- Email: [email protected]
PATIENT SPECIFIC SURGICAL SIMULATION OF THE ASCENDING THORACIC AORTA
Abstracts
were surveyed. Although faculty and residents found the tools easy to use, they felt that intermittent use of the assessment tools contributed to the lack of effective implementation. CONCLUSION: Implementing programmatic assessment is feasible, but intermittent assessment of competencies and surgical performance inhibits uptake. It may be more effective to implement an assessment program for all residents simultaneously compared to adopting a “phased in” approach by year as new residents enter a competency-based training program. Additionally, it may be more effective to incorporate assessment as a routine part of performing a task rather than expecting residents to periodically obtain assessment throughout a rotation. Individual programs may need to adapt assessment tools to the particular needs of their programs to facilitate effective implementation.
120 ECG COMPUTER INTERPRETATION AND CARDIOLOGY TRAINEES: HELP OR HINDERANCE?
S135
fasicular block (65% with ECG-CI vs 31% without ECG-CI), and early repolarization (71% with ECG-CI vs 38% without ECG-CI). However, complete heart block, pre-excitation, and Brugada were correctly identified even in absence of ECG-CI. The presence of ECG-CI significantly increased interpretation accuracy for chamber hypertrophy (p<0.05). Interpretation accuracy for ischemia, pacemaker rhythm, artifacts, and lead malposition were also improved with ECG-CI. CONCLUSION: Trainees appear to correctly interpret ECGs independently of ECG-CI. However, the presence of ECG-CI increased the accuracy of the residents’ interpretation. As ECG-CI appears to provide incremental accuracy to ECG diagnoses, patients may ultimately benefit from improved diagnostic accuracy. Table 1: Percentage of Residents who correctly identified the critical diagnoses by categories ECG Computer Interpretation ECG Computer Not Available Interpretation Available
Diagnosis
Overall
C1
C2
C3
Overall
C1
C2
C3
Arrhythmias (n=7)
85
83
87
88
83
84
89
79
Conduction System Disease (n=9)
73
66
77
76
83
80
81
89
Ischemia (n=4)
64
55
61
84
77
77
55
80
Hypertrophy (n=2)
19
25
20
10
59
72
67
25
Toronto, Ontario
Hyperkalemia (n=1)
81
67
80
100
88
86
100
75
BACKGROUND:
Pacemaker (n=1)
50
67
20
60
59
86
50
75
Artifacts (n=1)
35
14
67
25
56
50
60
60
Lead Malposition (n=1) 69
50
80
80
100
100
100
100
AY Chan, I Mangat, L Casella, J Janevski, P Dorian, EH Yu Interpretation of electrocardiograms (ECGs) is a fundamental skill for cardiologists. Prior data has suggested that ECG-computer interpretation (ECG-CI) may increase accuracy. In current clinical practice, ECGs are often presented with ECGCI, which may or may not be accurate. Although Cardiology trainees are taught to interpret ECGs independent of ECG-CI, the purpose of this study was to determine if ECG-CI affected the accuracy of ECG interpretation by Cardiology trainees. METHODS: Thirty-three consenting trainees (100% of the training program) representing all 3 training years (13 first (C1), 11 second (C2), and 9 third-year (C3) trainees) were randomized into 2 groups with relatively equal distribution of levels of training in each. Twenty-six pre-selected ECGs with important findings, including arrhythmias, conduction disorders, ischemia, hypertrophy, metabolic abnormalities, and device rhythms were sorted into 2 identical sets (A and B). For Set A, ECG-CI was included with only the first 13 ECGs, and for Set B ECG-CI was included with only the last 13 ECGs. One group of trainees interpreted Set A and the other group Set B. A marking key was developed by consensus of two experienced ECG interpreting cardiologists. All ECG interpretations were independently marked by both individuals blinded to trainee identity and year of training. RESULTS: The percentage of trainees who correctly identified the critical diagnoses on the ECGs in each category are listed in Table 1. Independent of ECG-CI, trainees were able to accurately identify most arrhythmias including AVNRT/ AVRT, ventricular tachycardia, and pre-excited atrial fibrillation. However, AV dissociation was identified poorly (82% with ECG-CI vs 63% without ECG-CI). In the absence of ECG-CI, the following conduction system disorders were interpreted suboptimally: bifasicular block (88% with ECG-CI vs 65% without ECG-CI), left posterior
