Simulation‐based fetal shunting training

Abstract

Objectives To develop a simulation model and assess the learning curve of fetal shunting. Methods Three staff and three trainees performed fetal shunting on a model using the fetal bladder stent. The model was evaluated according to various sources of validity evidence. The number of procedures to reach competency was determined by the learning curve‐cumulative summation (LC‐CUSUM) and CUSUM analysis. The learning and control phases were defined as the periods before and after passing the level of competency, respectively. Results The model was validated to be constructive in the educational process. A total of 600 procedures were carried out with an overall success rate of 94.2% and no significant difference between staff and trainees. The average number of procedures to reach competency was 47. Total procedural time decreased after passing the level of competency. Although the trainees required a longer procedural time in the learning phase than the staff did, there was no significant between‐group difference in the control phase. Conclusions Using this model, the estimated number of procedures to achieve competency was 47, as substantiated by the increased procedural success and reduced procedural time in the control phase. Training on this simulation model may improve technical performance.

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“…47 This raises questions about the viability of smaller programmes, and emphasises the need for appropriate high-fidelity training models for this (and other) fetal procedures. 48,49 Imaging, and increasingly MRI, is key in selecting cases suitable for fetal therapy as it is used for planning, simulating, and optimising fetal surgery. An early application is likely to be in the treatment of twin-to-twin transfusion syndrome where a combination of Doppler and MRI are used to determine placenta and vascular structure, 50 and, using computer vision and deep learning techniques, the ideal entry point and the laser trajectory can be determined.…”

“…Centres performing high volumes of in‐utero surgery report that it takes up to 30 (open) or 60 (fetoscopy) procedures to become proficient . This raises questions about the viability of smaller programmes, and emphasises the need for appropriate high‐fidelity training models for this (and other) fetal procedures …”