Paediatric residents painting 3D congenital heart disease models

Abstract

Congenital heart defects (CHDs) are the most common congenital anomaly affecting 1% of newborns, with 8% of CHDs having only one effective or ‘single’ ventricle. It is critical that paediatricians and paediatric residents understand cardiac defects, both anatomically and physiologically, as these lesions are commonly encountered in clinical practice. CHDs can be complex and challenging to understand. Many current educational tools for learning about CHDs have limited interactive qualities and may not support kinesthetic learning preferences.

3D printing technology is increasingly affordable, accessible, and can create highly accurate models of CHDs from CT or MRI scans.¹ We printed 3D models of the three stages of single ventricle palliation (Stage 1: Norwood procedure for hypoplastic left heart syndrome, Stage 2: Glenn procedure, Stage 3: Fontan procedure), which are anatomically complex CHDs. These defects were chosen as each stage demonstrates significant changes in physiology which correspond to clinical manifestations in patients. We printed the models using a white firm plastic material (polylactic acid or PLA) suitable for acrylic paint application. We provided a 1 hour teaching session starting with a 20-minute didactic portion orienting the learners to the 3D models and demonstrating the cardiac anatomy via presentation by a paediatric cardiologist, followed by a 40-minute interactive portion where groups of three residents each painted a 3D model corresponding to one of the stages of the single ventricle palliation with red, blue and purple paint. Residents were instructed to use paint to demonstrate relative oxygen saturations of the blood in the different areas of the heart: red for oxygenated blood, blue for deoxygenated blood, and purple for mixed or partially oxygenated blood. Digital versions of the 3D model with the corresponding red, blue, and purple colouring (Stage 1: https://skfb.ly/otyZA; Stage 2: https://skfb.ly/otAUX; Stage 3: https://skfb.ly/oAOyV) and physical models with this colouring (Vero material using Stratasys J750 printer) were provided as guides. Two paediatric cardiology fellows circulated to answer questions and guide individual residents. Residents were encouraged to discuss their models within their groups to compare the different stages of the single ventricle palliation and could keep their painted model. Thirty-eight residents participated.

We found that this novel method of interactive teaching was feasible and appeared enjoyable and informative for paediatric trainees. Many residents remained beyond the allotted time to continue their conversations or to finish painting their model, suggesting that this was an interesting educational session for the residents and that an increased time allotment for the painting activity would be valuable. We observed resident engagement via discussions within their groups, comparison of the models of different stages, and residents asking questions about the models and the clinical implications of each stage of the single ventricle palliation. The session required significant time investment to print models and prepare painting materials, but overall material costs were not prohibitive as our institution owned the 3D printer. Given the resident engagement and positive feedback, we intend to repeat similar sessions focusing on different CHDs.