ImPulse – New Paradigm for Pediatric Cardiac Surgery Training
The only way for trainees to practice pediatric surgery is to operate on actual patients. Unfortunately, this exposes them to unnecessary risk; thus, parents and senior surgeons hesitate to let them train. ImPulse offers trainees a high-fidelity simulation training module teaching the various steps of pediatric cardiac surgery from start to finish in a safe environment that is accurate, consistent, and repeatable. Thus, transitioning from opportunity-based training to on-demand training.
Cross-border/international
Germany
Other
Palestine
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The project is developed and implemented in Germany. However, I wanted to ensure the project would be viable just as much in politically and economically constrained areas, hence my research and planned implementation in Palestine and South Africa.
It addresses urban-rural linkages
It refers to other types of transformations (soft investment)
ImPulse offers trainees a high-fidelity simulation training module called Janān, simulating the various steps of pediatric cardiac surgery from start to finish in a safe environment that is accurate, consistent, and repeatable. The simulated operations use the same tools and equipment as actual surgery. Thus, transitioning pediatric cardiology programmes from opportunity-based training to on-demand training.
Currently, the only way for trainees to practice pediatric surgery is to operate on actual patients. Unfortunately, this exposes patients to unnecessary risk; thus, parents and senior surgeons tend to prevent surgical trainees from practising on said patients. This significantly reduces the chances of trainees’ manual dexterity development and surgical skills acquirement, thus extending their training far beyond the prescribed five years.
Besides removing the dependence on actual patients for practice, Janān allows trainees to gain familiarity and confidence with all steps of pediatric heart surgery. For instance, trainees can cut the model’s chest and breastbone open, connect the heart to a heart-lung machine (the basis of every open-heart surgery), perform corrective surgery on the heart module, and finally, close and stitch Janān for recovery.
Janān is entirely 3D printed, with heart modules representing common congenital heart deformities that all pediatric cardiac surgeons should be able to treat. The heart modules are based on actual patients’ CT scans, which I sculpted the congenital heart diseases into under the guidance of cardiac surgeons.
3D printing is especially beneficial for economically and politically constrained areas where it is otherwise difficult to access or import medical devices. Alongside providing physical modules for purchase, I plan to freely publish the files and assembly manuals online to help surgical trainees develop their skills worldwide.
Accessible education
Pediatric heart surgery
Surgical training
Simulation training
Medical 3D printing
ImPulse aims to establish a new paradigm for pediatric cardiac surgery training that is sustainable and not dependent on the use of actual patients for hands-on practice. By providing high-fidelity simulation training modules, students could train on demand rather than when the opportunity arises, providing a more sustainable form of surgical training.
Furthermore, some institutions use harvested animal organs instead of relying on actual patients for hands-on training. Unfortunately, those animals tend to have healthy organs that barely resemble the human heart, let alone human congenital heart diseases. Therefore, training on harvested organs is inadequate at best and a cruel waste of animal life at worst.
On the other hand, a simulation training module that meaningfully develops the trainees’ surgical competence will spare the lives of human patients and animals.
Finally, as Janān is fully modular and reusable, multiple training sessions can be conducted on the same model; this intelligent use of materials extends the sustainable aspects of ImPulse to encompass the conservation of resources in clinical education and the reduction of simulation training’s carbon footprint.
My design process in ImPulse followed the philosophy and values of Kenya Hara. To be specific, the aesthetics of “emptiness”. Instead of a system for discarding elements or clearing up spaces, emptiness or ku is a more fundamental state of being.
Ku is not a poverty or absence of ideas or materials. Indeed, it’s a much richer notion than the common understanding of “emptiness.” Instead, it’s a stance—a readiness to receive inspiration from the outside. “To offer an empty vessel is to pose a single question and to be wholly ready to accept the huge variety of answers,” says Hara. ”Emptiness is itself a possibility of being filled.”
I represent this “emptiness” concept in ImPulse by designing Janān (the simulation training model) as an empty canvas for empathy and human connection. By removing gender, race, and societal connotations in the model’s design, trainees can project their image into this faux patient, thus building a greater sense of empathy and respect for the human anatomy during training sessions.
To balance this opportunity for subjective experience, the internals of Janān are what I call high-resolution and high-fidelity. The internal modules, specifically the heart modules, are based on actual patients’ CT and MRI scans, thus representing the human anatomy and heart diseases in such detail that rivals operating on patients. This experience is further pushed by fabricating the heart modules out of flexible synthetic material, mimicking the tactility and behaviour of actual tissue.
This duality of philosophy and approach allows ImPulse to create a relevant solution that feels natural in all clinical and cultural settings.
The key objectives of ImPulse range across multiple themes:
- Accessible teaching: as ImPulse does away with the reliance on actual patients for surgical training, more students will be able to access advanced surgical training during their prescribed training years. This would allow the trainees to develop competence consistently and quickly. Furthermore, having fabricated modules in large volumes will help standardise teaching and evaluation across students and institutes.