121 PATIENT SPECIFIC SURGICAL SIMULATION OF THE ASCENDING THORACIC AORTA J Garcia, Z Yang, K Lachapelle, R Mongrain, R Leask Montréal, Québec BACKGROUND:
Currently, surgical training outside the clinic is primarily limited to practice on expensive cadavers or phantoms made of non-realistic materials representing a limited number of pathologies. Therefore, there is a need of new vascular simulators with anatomical and physiological fidelity to allow for optimal pre-procedural practice. The present study aimed at creating 3D printed phantoms for surgical training with anatomical and biomechanical fidelity to mimic human ascending thoracic aortic tissue. METHODS: The in vivo anatomy of patients was acquired from CT-scans of patients with an ascending thoracic aortic aneurysm. A series of three-material composites suitable for three-dimensional printing (Connex3, Objet500, Stratasys, Eden Prairie, MN, USA) were created to mimic the mechanical behaviour excised aortic tissue and screened by planar biaxial tensile testing (Electroforce ELF 3200, Bose Framingham, MA, USA). The apparent stiffness and energy loss were compared between the aortic tissues (healthy and pathological) and composite candidates. RESULTS: One candidate composite which was representative of aneurysmal AA tissue (Bonferroni’s post-test p<0.05) was then selected and implemented in the three-dimensional aorta model of an idealized and patient specific aneurysm model.
S136 CONCLUSION:
A method to create 3D printed models of patient specific aortopathies suitable for surgical training has been developed. The use of a composite 3D printed material allows us to tailor the mechanical properties of the model and produce the necessary distension and suture retention strength needed for surgical training. Figure: a) Numerical model of the patient specific aorta with the implementation of the selected composite and b) Printed patient specific phantom for surgical training after the printing.
122 EXAMINING PERCEPTIONS OF BARRIERS TO PATIENT ENGAGEMENT IN CLINICAL RESEARCH AMONG RESEARCH SCIENTISTS IN A CARDIOVASCULAR RESEARCH NETWORK
Canadian Journal of Cardiology Volume 32 2016
that it would be valued by patients, lend research legitimacy, and balance power by unsettling a traditionally paternalistic model of healthcare. However, few were prepared to embrace patient engagement unreservedly. Most saw value in select aspects of the strategy. They identified three challenges relating to patient engagement: a) Patient selection - who would be chosen? b) Role clarification - what would be the scope of patient engagement? c) Lack of evidence - why engage in patient engagement given the lack of evidence demonstrating its impact? CONCLUSIONS: This study offers new insights that will guide our network in tailoring our patient engagement strategy by, 1) ensuring research scientists are educated on the conceptual meaning and scope of patient engagement in order to effectively partner with patients in research, 2) offering guidance to select patient partners with requisite knowledge and skills to engage in targeted roles, 3) facilitating access to resources and tools enabling the operationalization of patient engagement strategies at the study level, and 4) ensuring new evidence demonstrating the impact of patient engagement is disseminated within the research community. Canadian Institutes of Health Research; Hamilton Health Sciences-Research Administration
Hamilton, Ontario
123 THE QUALITY, NOT THE TYPE OF INSTRUCTION IMPROVES TRAINEES’ ABILITIES TO INTERPRET ECGS: A META-ANALYSIS
BACKGROUND:
L Rourke, J Leong, T Chatterly, M Graham
