Entrenamiento quirúrgico con fantomas en cirugía de estrabismo / Surgical training with phantoms in strabismus surgery

Antecedentes y objetivo La simulación en el aprendizaje quirúrgico responde a necesidades éticas y pragmáticas. Nuestro propósito es describir los efectos sobre las habilidades quirúrgicas de la realización de un taller de entrenamiento quirúrgico en cirugía de estrabismo con fantomas. La preocupación por la seguridad del paciente obliga a plantearse el empleo de simuladores (virtuales y físicos tridimensionales) y modelos animales permite al aspirante practicar sin riesgos los procedimientos antes de enfrentarse a un caso real. Material y métodos Realización de un taller con contenido teórico previo y práctica real con fantomas diseñados para simular cirugía de estrabismo (globo ocular, 6 músculos, conjuntiva, párpado y cápsula de Tenon insertados en cráneo) de dimensiones anatómicas reales. Encuesta de satisfacción y evaluación subjetiva de aprendizaje por parte del alumno y del tutor experto según el modelo de evaluación de Kirkpatrick. Resultados Completaron la encuesta 100% de los 26 alumnos asistentes a dos cursos (15 alumnos en un curso y 11 alumnos en otro curso) y 100% de los tres tutores que participaron en ambos cursos; 20 eran médicos residentes y 20 especialistas en oftalmología. La satisfacción global de los alumnos fue de 8,2 (± 0,68). Conclusiones Según los resultados de la encuesta de evaluación de acciones formativas de Kirkpatrick, la percepción de alumnos y tutores es que el entrenamiento con fantomas en cirugía de estrabismo puede ayudar a mejorar las habilidades necesarias para una práctica segura e independiente. Siendo el objetivo último mejorar la seguridad del paciente (AU)

Background and purpose Simulation in surgical learning responds to ethical and pragmatic needs. Our purpose is to describe the effects on surgical skills of conducting a surgical training workshop on strabismus surgery with phantoms. Concern for patient safety makes it necessary to consider the use of simulators (virtual and three-dimensional physical) and animal models that allow the applicant to safely practice the procedures before facing a real case. Material and methods Realization of a workshop with previous theoretical content and real practice with phantoms designed to simulate strabismus surgery (eyeball, six muscles, conjunctiva, eyelid and Tenon capsule inserted in the skull) of real anatomical dimensions. Satisfaction survey and subjective evaluation of learning by the student and the expert tutor according to the Kirkpatrick evaluation model. Results 100% of the 26 students attending two courses (15 students in one course and 11 students in another course) and 100% of the three tutors who participated in both courses completed the survey. Twenty were resident doctors and 20 specialists in ophthalmology. The overall satisfaction of the students was 8.2 (± 0.68). Conclusions According to the results of the Kirkpatrick training actions evaluation survey, the perception of students and tutors is that training with phantoms in strabismus surgery can help improve the skills necessary for safe and independent practice. The ultimate goal being to improve patient safety (AU)

Surgical training with phantoms in strabismus surgery.

BACKGROUND AND PURPOSE: Simulation in surgical learning responds to ethical and pragmatic needs. Our purpose is to describe the effects on surgical skills of conducting a surgical training workshop on strabismus surgery with phantoms. Concern for patient safety makes it necessary to consider the use of simulators (virtual and three-dimensional physical) and animal models that allow the applicant to safely practice the procedures before facing a real case. MATERIAL AND METHODS: Realization of a workshop with previous theoretical content and real practice with phantoms designed to simulate strabismus surgery (eyeball, 6 muscles, conjunctiva, eyelid and tenon capsule inserted in the skull) of real anatomical dimensions. Satisfaction survey and subjective evaluation of learning by the student and the expert tutor according to the Kirkpatrick evaluation model. RESULTS: Total, 100% of the 26 students attending two courses (15 students in one course and 11 students in another course) and 100% of the 3 tutors who participated in both courses completed the survey. 20 were resident doctors and 20 specialists in ophthalmology. The overall satisfaction of the students was 8.2 (±0.68). CONCLUSIONS: According to the results of the Kirkpatrick training actions evaluation survey, the perception of students and tutors is that training with phantoms in strabismus surgery can help improve the skills necessary for safe and independent practice. The ultimate goal being to improve patient safety.

