Montgomery Spencer Jason, Kooner Sahil Singh, Ludwig Taryn Elaine, Schneider Prism Steorra
University of Calgary Health Sciences Centre, Calgary, Alberta, Canada.
University of Calgary Health Sciences Centre, Calgary, Alberta, Canada.
J Surg Educ. 2020 Mar-Apr;77(2):472-478. doi: 10.1016/j.jsurg.2019.10.004. Epub 2020 Feb 6.
To determine if three-dimensionally printed (3Dp) fracture models can improve orthopedic trainee education.
A prospective comparison study of orthopedic trainees and attending surgeons was performed, where a range of calcaneal fractures were used for creating anonymized 3Dp models. Study participants rotated through workstations viewing computed tomography images and either a digital 3D volume rendering or 3Dp model of the fractured calcaneus. Diagnosis, time for evaluation, confidence of fracture understanding, perceived model accuracy, and proposed treatment were compared using a standardized questionnaire.
Sixteen resident trainees and 5 attending surgeons participated in this study. Attending surgeons were required to have fellowship training in trauma or foot and ankle surgery and manage calcaneal fractures as part of their current practice.
Junior residents had the slowest time of assessment (mean = 121 ± 54 seconds) and lowest percentage of correct diagnoses (69%), although these findings did not reach significance compared to the other residency years. Residents displayed higher levels of confidence in fracture understanding with increasing residency year of training (p < 0.0001), and this confidence was greater for cases that included a 3Dp model (p < 0.03). Perceived accuracy of cases with 3Dp models was significantly higher than cases without 3Dp models (7.0 vs 5.5 p < 0.001).
This study found that 3Dp models increase the perceived accuracy of fracture assessment, though no statistically significant improvement in diagnostic accuracy was observed. The 3Dp models did improve trainee confidence, although this effect diminished with increasing residency year. In orthopedic residency training programs, 3Dp models of complex fractures can be a valuable educational tool, especially for junior trainees.
确定三维打印（3Dp）骨折模型是否能改善骨科实习生的教育。
对骨科实习生和主治外科医生进行前瞻性比较研究，使用一系列跟骨骨折创建匿名的3Dp模型。研究参与者轮流在工作站查看计算机断层扫描图像以及跟骨骨折的数字三维容积再现或3Dp模型。使用标准化问卷比较诊断结果、评估时间、对骨折理解的信心、感知的模型准确性和建议的治疗方法。
16名住院实习生和5名主治外科医生参与了本研究。主治外科医生需要接受创伤或足踝外科的专科培训，并在其当前的临床工作中处理跟骨骨折。
初级住院医生的评估时间最慢（平均 = 121 ± 54秒），正确诊断的百分比最低（69%），尽管与其他住院年限相比，这些结果没有达到统计学意义。随着住院培训年限的增加，住院医生对骨折理解的信心水平更高（p < 0.0001），对于包含3Dp模型的病例，这种信心更大（p < 0.03）。有3Dp模型的病例的感知准确性显著高于没有3Dp模型的病例（7.0对5.5，p < 0.001）。
本研究发现，3Dp模型提高了骨折评估的感知准确性，尽管未观察到诊断准确性有统计学意义的提高。3Dp模型确实提高了实习生的信心，尽管这种效果随着住院年限的增加而减弱。在骨科住院医师培训项目中，复杂骨折的3Dp模型可以是一种有价值的教育工具，特别是对于初级实习生。
