Why is it important to train in pediatric cardiovascular surgery?
Due to scientific and technological advances, the design and implementation of new training programs in cardiovascular surgery that update concepts and contents to the new clinical-surgical alternatives introduced in recent years is inevitable.
For decades, medical training has been based on an apprenticeship model that provides for graded responsibility in the operating room by performing actual procedures on patients. However, it is becoming increasingly evident that this type of practice should not be used as the primary training instance for the acquisition of basic surgical skills. In this way, simulation emerges as a viable and effective alternative as a training method.
The figure below shows the different levels of the medical skills acquisition process in relation to a traditional learning curve.
Does simulation accelerate the learning curve?
Simulation allows the surgeon to face real procedures that train him/her in decision making from a cognitive perspective and strengthen team collaboration.
By participating in progressive training, they can dedicate as much time as they wish to practice a certain scenario until they acquire the necessary skills and abilities, which significantly accelerates the learning curve, as can be seen below.
Following this line, a study conducted by the Faculty of Medicine of the University of Seville (2017) concluded that by setting up simulation scenarios, students demonstrated an evident improvement in the assimilation of information and in their clinical-practical skills.
Within the field of simulation in pediatric cardiovascular surgery, Hussein analyzed training on 3D soft-material printed models for congenital arterial switch pathology. In this study, where 30 cardiovascular surgeons participated, they found that 80% of the surgeons improved their skills between the first and second simulation, and that 100% of them reduced the procedure time between the first and second instance of training.
Simulation plays a fundamental role for the medical professional to complement his or her training in low prevalence or highly complex diseases that under normal conditions may require months or years to master safely.
An example of this is the cardiovascular surgery simulator developed by Mirai 3D together with Dr. Ignacio Lugones and doctors from Htal. Elizalde, which contributes to training in a congenital pathology, aortic coarctation, which is found in 5% of those born with congenital heart defects.
Decrease in aortic clamping time with hands-on training
With the aforementioned simulator, we sought to measure the effectiveness of the training. For this reason, two simulation days were carried out where preliminary results were obtained. Each training included a technical training class on surgery, followed by 3 instances of simulation for each professional.
Although the study is limited, it can be seen in the image that there is a trend towards a decrease in the clamping time of each intervention. These findings are promising and have been the starting point for further studies and training for many more physicians in different regions.
To this end, a virtual hands-on course for cardiovascular and general surgeons was held for the first time on March 21. The course used the new simulator design, which allows training from the most basic knowledge of vascular anastomosis to specific training in coarctation of the aorta.
The importance of introducing the learning instance in vascular anastomosis allows, on the one hand, young cardiovascular surgeons to cover the different ranges of difficulty, thus providing a comprehensive experience. On the other hand, it allows surgeons from other specialties to improve their techniques in vascular control, which is a very critical complication in non-vascular surgeries.
On a scale of 1 to 8, the course participants rated the theoretical content, the practical exercises performed and the realism of the vascular models with an average of 7.
3D technology from generic practice to patient-specific planning
As mentioned in this article, simulation allows the surgeon to train in the different techniques and improve his performance thanks to repetitive practice in a safe environment. But this training, in general, is performed on standard models.
It is therefore of great interest to develop the concept of duality between simulation and 3D planning in surgery. On the one hand, to create instances of continuous "surgical exercise" but on the other hand, to make use of 3D anatomical models, which are three-dimensional figures that replicate the patient's anatomy, which will provide the physician with a better understanding of the particular physiological and pathological anatomy of the person to be treated and anticipate critical situations that require quick and effective action.
- Juvin-Bouviera C. et al (2017) Simulation in cardiac surgery: the future of teaching in our specialty?, Faculty of Medicine, University of Seville, DOI: 10.1016/j.circv.2017.01.004
- Centella T, Hornero F (2017) Simulation-based training: a necessary change in the training of our specialty. Cardiovascular Surgery, 2017: 24(4): 187-189 - Cates, C., Gallagher A. (2011) The future of simulation technologies for complex cardiovascular procedures. European Heart Journal (2012) 33, 2127–2134 doi:10.1093/eurheartj/ehs155
- Puente García, N. M., Fernández Gómez, M. L., & Voces García, D.. (2001). Coarctation of the aorta: diagnosis of suspicion in primary care consultation. Medifam, 11(6), 77-85. Retrieved from http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1131-57682001000600008&lng=es&tlng=es