Perioperative Interactive Education

The Perioperative Interactive Education (PIE) team in the Department of Anesthesia and Pain Management at Toronto General Hospital is developing a wide variety of online teaching aids to enhance the teaching of perioperative medicine. These resources aids are intended to be used both by medical educators in small group sessions or lectures and by trainees for self-study. They are all freely available on the Web to educators and trainees around the world. The PIE Web site (http://pie.med.utoronto.ca) describes all the projects under development and the team members who are involved in this initiative. The projects are available in four Web sites:
 

Advanced Cardiac Monitoring http://pie.med.utoronto.ca/Edwards/index.htm This Web site illustrates the embryologic development of the heart from the cardiac crest to the separation of the outflow tracts using a 3D model which can be rotated horizontally to view the model from any angle. A time line can be dragged to show the growth and development between each of the stage.
Awake Bronchoscopic Intubation http://pie.med.utoronto.ca/BI/index.htm This website is intended for anesthesiologists of all levels, including residents, fellows and staff anesthesiologists. It also serves as a resource for Emergency and Intensive Care physicians who may be required on occasion to perform an awake bronchoscopic intubation. There are 5 modules and within each module, the reader starts with basic information and can move onto advanced concepts. The participant is encouraged to take the self test at the end of each module.
Cardiac Anesthesia  http://pie.med.utoronto.ca/ca This Web site contains teaching material relevant to perioperative care. It contains an interactive module illustrating the movement of water between the body fluid compartments in fluid management, and a module describing the factors involved in the control of blood pressure and cardiac output (Starling’s Law). Patient simulations of postoperative cardiac patients and weaning patients from cardiopulmonary bypass are under development.
Cardiac Embryology  http://pie.med.utoronto.ca/htbg This Web site illustrates the embryologic development of the heart from the cardiac crest to the separation of the outflow tracts using a 3D model which can be rotated horizontally to view the model from any angle. A time line can be dragged to show the growth and development between each of the stage.
Malignant Hyperthermia http://pie.med.utoronto.ca/MH/index.htm This website is intended to provide information about the Malignant Hyperthermia Investigation Unit at Toronto General Hospital, as well as providing a tool for clinicians to learn about MH, its treatment, and current research.
Obstetric Anesthesiology http://pie.med.utoronto.ca/OBAnesthesia/index.htm The website contains five topics related to the use of ultrasound in obstetric anesthesia.
Point of Care Ultrasound http://pie.med.utoronto.ca/POCUS/index.htm This website provides interactive modules for teaching Focused Cardiac Ultrasound (FOCUS) and Lung Ultrasound at the point-of-care. The modules on this website are intended to help the user to relate ultrasound images to the three-dimensional anatomy of the structures they are viewing.
Virtual Liver  http://pie.med.utoronto.ca/vliver This Web site helps trainees learning to interpret the anatomical structures in CTs of the liver in surgical planning. We have created a 3D model of a liver and its internal structure of arteries, veins, portal and biliary systems. The model can be made transparent to view the internal structures, and the model rotated either horizontally or vertically to view it from any angle. The structures can be labeled, and the corresponding structures in the CT can be seen alongside the 3D model. The Cuinaud segments and standard surgical resections of the liver can also be viewed with different levels of transparency to see the internal structure related to these segments.
Virtual Spine http://pie.med.utoronto.ca/VSpine/index.htm This website contains a Lumbar Anatomy Teaching Module to aid students and educators to understand and teach lumbar spinal anatomy. There is also a Lumbar Spine Ultrasound module which is aimed at teaching ultrasound-guided regional anesthesia for the lumbar spine. The module contains a section teaching the sonoanatomy of the lumbar spine and a section allowing users to perform a simulated ultrasound of the lumbar spine in preparation for spinal anesthesia.
Virtual TEE  http://pie.med.utoronto.ca/tee This Web site helps trainees learn the 20 standard diagnostic views in transesophageal echocardiography (TEE). One of the major challenges in learning TEE is translating toe 2D structures seen in the TEE image into the 3D structure of the heart. We have created a module with a 3D model of the heart which can be rotated and opened to reveal the structures represented in video clips of the 20 standard diagnostic TEE views. This assists trainees in understanding the relationship between the position of the probe, the angle of the echo plane and structures being imaged. The Virtual TEE site also has a Guide Sheet for navigating the 20 standard diagnostic views which is available as both a downloadable pdf for printing and an interactive online application. There are also online self-tests which trainees can use to assess their learning. There are now versions of the TEE Standard Views application in Chinese, Japanese and Polish. Russian, French and Spanish versions are under development.
Virtual TTE http://pie.med.utoronto.ca/TTE/index.htm This website covers the 20 standard diagnostic TTE views that are used by cardiologists in conducting a full echocardiography exam. The module provides a 3D model of the heart allowing the user to visualize the relationship between the probe and echo plane and the heart, and relate the cardiac structures in the TTE image to 3D model.