Application of a three-dimensional-printed endoscopic retrograde cholangiopancreatography simulation operation model in surgical training and teaching

Table 1 Model effectiveness evaluation

Domain	Observed average
Physical attributes
Anatomical landmark visibility	4.25
Model organ size accuracy	4.3
Authenticity of materials	4.4
Overall impression of the model	4.35
Realism of experience
The force required to move the duodenoscope within the model	4.6
The force required to insert the guidewire	4.35
Authenticity of the duodenal papilla	4.2
Rate your ability to perform the below tasks on the simulator
Using a duodenoscope to locate the papilla	4.1
Guidewire placement catheter	4.5
Nipple incision	4.3
Insertion of stone extraction basket	4.3
Basket stone extraction	4.15
Rate the value of the simulator
Evaluating the value of simulators as training tools	4.4
Evaluating the value of simulators as teaching tools	4.6
Rate the simulator’s relevance to your real-world operations	4.45

Ratings from two senior doctors. Full score for each item: 5 points.

Table 2 Baseline characteristics of participants, mean ± SD

Variables	General teaching (n = 15)	Model teaching (n = 15)	χ2 value	P value
Sex, male/female	12/3	13/2	0.475	0.638
Age (year)	26.4 ± 2.0	26.6 ± 1.7	-0.297	0.769
Education level (undergraduate/master/PhD)	10/5/0	10/4/1	-0.323	0.749
Time spent in hepatobiliary surgery (year)	2.1 ± 0.7	1.7 ± 0.8	1.213	0.235
Time spent in endoscopy (year)	0.2 ± 0.4	0.1 ± 0.4	0.475	0.07
Pre-teaching theoretical performance	41.3 ± 9.9	40.0 ± 8.2	0.401	0.692
Pre-teaching understanding of biliary anatomy	2.3 ± 0.7	2.2 ± 0.6	0.462	0.647
Pre-teaching patient management	2.0 ± 0.5	2.0 ± 0.3	0.182	0.857
Pre-teaching understanding of complications	2.1 ± 0.5	2.3 ± 0.6	-1.148	0.261
Pre-teaching procedural steps	1.5 ± 0.3	1.7 ± 0.3	-1.855	0.07
Pre-teaching confidence	1.7 ± 0.3	1.8 ± 0.3	-0.915	0.368

Table 3 Post-teaching outcomes and standardized effect sizes, mean ± SD

Outcome	General teaching (n = 15)	Model teaching (n = 15)	P value	Hedges’ g
Theoretical performance	71.0 ± 6.3	70.0 ± 7.9	0.614	-0.13
Understanding of biliary anatomy	6.4 ± 0.5	8.1 ± 0.5	< 0.0011	-3.31
Patient management	7.1 ± 0.5	7.5 ± 0.5	0.0401	0.78
Understanding of complications	6.7 ± 0.5	7.1 ± 0.4	0.0361	0.86
Procedural steps	5.7 ± 0.4	7.3 ± 0.8	< 0.0011	2.46
Confidence	6.9 ± 0.6	7.3 ± 0.2	0.0121	0.87

¹Significant difference.

Hedges’ g represents small-sample bias corrected standardized mean differences. Effect size interpretation: Small (0.2), moderate (0.5), large (≥ 0.8).