Discussion

This study enrolled 35 participants, none of whom dropped out. The results suggested the potential educational value and cost-efficiency of three-dimensional-printed heart models as teaching aids, with the educational benefit appearing more evident among undergraduate medical students. Given the small sample size and single-centre design, this study should be considered exploratory in nature. These findings suggest that three-dimensional-printed models have the potential to substantially enhance traditional slide-based learning in undergraduate medical education. In contrast, the educational impact among postgraduate year 1 and year 2 residents was less pronounced, and the applicability of these findings to postgraduate training therefore remains uncertain. These results differ from those of Wang et al., ^{Reference Wang, Liu and Luo26} who reported that three-dimensional-printed cardiac models were not superior to traditional teaching models for undergraduate medical education on cardiac diseases. However, the three-dimensional-printed model in Wang et al. was simple and lacked interactivity, being designed solely for anatomical education rather than for demonstrating procedures such as cardiac catheterisation.

Historically, cardiology training for undergraduate medical students and junior doctors has primarily relied on traditional methods, such as theoretical lectures, and has not incorporated practical components. ^{Reference McMahon, Tretter and Redington27} The conventional pedagogical strategy for complex medical procedures, such as cardiac catheterisation, has predominantly followed the apprenticeship model, which emphasises observation and hands-on practice, adhering to the traditional “see one, do one, teach one” doctrine. ^{Reference Hopfner, Jakob and Tengler20} Training in this framework occurs directly within the catheterisation laboratory, which might not provide the most conducive learning environment, given that training opportunities often occur spontaneously. This can potentially increase stress among trainees and adversely affect the learning process. Despite its historical success in transferring practical knowledge, the apprenticeship model faces significant issues, including extended procedure times, increased costs, reduced operational efficiency, and heightened stress among trainees, which can prevent students from effectively achieving educational outcomes. ^{Reference Babineau, Becker and Gibbons28,Reference Wetzel, Kneebone and Woloshynowych29}

The process of learning cardiac procedures can vary in complexity, ranging from simple to highly intricate. Therefore, the proportional adjustment of costs for introductory training models is essential. Simulation-based clinical training is particularly effective for teaching technical skills. High-fidelity mannequin simulators are excellent tools used in the demonstration of procedural skills, including cardiac catheterisation. These simulators can replicate physical findings such as oxygen saturation, respond physiologically to medications, and undergo various procedures. However, these advanced mannequins can cost more than US＄250,000. ^{Reference Srinivasan, Hwang, West and Yellowlees30}

Nowadays, three-dimensional printing technology has become a common component of clinical and medical education in cardiology. ^{Reference Lindquist, Gosnell and Khan31,Reference Chetan, Valverde and Yoo32} Medical education is a lifetime learning process, spanning from undergraduate to postgraduate to specialty training and beyond.

Using three-dimensional cardiac models in cardiology education enhances trainees’ understanding of complex anatomy, provides high-fidelity simulation experiences, and increases exposure to rare pathologies, thereby reducing the steepness of the learning curve. Additionally, three-dimensional printing improves engagement, accelerates comprehension of anatomical defects, and exposes students to a wide range of malformations, even within the same condition. ^{Reference Anwar, Singh and Miller11,Reference Valverde33} Studies on the teaching of CHD have demonstrated that compared with traditional imaging methods, three-dimensional-printed models significantly enhanced the anatomical knowledge of medical students, paediatric cardiology fellows, and consultants. ^{Reference Costello, Olivieri and Su9,Reference Valverde, Gomez and Byrne34} Participants reported that three-dimensional models improved their understanding of CHD, increased their interest in anatomy, enhanced their grasp of imaging techniques, and were beneficial for patient communication. The participants advocated for the inclusion of three-dimensional models in medical workshops and for their use as substitutes for cadaveric specimens in teaching. ^{Reference Valverde, Gomez and Byrne34}

The feasibility of using three-dimensional-printed heart models to plan endovascular stenting for transverse arch hypoplasia has been demonstrated. ^{Reference Valverde, Gomez and Coserria35} Participants found these models advantageous for planning interventions, enhancing communication, and reducing catheterisation complications. Additionally, research involving individuals with varying levels of cardiac catheterisation experience indicated that practice with three-dimensional models led to decreased fluoroscopy times. Most participants reported that the three-dimensional models were effective for learning the process of catheter intervention, familiarising themselves with catheterisation devices, and improving patient safety through increased practice opportunities. ^{Reference Brunner, Thierij and Jakob36} Although data supporting training in interventional cardiology are limited, the Society for Cardiovascular Angiography and Intervention’s Simulation Committee anticipates that simulation will become a more crucial component of training and certification maintenance over time. ^{Reference Green, Klein and Pancholy37}

Three-dimensional models have been employed in the training of students in medical, nursing, respiratory therapy, and resident programmes. ^{Reference Biglino, Capelli and Koniordou38–Reference Yang, Chen, Liu, Liu and Chao41} Three-dimensional models have been demonstrated to improve spatial awareness and the ability to identify anatomical structures. Despite these positive findings, several studies have reported no significant long-term benefits of three-dimensional models. ^{Reference McKinley, Stuart, Ailawadi and Brunswick42–Reference Ochoa, Segal, Garcia and Fischer44} Considering the different stages of learning and the varying levels of difficulty associated with various techniques, we must effectively integrate three-dimensional-printed models into medical education curricula.

This study has several limitations. First, the sample size was small, and the participants were recruited from a single institution, restricting the generalizability of the findings. In addition, a formal power calculation was not performed, which may further limit the statistical robustness of the results. Second, immediate testing may not be the most practical method for evaluating the learning process. In the short term, focusing on enhancing students’ motivation and appreciation is more advantageous. However, this approach does not allow assessment of long-term knowledge retention or objectively measured procedural skills, including catheterisation proficiency. Overall test performance or pass rates would be more appropriate metrics for long-term evaluation. Additionally, enrolling all medical students without a calculated sample size may introduce bias.

Further evaluations are necessary to determine the effectiveness of three-dimensional-printed models in advanced educational settings. Larger multicentre studies with follow-up assessments and objective procedural-skill assessments are warranted to evaluate knowledge retention and skill transfer, particularly in postgraduate medical education, to provide a more comprehensive understanding of the educational benefits and limitations of these models. Although this study lacks sufficient statistical power, its primary objective was to encourage faculty and school administrators to adopt these tools to enhance students’ educational experiences.