Effectiveness of 3D Printed Models for Knee Arthrocentesis Teaching

Objectives Three-dimensional (3D) printing technology training models are becoming more common in medical education. 3D printed models are an accessible, cost effective, realistic in anatomy, and reusable option. We evaluated if targeted educational tools and training on 3D-printed knee arthrocentesis models would improve learner confidence and performance in knee joint injection and arthrocentesis. Methods Medical students and residents completing a rheumatology rotation at the Nova Scotia Rehabilitation and Arthritis Centre were recruited. Participants completed surveys pre- and post-educational module, assessing confidence with knee arthrocentesis, using a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Participants performed knee arthrocentesis on the 3D knee model twice, once prior to completing an educational module, and again following module completion. Participants were formatively evaluated both pre- and post-learning module, using a standardized grading metric consisting of 18 categories. Pre- and post-module scores were paired and compared using the non-parametric Wilcoxon signed rank test. Descriptive statistics were reported as median and interquartile range (IQR) for non-normal continuous variables and frequency and proportions for categorical variables. Results A total of 25 students participated, 12 medical students and 13 residents, ranging from first year medical students to residents in post graduate year 4. Formative assessment scores improved from a median score of 13 out of 18 (IQR 7.5,16) pre-module, to 17 out of 18 (IQR 16,18) post-module (p-value < 0.001) (Figure 1). Within the 18 categories learners scored lowest on “perform pre-procedural time-out” (14% of participants correctly performed) and “post procedure instructions” (24% of participants correctly performed) in the pre module rubric. They improved most in these categories in the post-module rubric, 66% score correctly for “pre-procedural time-out” and 76% score corrected for “post-procedural instructions.” Learners’ confidence with arthrocentesis improved from a pre-module median score of 3 out of 5 (IQR 2,4) to post-module median score of 5 (IQR 4,5), with all except 1 study participant showing improvement in post-module scores. Learners rated the use of the module as a valuable learning experience, median 5 (IQR 5, 5) and the use of the 3D arthrocentesis model as valuable to their learning, median 5 (IQR 5, 5). Figure 1. Box plot of formative evaluation scores pre and post module completion. Conclusion The use of a 3D printed knee model for arthrocentesis teaching improved both performance and learner confidence, across various stages of training. Areas of further investigation include assessing retention of knowledge, expansion to other learning sites and utility of other 3D models (other anatomic sites and US compatible models).