Fabricación de modelos anatómicos articulares para formación en intervencionismo ecoguiado / Anatomic joint models for eco-guided interventionism training manufacture

Introducción: El intervencionismo ecoguiado ha supuesto un cambio en la forma en que los especialistas de medicina física y rehabilitación se enfrentan al dolor musculoesquelético y a otros problemas como la espasticidad. La implantación de las unidades de intervencionismo ecoguiado mejora los resultados de los tratamientos mínimamente invasivos, habituales en la práctica clínica de nuestra especialidad. El mayor inconveniente de esta práctica es la larga curva de aprendizaje y la dificultad para llevar a cabo prácticas durante los cursos de formación. Objetivo: Desarrollar un sistema de fantomas que permita la práctica de intervencionismo en modelos anatómicos acortando los tiempos de aprendizaje y mejorando la certeza al alcanzar el objetivo de la práctica intervencionista. Métodos: Se describe el método de fabricación de modelos tridimensionales de articulaciones a partir de imágenes obtenidas de tomografía axial computarizada, y su inclusión posterior en moldes realizados con gelatina alimenticia, que permiten obtener unos fantomas similares a modelos articulares reales que posibilitan su estudio mediante técnicas de ecografía y la práctica del intervencionismo ecoguiado. Conclusión: Los modelos articulares tridimensionales con gelatina alimenticia son útiles en la práctica y aprendizaje de las técnicas de intervencionismo ecoguiado articular.(AU)

Introduction: Eco-guided interventionism has changed the way Physical Medicine and Rehabilitation specialists deal with musculoskeletal pain and other problems such as spasticity. The implementation of the Eco-Guided Intervention Units improves the results of the usual minimally invasive treatments in our speciality's clinical practice. The biggest drawback of this practice is the long learning curve and the difficulty of practice during training courses. Objective: To develop a system of phantoms that allow the practice of interventionism in anatomical models by shortening learning times and improving certainty by achieving the objective of interventionist practice. Methods: Describes the method of manufacturing three-dimensional models of joints with images obtained from computerized axial tomography, and their subsequent inclusion in gelatin's made molds, which allow to obtain phantoms, similar to real joint models, that allow to study using ultrasound techniques, and the practice of eco-guided interventionism. Conclusion: Three-dimensional joint models made with gelatin are useful in the practice and learning of joint eco-guided interventionism techniques.(AU)

[Anatomic joint models for eco-guided interventionism training manufacture]. / Fabricación de modelos anatómicos articulares para formación en intervencionismo ecoguiado.

INTRODUCTION: Eco-guided interventionism has changed the way Physical Medicine and Rehabilitation specialists deal with musculoskeletal pain and other problems such as spasticity. The implementation of the Eco-Guided Intervention Units improves the results of the usual minimally invasive treatments in our speciality's clinical practice. The biggest drawback of this practice is the long learning curve and the difficulty of practice during training courses. OBJECTIVE: To develop a system of phantoms that allow the practice of interventionism in anatomical models by shortening learning times and improving certainty by achieving the objective of interventionist practice. METHODS: Describes the method of manufacturing three-dimensional models of joints with images obtained from computerized axial tomography, and their subsequent inclusion in gelatin's made molds, which allow to obtain phantoms, similar to real joint models, that allow to study using ultrasound techniques, and the practice of eco-guided interventionism. CONCLUSION: Three-dimensional joint models made with gelatin are useful in the practice and learning of joint eco-guided interventionism techniques.

Simulation in Otolaryngology: A teaching and training tool. / Simulación en Otorrinolaringología: una herramienta de enseñanza y entrenamiento.

Simulation in medical education is an effective method of teaching and learning, allowing standardisation of the learning and teaching processes without compromising the patient. Different types of simulation exist within subspecialty areas of Otolaryngology. Models that have been developed include phantom imaging, dummy patients, virtual models and animal models that are used to teach and practice different skills. Each model has advantages and disadvantages, where virtual reality is an emerging model with a promising future. However, there is still a need for further development of simulation in the area of Otolaryngology.

Diseño e implementación de un modelo de enseñanza en ambiente simulado de paracentesis abdomina / Design and implementation of an environment teaching model simulated abdominal paracentesis