SL Carroll, G Embuldeniya, J Abelson, A Berkesse, M McGillion, JS Healey Patient engagement in clinical research is currently dominating discourse in research settings, driven in part by Canada’s Strategy for Patient Oriented Research (SPOR) and its vision to shape a sustainable and equitable health care system. It is expected that involving patients in research will improve the relevance of both research and care. However, as indicated by the Canadian Institutes of Health Research (CIHR), meaningful patient engagement can only be fostered in a climate where stakeholders understand and recognize its value. This study aimed to assess researchers’ perceptions of the meaning and value of patient engagement in research across the Canadian Stroke intervention Network (C-SPIN), to aid in the development of patient engagement initiatives and identify potential barriers to patient engagement that may be mitigated. METHODS: We employed a qualitative approach using semistructured telephone interviews with consenting C-SPIN research scientists from across Canada in 2015. Data were analysed using insights from thematic and content analysis with key categories iteratively identified and organized using NVivo 10. Inductive analysis was conducted with codes emerging from the data rather than a pre-existing coding scheme. RESULTS: Consent was obtained from 23 researchers with 16 interviews completed. Results indicated diversity and indeterminacy in participants’ understanding of patient engagement; many were uncertain about the meaning of the concept itself. Participants valued patient engagement because they thought
Edmonton, Alberta BACKGROUND: Several reports have questioned the efficacy of the instruction that is designed to improve the abilities of physicians to interpret ECGs. The purpose of this study was to examine the quality of training and its impact on abilities. METHODS: We conducted a comprehensive review of the literature, and synthesized our results using meta-analysis. We searched MEDLINE, EMBASE, CINAHL Plus, and PscyhInfo from inception to January 2016. We selected prospective studies that examined the effect of an instructional intervention on participants’ basic knowledge of cardiac anatomy and electrophysiology and on their ability to recognize diagnostic patterns in ECG tracings. Two reviewers extracted information on three variables: i) the methodological quality of the studies, ii) the effect of instruction on the acquisition of knowledge and skill, and iii) instructional quality. Instructional quality is an index of the extent to which an educational event incorporates four practices of effective instruction: presenting information, eliciting performance, assessing learning, and providing feedback. RESULTS: 28 studies (3,304 participants) analyzing 46 distinct instructional interventions were synthesized. The methodological quality of most studies was moderate. The instructional quality varied: all interventions presented information and assessed learning, but fewer than half elicited performances and provided feedback. The instructional interventions that incorporated all
were surveyed. Although faculty and residents found the tools easy to use, they felt that intermittent use of the assessment tools contributed to the lack of effective implementation. CONCLUSION: Implementing programmatic assessment is feasible, but intermittent assessment of competencies and surgical performance inhibits uptake. It may be more effective to implement an assessment program for all residents simultaneously compared to adopting a “phased in” approach by year as new residents enter a competency-based training program. Additionally, it may be more effective to incorporate assessment as a routine part of performing a task rather than expecting residents to periodically obtain assessment throughout a rotation. Individual programs may need to adapt assessment tools to the particular needs of their programs to facilitate effective implementation.
