Lauren M. Davis

Melanoma simulation model: promoting opportunistic screening and patient counseling.

IMPORTANCE Lack of training hampers melanoma recognition by physicians. OBJECTIVE To evaluate a melanoma simulation model to teach visual assessment and counseling skills. DESIGN AND SETTING Simulation model study in an academic research setting. PARTICIPANTS A convenience sample of third-year medical students was randomly assigned to receive the intervention before or after a standardized patient. INTERVENTION During the primary care clerkship, medical students participated in melanoma skills training using 2 simulation models replicating melanomas and abnormal or benign nevi. Scoring threshold rules for visual assessment and management of pigmented lesions and videos of patient counseling were provided. MAIN OUTCOME MEASURES Identifying a melanoma moulage and counseling the standardized patient. Secondary measures were preintervention and 2-week postintervention knowledge, attitudes about and confidence in their ability to perform opportunistic surveillance and counseling, as well as identification on the model of clinically suspicious pigmented lesions, lesions needing a biopsy, and lesions to be monitored for change. RESULTS Among 74 students, confidence in their ability to perform opportunistic surveillance improved significantly after skills training (P < .05, χ2 test). Monitoring clinically suspicious lesions for change decreased from 16% (12 of 74) to 3% (2 of 74) and performing a biopsy increased from 80% (59 of 74) to 96% (71 of 74), monitoring benign lesions for change decreased from 43% (32 of 74) to 3% (2 of 74), and biopsying melanoma in situ increased from 10% (7 of 74) to 26% (20 of 74) (P < .05 for all, χ2 test). Detection of the melanoma moulage on the standardized patient occurred more often by trained students (P < .05, χ2 test). CONCLUSION AND RELEVANCE A 1-hour melanoma simulation education and skills training experience improved performance of opportunistic surveillance, management, and patient counseling by third-year medical students. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01191294.

Design and development of a novel thoracoscopic tracheoesophageal fistula repair simulator.

Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) is a technically challenging surgical procedure. This congenital anomaly is rare; therefore, training opportunities for surgical trainees are limited. There are currently no validated simulation tools available to help train pediatric surgery trainees. The simulator that was developed is a low-cost, reusable model. It simulates the right side of a term neonate chest and contains a tissue block that has been surgically modified to replicate the anatomy of EA/TEF.

Design and development of low-cost tissue replicas for simulation of rare neonatal congenital defects.

Studies have shown that simulation can be a valuable tool for training pediatric surgeons to perform thoracoscopic repair of rare congenital anomalies [1-3]. The previously evaluated models were high fidelity, hybrid models that required the use of fetal bovine or porcine tissue blocks within a simulated neonate chest cavity. Real tissue blocks can be expensive, and may not be readily available in some parts of the world. We have developed low-cost, portable simulators for esophageal atresia with tracheoesophageal fistula (EA/TEF) and duodenal atresia (DA) that recreate the 3-dimensional challenges for minimally invasive repair. These are fully simulated models of the thoracic and abdominal cavities containing synthetic tissue that replicates the required anatomy.

Design and development of a laparoscopic gastrostomy tube placement simulator.

Laparoscopic gastrostomy tube placement is a common surgical procedure performed in infants. There are currently no commercially available simulation tools for pediatric surgeons to use for surgical training and practice purposes. We have created a low cost and reusable laparoscopic gastrostomy tube placement model for use in pediatric surgical education.

The evolution of design: a novel thoracoscopic diaphragmatic hernia repair simulator.

As advanced minimally invasive techniques have become more prevalent, there has been an increase in the number of pediatric surgeons performing thoracoscopic repair of congenital diaphragmatic hernia (CDH). Opportunities to learn and practice this procedure are few. The use of a simulation model for thoracoscopic CDH repair may help reduce errors in the operating room. Prototypes for low and high fidelity CDH repair simulators were designed and built. These prototypes allow pediatric surgery trainees the opportunity to learn and practice thoracoscopic CDH repair before performing this operation on infants.

Board 511 - Technology Innovations Abstract 3D Printing: A New Frontier in Simulation (Submission #514)

Introduction/Background Three dimensional printing is becoming prevalent for a variety of uses in the medical field. Scientists aim to use these technologies to print living organs for transplant, or to print implants that perfectly fit inside patients, as well as other applications. Simulation is one area where 3D printing is not utilized frequently, but can be extremely useful. Studies have shown that 3D printed models can be used for simulating a variety of procedures. We have developed a range of low-cost, reusable simulators that can be produced using 3D printing technologies. Three dimensional printing has historically been used across industries including automotive, aviation, manufacturing, and medical. Common applications within the medical field include dental fabrication, scaffolds for tissue engineering and prototyping medical devices.1 Some more recent applications include prosthetics, and medical implants.2-3 We have used 3D printing to create a range of pediatric surgery simulators. Methods Three dimensional computer modeling is useful when tasked with the design of complex models. This kind of modeling allows accurate geometries to be created. Rapid prototypes can be created from 3D models using CNC machining technologies and 3D printing, among other Methods. Three Dimensional printing is fast, cost effective, and can build functional parts instantly. A variety of 3D printers and software are available for rapid prototyping, each providing different solutions to issues we encounter in simulator design. Due to the intricate nature of infant anatomy, it is difficult to create hand-made, functional models for complex surgical procedures. Our team decided to use 3D computer modeling and rapid prototyping as a means for designing and manufacturing a range of simulators for pediatric surgical procedures. A variety of materials were tested during the design process to determine what would be the most durable and functional for molds and models. Some of the materials used include ABS plastic, glass-filled nylon, flexible rubber-like digital material, digitally blended mix of rigid and flexible material, and high performance composite. Extrusion, granular, powder bed, laminated, and light polymerized printers were all used for rapid prototyping during the design process. Soft tissue-like materials are not available for 3D printers; therefore we printed the inverse of the design to use as a mold with silicone rubber. Results: Conclusion In Conclusion, 3D printing can be used to create functional simulation models for medical education and research. Through this work, we determined that different materials work best for different applications. Parts that needed to withstand higher forces and pressures from surgical tools were initially made in ABS plastic. The joints were brittle and led us to redesign using a combination of digitally blended rigid and flexible material. The flexible material prevented the models from breaking at joints, while the rigid material maintained the geometry of the structure. Molds were originally made in ABS plastic, but that did not provide high enough resolution resulting in unwanted patterns in the final parts. The mold was reprinted in a high performance composite powder, yielding a mold with high resolution that could be easily sanded smooth. A variety of silicone rubbers were used inside the molds to create soft tissue-like organs. Physicians were able to complete procedures on these organs using standard surgical and medical tools. The models have also been coupled with explanted animal tissue blocks. After use with animal tissue, the integrity of the model was not compromised during the sanitization process and was able to be reused multiple times. The models represented here have received favorable feedback from practicing physicians and trainees at conference training courses across the globe. References 1. Banham R. Printing a Medical Revolution. Connections, Finding opportunity in the global economy. http://individual.troweprice.com/public/Retail/Planning-&-Research/Connections/3D-Printing/Printing-a-Medical-Revolution. Accessed July 23, 2013. 2. Godt, E. The Cutting Edge: 3D Printing in Medicine. HealthImaging. http://www.healthimaging.com/topics/practice-management/cutting-edge-3d-printing-medicine. Accessed July 23, 2013. 3. Reiffel AJ. High-Fidelity Tissue Engineering of Patient Specific Auricles for Reconstruction of Pediatric Microtia and Other Auricular Deformities. PLoS One.2013:8(2). Disclosures None.