Resumen: El aprendizaje de los estudiantes de Medicina de Pregrado en ambiente simulado constituye una alternativa en la obtención de competencias técnicas y no técnicas. Objetivo: Desarrollar un fantoma e implementar un taller modular de entrenamiento de paracentesis abdominal en ambiente simulado para estudiantes de Medicina. Métodos: Se diseñaron y desarrollaron modelos para la realización de paracentesis abdominal en la Escuela de Diseño de la Pontificia Universidad Católica de Chile (PUC) y se implementó un taller para alumnos de 4to año de Medicina de la PUC, utilizando un enfoque constructivista, sesiones de entrenamiento simulado con debriefing basadas en el modelo plus-delta y evaluación pre y post-procedimiento siguiendo los principios de evaluación para el aprendizaje. Resultados: Se desarrollaron 3 prototipos hasta llegar a un modelo definitivo de alta fidelidad basado en la percepción de 20 expertos. 237 alumnos asistieron a un taller de paracentesis abdominal en el Centro de Cirugía Experimental y Simulación Universidad Católica (UC). Este consistió en una actividad práctica grupal (7-8 alumnos por sesión) que incluyó: una evaluación pre-sesión, un vídeo instruccional, una demostración en tiempo real en el fantoma por parte de un docente, la realización guiada del procedimiento por parte de los alumnos, debriefing y cierre de la sesión. Conclusiones: Un modelo de enseñanza en ambiente simulado es posible de ser diseñado e implementado exitosamente en un centro educacional para estudiantes de Medicina de Pregrado. Este taller de paracentesis permite entrenar a los alumnos en la realización de paracentesis abdominal en un ambiente seguro para los alumnos y pacientes y puede ser implementado a bajo costo en otros centros o instituciones. (AU)

Abstract: Simulated environments are an option in the learning process of undergraduate medical students in order to obtain technical and non-technical. Aim: To develop a mannequin for abdominal paracentesis and the implementation of a training workshop to perform abdominal paracentesis in a simulated environment for undergraduate medical students. Methods: The prototypes were designed and developed to perform abdominal paracentesis at the School of Design at the Pontificia Universidad Católica de Chile (PUC) and a workshop was implemented in a course with 4-year medical students at the PUC, using a constructivist approach and simulated training sessions and providing debriefing (based on plus-delta model) and pre-post training assessment following the principles of Assessment for Learning. Results: Three prototypes were developed until the final high-fidelity-mannequin was achieved. The abdominal paracentesis workshop was attended by 237 students at the Universidad Católica (UC) Experimental Surgery and Simulation Center. This was a hands-on group activity (7-8 students per session) including pre-session assessment, instructional video-tape, real-time demonstration of abdominal paracentesis procedure by the clinical teacher, followed by abdominal paracentesis performed by the students, debriefing and closing session. Conclusions: A teaching model in a simulated environment is feasible to be successfully designed and implemented in an educational center for undergraduate medical students. This workshop allows students training process to perform abdominal paracentesis in a safe environment for students and patients and it can be implemented in other centers or institutions with low cost.(AU)

THE EFFECTS OF TIME AND MOISTURE ON ELASTICITY IMAGING PHANTOM PHYSICAL AND MECHANICAL PROPERTIES: A PILOT STUDY / EFECTOS DE TIEMPO Y HUMEDAD EN LAS PROPIEDADES MECÁNICAS Y FÍSICAS DE UN FANTOMA DE IMÁGENES DE ELASTICIDAD: ESTUDIO PILOTO / EFEITOS DO TEMPO E UMIDADE NAS PROPRIEDADES MECÂNICAS E FÍSICAS DE UMA FANTOMA DE IMAGENES DE ELASTICIDADE: UM ESTUDO PILOTO

Elasticity imaging phantoms are used to mimic human tissue as a means of testing and validating non-invasive techniques for measuring mechanical properties of human tissues. Limited studies of phantom stability have shown that phantom stiffness change over time when exposed to air. The goals of this study were to investigate how the physical and mechanical properties of elasticity imaging phantoms change with time and moisture state. Two moisture states were tested; a dry state where the phantom was exposed to open air and a wet state where the phantom was submerged in water for 480 minutes. Polyvinyl alcohol (PVA) phantoms (cylindrical shape) were used. The properties of the phantom were found using flat indentation tests and a test battery that included a precondition test, a 0.05 mm/s triangle test, a 5 mm/s triangle test and a ten-second ramp-and-hold relaxation test. This battery was done at multiple time points: 0, 15, 30, 45, 60, 120, 180, 240, 360 and 480 minutes. At each time point, the modulus, stiffness and relaxation at 10 seconds were calculated. In addition, the mass and volume of the phantoms were measured at each time point. The physical and mechanical properties of the phantoms were found to be statistically dependent on moisture state and time (p<0.05). The stiffness and moduli of the dry samples increased with time while the mass and volume decreased with time. Additionally, a strong correlation was found between the change in mass and change in modulus/stiffness for the dry phantoms. For the wet samples, the modulus and stiffness decreased with time while the mass and volume increase with time. The properties of the phantom begin to change within 15 minutes, the percentage change of the mechanical and physical properties remained, on average, under 10% during the first hour and increased up to 50% during 8 hours. These property changes of phantoms should be considered when using phantoms to test or validate non-invasive techniques.

