Design, Development and Validation of an Anatomical 3D printed Equine Cervical Articular Process Joint Model as an Ethical Alternative for the Training of Ultrasound-Guided Intra-Articular Injections

Abstract

Simulation-based medical education is an ethical and effective alternative in healthcare education that facilitates the development of cognitive and technical skills using simulation models, whilst protecting patients from unnecessary risks. This thesis investigates the implementation of simulation-based medical education in veterinary medicine to teach ultrasound-guided injections of the equine cervical articular process joints. The first objective of this project was to compare the qualitative ultrasonographic characteristics of three-dimensional (3D) printed models of an equine cervical articular process joint to that of a dissected equine cervical spine (gold standard). Thirteen 3D cervical articular process joint models were printed using several materials, printers, and printing technologies. Ultrasound video clips with the 3D printed models and gold standard immersed in water were recorded and compared to one another. Six 3D printed models had ultrasonographic characteristics similar to the gold standard (material, printer and printing technology): nylon PA 12, EOS Formiga P100, selective laser sintering; Onyx nylon with chopped carbon fiber, Markforged Onyx Two, fused deposition modeling; polycarbonate, Ultimaker 3, fused deposition modeling; gypsum, ProJet CJP 660 Pro, ColorJet Printing; polylactic acid, Prusa I3, fused deposition modeling; and high temperature V1 resin, Form 2, stereolithography. The second objective was to develop and validate a model of an equine cervical articular process joint to teach ultrasound-guided intra-articular injections. Five identical models of an equine cervical articular process joint were 3D printed, mounted, and embedded. The ability of experts and novices to successfully insert a needle into the joint space of the model using ultrasound guidance was assessed and graded using an Objective Structured Clinical Examination (OSCE). Scores from experts and novices were compared to evaluate the construct validity of the model. Participants also answered a survey assessing the face and content validity of the model. Results partially supported the construct validity of the model and proved the face and content validity of this new training tool. The development and validation of a model of an equine cervical articular process joint laid the foundation for further research in the development of a full-size equine neck model.