SLR - July 2022 - Daniele Cole, DPM
Reference: Banwell HA, Causby RS, Crozier AJ, Nettle B, Murray C. An exploration of the use of 3D printed foot models and simulated foot lesions to supplement scalpel skill training in undergraduate podiatry students: A multiple method study. PLoS One. 2021 Dec 13;16(12):e0261389. doi: 10.1371/journal.pone.0261389. PMID: 34898648; PMCID: PMC8668139.Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Daniele Cole, DPM
Residency Program: MetroWest Medical Center – Framingham, MA
Podiatric Relevance:
Podiatrist and podiatry students frequently use scalpels in clinic practice. Students may have little to no experience when initially using scalpels and teaching this skill can be difficult. Additionally, with reduced face-to-face learning during the pandemic, students get less opportunity to practice in clinic. Using 3D printed foot models wound allow students to become familiar with scalpel hand skills in a low risk setting.
Methods:
Three study designs were used. The first was a repeated measure trial, evaluating confidence and anxiety of second-year students who received a 1-hour training with a callused 3D foot model (n=24) vs final-year students who attended a half day ulcer management workshop with a 3D foot ulcer model (n=15). The second study was a randomized control trial (RCT) comparing confidence and anxiety of second-year students’ scalpel practice using 3D printed models (intervention, n=12) vs standardized teaching (control, n=15). The third was a focus group of final year students (n=5), discussing fidelity of the models. Anxiety, self-confidence, and task self-efficacy were measured using the Competitive State Anxiety Inventory-2 survey and a purpose-built questionnaire. These were given to students before and after the workshops.
Results:
-Repeated measure trial: For final-year students, there was a significant decrease in cognitive state and somatic state anxiety from baseline to follow-up. There was also a statistically significant increase in self-confidence and task self-efficacy. For the second-year students, there was no significant difference in cognitive or somatic anxiety from baseline to follow-up. There was a statistically significant increase in self-confidence and task self-efficacy.
-RCT: For the second-year students, there was no significant interaction effect for cognitive state anxiety, somatic state anxiety, or task self-efficacy. There was significant interaction effect for self-confidence over time for both the control and intervention group.
-Focus group: Students reported that the callus models’ hardness helped with learning to anchor their hands when using the scalpel. Students stated liking the different layers of the ulcer models, which replicated real-life ulcers. Students that had previously been exposed to real-life pathology reported the models being less important to their learning. They stated these would be helpful for second- and third-year students. The students also expressed value in practicing sterile technique and dressing applications while doing the workshop.
Conclusion:
The studies found that using 3D printed models lead to increased confidence with both the second-year and final-year students. Using models also decreased anxiety of scalpel use with the final-year students. When compared to traditional teaching methods, there was similar decrease in anxiety and increase in confidence. This investigation benefited from the multiple study designs. The authors were able to explore using 3D foot models with two different cohorts. Limitations included small sample sizes, especially of the focus group, and the repeated measures study did not have a control group. Also, obtaining models would have an increased cost over more traditional teaching method. Overall, this study demonstrated that 3D foot models are an effective tool for increasing confidence of scalpel use with undergraduate podiatry students, providing another resource which enhances students’ practice before treating patients.