120 ECG COMPUTER INTERPRETATION AND CARDIOLOGY TRAINEES: HELP OR HINDERANCE?
S135
fasicular block (65% with ECG-CI vs 31% without ECG-CI), and early repolarization (71% with ECG-CI vs 38% without ECG-CI). However, complete heart block, pre-excitation, and Brugada were correctly identified even in absence of ECG-CI. The presence of ECG-CI significantly increased interpretation accuracy for chamber hypertrophy (p<0.05). Interpretation accuracy for ischemia, pacemaker rhythm, artifacts, and lead malposition were also improved with ECG-CI. CONCLUSION: Trainees appear to correctly interpret ECGs independently of ECG-CI. However, the presence of ECG-CI increased the accuracy of the residents’ interpretation. As ECG-CI appears to provide incremental accuracy to ECG diagnoses, patients may ultimately benefit from improved diagnostic accuracy. Table 1: Percentage of Residents who correctly identified the critical diagnoses by categories ECG Computer Interpretation ECG Computer Not Available Interpretation Available
Diagnosis
Overall
C1
C2
C3
Overall
C1
C2
C3
Arrhythmias (n=7)
85
83
87
88
83
84
89
79
Conduction System Disease (n=9)
73
66
77
76
83
80
81
89
Ischemia (n=4)
64
55
61
84
77
77
55
80
Hypertrophy (n=2)
19
25
20
10
59
72
67
25
Toronto, Ontario
Hyperkalemia (n=1)
81
67
80
100
88
86
100
75
BACKGROUND:
Pacemaker (n=1)
50
67
20
60
59
86
50
75
Artifacts (n=1)
35
14
67
25
56
50
60
60
Lead Malposition (n=1) 69
50
80
80
100
100
100
100
AY Chan, I Mangat, L Casella, J Janevski, P Dorian, EH Yu Interpretation of electrocardiograms (ECGs) is a fundamental skill for cardiologists. Prior data has suggested that ECG-computer interpretation (ECG-CI) may increase accuracy. In current clinical practice, ECGs are often presented with ECGCI, which may or may not be accurate. Although Cardiology trainees are taught to interpret ECGs independent of ECG-CI, the purpose of this study was to determine if ECG-CI affected the accuracy of ECG interpretation by Cardiology trainees. METHODS: Thirty-three consenting trainees (100% of the training program) representing all 3 training years (13 first (C1), 11 second (C2), and 9 third-year (C3) trainees) were randomized into 2 groups with relatively equal distribution of levels of training in each. Twenty-six pre-selected ECGs with important findings, including arrhythmias, conduction disorders, ischemia, hypertrophy, metabolic abnormalities, and device rhythms were sorted into 2 identical sets (A and B). For Set A, ECG-CI was included with only the first 13 ECGs, and for Set B ECG-CI was included with only the last 13 ECGs. One group of trainees interpreted Set A and the other group Set B. A marking key was developed by consensus of two experienced ECG interpreting cardiologists. All ECG interpretations were independently marked by both individuals blinded to trainee identity and year of training. RESULTS: The percentage of trainees who correctly identified the critical diagnoses on the ECGs in each category are listed in Table 1. Independent of ECG-CI, trainees were able to accurately identify most arrhythmias including AVNRT/ AVRT, ventricular tachycardia, and pre-excited atrial fibrillation. However, AV dissociation was identified poorly (82% with ECG-CI vs 63% without ECG-CI). In the absence of ECG-CI, the following conduction system disorders were interpreted suboptimally: bifasicular block (88% with ECG-CI vs 65% without ECG-CI), left posterior
121 PATIENT SPECIFIC SURGICAL SIMULATION OF THE ASCENDING THORACIC AORTA J Garcia, Z Yang, K Lachapelle, R Mongrain, R Leask Montréal, Québec BACKGROUND:
Currently, surgical training outside the clinic is primarily limited to practice on expensive cadavers or phantoms made of non-realistic materials representing a limited number of pathologies. Therefore, there is a need of new vascular simulators with anatomical and physiological fidelity to allow for optimal pre-procedural practice. The present study aimed at creating 3D printed phantoms for surgical training with anatomical and biomechanical fidelity to mimic human ascending thoracic aortic tissue. METHODS: The in vivo anatomy of patients was acquired from CT-scans of patients with an ascending thoracic aortic aneurysm. A series of three-material composites suitable for three-dimensional printing (Connex3, Objet500, Stratasys, Eden Prairie, MN, USA) were created to mimic the mechanical behaviour excised aortic tissue and screened by planar biaxial tensile testing (Electroforce ELF 3200, Bose Framingham, MA, USA). The apparent stiffness and energy loss were compared between the aortic tissues (healthy and pathological) and composite candidates. RESULTS: One candidate composite which was representative of aneurysmal AA tissue (Bonferroni’s post-test p<0.05) was then selected and implemented in the three-dimensional aorta model of an idealized and patient specific aneurysm model.
S136 CONCLUSION:
A method to create 3D printed models of patient specific aortopathies suitable for surgical training has been developed. The use of a composite 3D printed material allows us to tailor the mechanical properties of the model and produce the necessary distension and suture retention strength needed for surgical training. Figure: a) Numerical model of the patient specific aorta with the implementation of the selected composite and b) Printed patient specific phantom for surgical training after the printing.
