Rubio-López Alberto, García-Carmona Rodrigo, Zarandieta-Román Laura, Rubio-Navas Alejandro, González-Pinto Ángel, Cardinal-Fernández Pablo
Intensive Care Unit, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain.
Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.
Adv Simul (Lond). 2025 Apr 4;10(1):19. doi: 10.1186/s41077-025-00348-0.
Training in invasive procedures like pericardiocentesis is a critical component of medical education but poses significant challenges due to its complexity and infrequent clinical application. Pericardiocentesis is an invasive procedure used to remove excess pericardial fluid from the pericardial sac, typically performed to relieve cardiac tamponade. It requires precise anatomical knowledge, ultrasound guidance, and dexterous needle placement to minimize complications. Simulation-based training, particularly with innovative technologies such as 3D printing and virtual reality (VR), offers accessible and cost-effective solutions. This study compared the effectiveness of 3D-printed mannequins and VR simulations in pericardiocentesis training, focusing on learning outcomes, stress responses, and cognitive load.
Thirty-five final-year medical students participated in this quasi-experimental study, receiving training with both models in separate sessions under the supervision of two experienced instructors. Learning outcomes were evaluated using the objective structured clinical examination (OSCE), while stress responses were assessed via heart rate variability (HRV), a measure of fluctuations in heart rate that reflect stress levels. Perceived cognitive load was measured with the NASA Task Load Index (NASA-TLX). Wilcoxon signed-rank and Friedman tests were used for statistical analysis.
The 3D-printed mannequin outperformed VR in tasks requiring fine motor skills, such as material handling and drainage placement (Z = - 2.56, p < 0.05; Z = - 2.34, p < 0.05). VR training, however, was associated with lower mental demand and effort (Z = - 2.147, p < 0.05; Z = - 2.356, p < 0.05). Biometric analysis indicated higher stress levels during mannequin-based training (SD1/SD2, chi-square = 14.157, p < 0.01), reflecting its closer replication of real-life clinical conditions.
Both 3D-printed mannequins and VR simulations serve as effective tools for pericardiocentesis training, each offering unique advantages. The 3D-printed mannequin supports tactile skill acquisition, while VR enhances cognitive engagement in a low-stress environment. A hybrid approach-beginning with VR and progressing to 3D-printed models-maximizes training outcomes, particularly in resource-limited settings, where affordable simulation tools can improve access to medical education.
心包穿刺等侵入性操作的培训是医学教育的关键组成部分，但由于其复杂性和临床应用不频繁，带来了重大挑战。心包穿刺是一种用于从心包腔中抽出过多心包积液的侵入性操作，通常用于缓解心脏压塞。它需要精确的解剖学知识、超声引导以及灵活的进针操作，以尽量减少并发症。基于模拟的培训，特别是借助3D打印和虚拟现实（VR）等创新技术，提供了便捷且经济高效的解决方案。本研究比较了3D打印人体模型和VR模拟在心包穿刺培训中的有效性，重点关注学习成果、应激反应和认知负荷。
35名医学专业最后一年的学生参与了这项准实验研究，在两名经验丰富的教员的监督下，分别使用两种模型进行培训。使用客观结构化临床考试（OSCE）评估学习成果，通过心率变异性（HRV）评估应激反应，HRV是反映应激水平的心率波动指标。使用美国国家航空航天局任务负荷指数（NASA-TLX）测量感知认知负荷。采用Wilcoxon符号秩检验和Friedman检验进行统计分析。
在需要精细运动技能的任务中，如材料处理和引流管放置，3D打印人体模型的表现优于VR（Z = -2.56，p < 0.05；Z = -2.34，p < 0.05）。然而，VR培训的心理需求和努力程度较低（Z = -2.147，p < 0.05；Z = -2.356，p < 0.05）。生物特征分析表明，基于人体模型的培训期间应激水平较高（SD1/SD2，卡方 = 14.157，p < 0.01），这反映了其对现实临床情况的更接近复制。
3D打印人体模型和VR模拟都是心包穿刺培训的有效工具，各有独特优势。3D打印人体模型有助于获得触觉技能，而VR则能在低压力环境中增强认知参与度。一种混合方法——先进行VR培训，再过渡到3D打印模型——能最大限度地提高培训效果，尤其是在资源有限的环境中，经济实惠的模拟工具可以改善医学教育的可及性。
