized complete bronchoscopy examination, so they will be well prepared for doing these procedures in clinical patients.
About the Author:
Dr. Stewart Ryan, BVSc(Hons), MS, Diplomate ACVS, Founding Fellow ACVS (Surgical Oncology), Senior Lecturer and Head of Small Animal Surgery service, UVet veterinary Hospital , Faculty of Veterinary and Agricultural Sciences
Stewart is a specialist veterinary surgeon at the Melbourne Veterinary School who loves exploring ways to make surgical treatments less invasive and make complex procedures more understandable for pet owners and students through advanced technologies including minimally invasive surgery, interventional radiology and 3D models for training and education.