Fantomas de imágenes de elasticidad se utilizan para imitar el tejido humano como un medio de ensayo y validación de técnicas no invasivas para medir las propiedades mecánicas de los tejidos humanos. La estabilidad de los fantomas se ha estudiado anteriormente y se ha encontrado que su elasticidad cambia con respecto al tiempo cuando están expuestas al aire. Los objetivos de este estudio fueron investigar cómo las propiedades físicas y mecánicas de los fantomas de imágenes de elasticidad cambian con el tiempo y el estado de humedad. Dos estados de humedad fueron examinados; un estado seco, donde el fantoma se expone al aire libre y un estado húmedo, donde el fantoma se sumergió en el agua. Se utiliza alcohol polivinílico (PVA) para crear los fantomas (forma cilíndrica). Las propiedades del fantoma se encontraron utilizando pruebas de indentación planas y una batería de pruebas que incluyeron una prueba de condición, a 0.05 mm/s prueba triangular, una prueba triangular 5 mm/s, y ensayo de relajación de rampa-retención de diez segundos. Esta batería se realiza en múltiples puntos de tiempo: 0, 15, 30, 45, 60, 120, 180, 240, 360 y 480 minutos. En cada punto de tiempo, se calcularon el módulo, la rigidez y la relajación en 10 segundos. Además, la masa y el volumen de los fantomas se midieron en cada punto de tiempo. Se encontró que las propiedades físicas y mecánicas de los fantomas son dependientes estadísticamente del estado de humedad y el tiempo (p <0,05). La rigidez y módulos de las muestras secas se incrementaron con el tiempo mientras que la masa y el volumen disminuyó con el tiempo. Adicionalmente, una fuerte correlación fue encontrada entre los cambios de masa respecto al cambio de módulo para las muestras secas. Para las muestras húmedas, el módulo y la rigidez disminuyeron con el tiempo, mientras que aumentó la masa y el volumen con el tiempo. Las propiedades de los fantomas comienzan a cambiar dentro de los 15 minutos, pero el porcentaje de cambio de las propiedades mecánicas y físicas se mantuvo, en promedio, menos del 10% durante la primera hora y aumentó hasta el 50% en las 8 horas. Estos cambios en las propiedades de los fantomas deben ser considerados cuando se utilizan para probar o validar las técnicas no invasivas.

Fantomas de imagenes de elasticidade foram utilizadas para imitar o tecido humano como um meio de testes e validação de técnicas não invasivas para medir as propriedades mecânicas dos tecidos humanos. A estabilidade dos fantomas foi estudada previamente e descobriram que a elasticidade se altera com o tempo quando é exposta ao ar. Os objetivos deste estudo foram investigar como as propriedades físicas e mecânicas dos fantomas de imagem de elasticidade mudam ao longo do tempo e o estado de umidade. Dois estados de umidade foram examinados; um estado de seca, em que o fantoma está exposta ao ar livre e um estado úmido, onde o fantoma foi imersa em água. é usado Álcool polivinílico (PVA) para criar o fantoma (forma cilíndrica). As propriedades do fantoma foram encontrados por meio de testes de indentação planas e uma bateria de testes, incluindo um teste de condição, a 0,05 mm / s teste triangular, um teste triangular de 5 mm / s, e teste de relaxamento rampa de Retenção de dez segundos. Esta bateria é realizada em vários pontos de tempo: 0, 15, 30, 45, 60, 120, 180, 240, 360 e 480 minutos. Em cada ponto de tempo, foram calculados o módulo de elasticidade, rigidez e relaxamento em 10 segundos,. Além disso, a massa e volume dos fantomas foram medidos em cada ponto de tempo. Verificou-se que as propriedades físicas e mecânicas dos fantomas são dependentes estatisticamente do estado de umidade e tempo (p <0,05). A rigidez e módulos das amostras secas aumentou com o tempo, enquanto a massa e volume diminuiu com o tempo. Além disso, foi encontrada uma forte correlação entre as alterações na massa com respeito à alteração do módulo para amostras secas. Para as amostras molhadas, o módulo de elasticidade e rigidez diminuiu ao longo do tempo, enquanto o aumento da massa e do volume ao longo do tempo. As propriedades dos fantomas começam a mudar dentro dos 15 minutos, mas a percentagem de variação das propriedades mecânicas e físicas permaneceram, em média, menos de 10% durante a primeira hora, e aumentou até 50% em 8 horas. Essas alterações nas propriedades dos fantomas deve ser considerado quando é usado para testar ou validar as técnicas não invasivas.