122 EXAMINING PERCEPTIONS OF BARRIERS TO PATIENT ENGAGEMENT IN CLINICAL RESEARCH AMONG RESEARCH SCIENTISTS IN A CARDIOVASCULAR RESEARCH NETWORK
Canadian Journal of Cardiology Volume 32 2016
that it would be valued by patients, lend research legitimacy, and balance power by unsettling a traditionally paternalistic model of healthcare. However, few were prepared to embrace patient engagement unreservedly. Most saw value in select aspects of the strategy. They identified three challenges relating to patient engagement: a) Patient selection - who would be chosen? b) Role clarification - what would be the scope of patient engagement? c) Lack of evidence - why engage in patient engagement given the lack of evidence demonstrating its impact? CONCLUSIONS: This study offers new insights that will guide our network in tailoring our patient engagement strategy by, 1) ensuring research scientists are educated on the conceptual meaning and scope of patient engagement in order to effectively partner with patients in research, 2) offering guidance to select patient partners with requisite knowledge and skills to engage in targeted roles, 3) facilitating access to resources and tools enabling the operationalization of patient engagement strategies at the study level, and 4) ensuring new evidence demonstrating the impact of patient engagement is disseminated within the research community. Canadian Institutes of Health Research; Hamilton Health Sciences-Research Administration
Hamilton, Ontario
123 THE QUALITY, NOT THE TYPE OF INSTRUCTION IMPROVES TRAINEES’ ABILITIES TO INTERPRET ECGS: A META-ANALYSIS
BACKGROUND:
L Rourke, J Leong, T Chatterly, M Graham
SL Carroll, G Embuldeniya, J Abelson, A Berkesse, M McGillion, JS Healey Patient engagement in clinical research is currently dominating discourse in research settings, driven in part by Canada’s Strategy for Patient Oriented Research (SPOR) and its vision to shape a sustainable and equitable health care system. It is expected that involving patients in research will improve the relevance of both research and care. However, as indicated by the Canadian Institutes of Health Research (CIHR), meaningful patient engagement can only be fostered in a climate where stakeholders understand and recognize its value. This study aimed to assess researchers’ perceptions of the meaning and value of patient engagement in research across the Canadian Stroke intervention Network (C-SPIN), to aid in the development of patient engagement initiatives and identify potential barriers to patient engagement that may be mitigated. METHODS: We employed a qualitative approach using semistructured telephone interviews with consenting C-SPIN research scientists from across Canada in 2015. Data were analysed using insights from thematic and content analysis with key categories iteratively identified and organized using NVivo 10. Inductive analysis was conducted with codes emerging from the data rather than a pre-existing coding scheme. RESULTS: Consent was obtained from 23 researchers with 16 interviews completed. Results indicated diversity and indeterminacy in participants’ understanding of patient engagement; many were uncertain about the meaning of the concept itself. Participants valued patient engagement because they thought
Edmonton, Alberta BACKGROUND: Several reports have questioned the efficacy of the instruction that is designed to improve the abilities of physicians to interpret ECGs. The purpose of this study was to examine the quality of training and its impact on abilities. METHODS: We conducted a comprehensive review of the literature, and synthesized our results using meta-analysis. We searched MEDLINE, EMBASE, CINAHL Plus, and PscyhInfo from inception to January 2016. We selected prospective studies that examined the effect of an instructional intervention on participants’ basic knowledge of cardiac anatomy and electrophysiology and on their ability to recognize diagnostic patterns in ECG tracings. Two reviewers extracted information on three variables: i) the methodological quality of the studies, ii) the effect of instruction on the acquisition of knowledge and skill, and iii) instructional quality. Instructional quality is an index of the extent to which an educational event incorporates four practices of effective instruction: presenting information, eliciting performance, assessing learning, and providing feedback. RESULTS: 28 studies (3,304 participants) analyzing 46 distinct instructional interventions were synthesized. The methodological quality of most studies was moderate. The instructional quality varied: all interventions presented information and assessed learning, but fewer than half elicited performances and provided feedback. The instructional interventions that incorporated all