- Affordability: Janān was designed to be entirely 3D printed. While high-fidelity heart modules require special materials and fabrication methods, the sum cost of fabricating Janān and its internal components comes at a fraction of the price of similar medical training devices.
- Representation: as Janān and its internal components are 3D printable, users can modify the model based on their needs or cultural context, thus making the representation of the region concrete. Furthermore, as the heart modules were designed based on patients’ scans, more heart modules can be created based on patients with novel or unique conditions and anatomies. Thus allowing those patients to be represented in surgical training or pre-op rehearsals.
- Crossing borders: ImPulse’s 3D files can be sent anywhere and to anyone’s benefit. A crucial use-case of this would be for patients who’d need to cross borders to receive treatment; in this case, the host institutions would receive the scans of said patients, request custom heart modules, and rehearse operations on those modules until perfection while waiting for the patient to arrive.
The indirect but main benefactors of ImPulse are newborns with congenital heart diseases in need of medical intervention. On average, 8 per 1000 infants are born with a heart deformity, hence the pressing need for trained and qualified surgeons to treat those newborn patients.
On the other hand, pediatric cardiac surgery students and trainers are the direct benefactors of ImPulse, as they would use the simulation training model for hands-on training and knowledge acquirement. Therefore, trainees and trainers will be involved in developing and testing the prototypes, the surgical training programme incorporating the model, and the evaluation criteria and methods.
During my master’s thesis work, I collaborated closely with the university hospital where I reside (Kiel, Germany) and with civil society and humanitarian agencies known for funding or treating congenital heart diseases across the globe.
For instance, while the heart modules are based on actual patient scans, I had to digitally construct the congenital heart diseases [CHD] into some modules. I did that under the guidance of anatomy and cardiology experts.
Furthermore, I collaborated with cardiac and pediatric surgeons leading training programmes to understand the requirements of a simulation training model for hands-on surgical training. This informed the design choices I made with ImPulse and the types of procedures (such as canulation, cutting the breastbones, etc.) possible to perform on Janān.
Finally, I frequently corresponded with humanitarian agencies to understand the context and constraints of global regions afflicted with a high prevalence of congenital heart diseases. For instance, I heavily consulted both Forensic Architecture and the Palestine Children's Relief Fund to understand the condition of Gaza’s alarmingly high number of CHD patients and the constraints of the region’s institute due to the blockade of imports and deteriorating healthcare infrastructure. This ultimately shifted ImPulse to ensure all components could be 3D printed, thus bypassing border and cost limitations.
ImPulse is fundamentally a clinical project solving a challenge present in medical institutions. Therefore, I had to utilise my background in design thinking to conduct qualitative research with surgical trainees and trainers.
I later used my skillset in industrial medical design (along with my professor’s guidance) to translate the research insight into physical prototypes to reengage with the medical professionals and irritate the solution.
Thus, the project is the product of the merger of the medical field knowledge and design discipline and sensibilities.
The only way for trainees to practice pediatric surgery is to operate on actual patients. Unfortunately, this exposes patients to unnecessary risk; thus, parents and senior surgeons tend to prevent surgical trainees from practising on said patients. Therefore, ImPulse innovates pediatric cardiac surgery training by providing simulation training models that rival hands-on patient training in its accuracy and skills development.
Finally, I reached this level of fidelity by taking digital scans of actual patients and converting them into 3D printable modules for hands-on training. So by using the same process, it is possible to create modules based on novel or complex conditions, allowing surgeons to rehearse various strategies before touching those patients.
Existing training programmes are not feasible in politically and economically constrained areas, making it impossible to establish highly specialised and well-trained local surgical teams. Consequently, I was compelled to design ImPulse within the limits of those constraints while providing an unprecedented level of surgical simulation training and anatomical fidelity. Thus, the simulation training modules can be transferred to any place and created locally.
Furthermore, my methodology and tools to create the modules for pediatric cardiac surgery training can be used to design other organs to simulate and train other medical procedures and conditions outside of cardiology.
The project started from an impulse to act & help after the war on Gaza in 2021. The Gaza strip has the highest prevalence of congenital heart diseases globally yet doesn't have local pediatric cardiac surgeons. The devastating number of newborns with heart diseases are attributed to the impossible living conditions, lack of necessary medical devices and equipment, and the frequent military assaults they suffer.
Unfortunately, as the world is facing more warfare and instability, I anticipate a rise in congenital heart diseases worldwide, hence the pressing need to establish and train pediatric cardiology teams where needed most.
I'm working towards this goal by researching and developing ImPulse in Germany, where I'm fortunate to collaborate between disciplines, conduct field tests, and have the resources necessary for fabrication. This contextual dichotomy allowed me to achieve an unprecedented level with ImPulse. As a result, the model provides a state-of-the-art experience that surpasses anything in Europe, yet it is accessible and viable in the most constrained settings.
