ImPulse - New Paradigm of Paediatric Cardiac Surgery Training

The specific problem addressed by ImPulse is the acute global shortage of adequately trained pediatric cardiac surgeons and the suboptimal methods currently used for their training. Pediatric cardiac surgery is a highly specialised field requiring precise and advanced surgical skills due to the complexity and variability of congenital heart deformities and the delicate and small nature of the patient’s organs. The traditional training approach heavily relies on the availability of suitable patient cases for hands-on experience, which poses significant limitations and risks.

Globally, congenital heart defects (CHDs) are among the most common birth defects, affecting about 1% of live births annually, which translates to approximately 1.35 million infants each year. However, the availability of skilled pediatric cardiac surgeons does not meet this need, particularly in low- and middle-income countries (LMICs) and especially in economically and politically constrained regions such as the Gaza Strip in the occupied Palestinian territories. The ratio of trained pediatric cardiac surgeons to the population is significantly lower than in high-income countries. In the case of the Gaza Strip, no locally trained surgeons can be found despite having one of the highest CHD prevalences globally.

On a global level, current training often involves using actual patients, which carries inherent risks and ethical concerns, or cadaveric and animal models, which may not adequately represent human congenital conditions and raise ethical and environmental issues. Moreover, these traditional methods can be costly and logistically challenging, limiting the frequency and diversity of training opportunities. 

ImPulse directly addresses these challenges by developing affordable, high-fidelity 3D-printed simulation modules. These modules can replicate a wide range of congenital heart deformities with great accuracy, providing a consistent and risk-free training tool. By reducing reliance on traditional methods, ImPulse aims to make high-quality training more accessible and cost-effective, thereby enabling a broader spectrum of medical professionals to become proficient in pediatric cardiac surgery.

The affordability and scalability of 3D printing technology make it a particularly powerful tool in democratising access to advanced surgical training, particularly in LMICs where resources are scarce, and the need for skilled surgeons is urgent. With the potential to produce these modules locally, our approach not only cuts down on costs but also increases the accessibility of training tools in areas constrained by political or economic constraints, paving the way for a more widespread and equitable distribution of medical education resources.

By focusing on these technological and educational advancements, ImPulse aims to directly impact the global capacity to train pediatric cardiac surgeons by addressing the most impacted region first, with a vision to increase the availability of skilled care for children with CHD worldwide. This approach not only enhances the quality of training but also addresses significant gaps in the current global healthcare delivery for one of the most vulnerable patient populations.

ImPulse's main solution is Janān, a neonatal simulation training model providing a suite of high-fidelity, 3D-printed simulation modules designed for the advanced training of pediatric cardiac surgeons. These modules are precise replicas of human hearts with congenital deformities, allowing trainees to practice surgeries in a risk-free, controlled environment. The modules are created using various 3D printing technologies [depending on the heart deformity represented], which can accurately reproduce human heart tissues' complex structures and textures.

 The process begins with medical imaging data, such as MRI or CT scans, from actual patients with various congenital heart defects. This data is then converted into detailed digital models using computer-aided design (CAD) software. These digital models serve as blueprints for the 3D printers, which layer synthetic materials to form the physical heart modules. Each module is crafted to mimic the feel and response of actual human tissue, offering trainees a realistic tactile experience during surgical practice.

Key features of ImPulse's Janān are:

1. Affordability: By utilising widely available and consumer-level 3D printing technologies and materials, ImPulse significantly reduces the cost of each module compared to traditional surgical training methods. This affordability makes it feasible to deploy these modules widely, including in resource-limited settings.
2. Accessibility: The technology allows the production of training modules locally or regionally, eliminating the need for expensive and logistically complex imports. This increases the accessibility of advanced surgical training tools worldwide.
3. Customisability: Since each heart module is produced from individual patient data, it can be customised to represent various congenital heart conditions. This diversity in training materials helps surgeons prepare for multiple scenarios they might encounter in the operating room.
4. Scalability: The design's modularity allows the training tools to be easily scaled up or down, depending on an institution's or a region's training needs. This flexibility ensures that our solution can be adapted to different educational environments and resource availability.
5. Sustainability: Using 3D-printed modules reduces reliance on cadaveric or animal models, which have significant ethical, environmental, and logistical implications. Furthermore, as Janān is modular, most of Janān's modules can be reused for further training sessions, thus reducing waste.

By providing a realistic, cost-effective, and ethically sound training tool, ImPulse empowers medical educators and institutions to enhance the proficiency of pediatric cardiac surgeons, ultimately improving surgical outcomes for young patients with congenital heart defects globally. The widespread implementation of this training technology has the potential to revolutionise the field of pediatric cardiac surgery by ensuring that surgeons are well-prepared to handle complex surgeries with confidence and competence.

ImPulse primarily serves three key demographics: pediatric cardiac surgery trainees in the Gaza Strip, surgical trainees worldwide, and neonatal patients with congenital heart defects (CHDs).

1. Pediatric Cardiac Surgery Trainees in the Gaza Strip:

The Gaza Strip faces a unique and critical challenge—it has one of the highest prevalences of CHD in the world yet lacks local pediatric cardiac surgeons. The area is critically underserved in terms of both medical infrastructure and specialist training, which the current situation has further exasperated. By providing high-fidelity 3D-printed simulation modules, ImPulse specifically addresses the gap in hands-on surgical training. This allows for local capacity building where trainees can develop and refine their surgical skills without patient involvement, significantly reducing the risks and ethical concerns associated with learning about actual patients. This targeted approach not only improves the skill set of local medical professionals but also aims to establish a sustainable, in-region pediatric cardiac surgery capability. Furthermore, when the current conflict concludes, Gaza’s healthcare infrastructure will have to be rebuilt, and pediatric cardiac services will be ImPulse’s contribution. 

2. Surgical Trainees Worldwide:

Globally, surgical trainees often struggle to gain enough practical experience before performing real-life surgeries. This is due to limited access to suitable training materials and opportunities, especially in complex and delicate specialities like pediatric cardiac surgery. ImPulse allows these trainees to practice and hone their skills on demand, using modules that accurately represent a wide variety of congenital heart conditions. The accessibility and affordability of our modules mean that they can be integrated into existing training programs worldwide, enhancing the overall quality of surgical education and thereby leading to better surgical outcomes.

3. Neonatal Patients with CHDs:

Neonates with CHDs are the most critical beneficiaries of ImPulse. By enhancing the training of pediatric cardiac surgeons, we indirectly improve the surgical care available to these vulnerable patients. Better-trained surgeons are more likely to perform successful surgeries with fewer complications, thus increasing survival rates and improving the quality of life for these infants. Furthermore, by advancing surgical training methods and reducing the dependency on live surgeries for education, ImPulse also upholds higher ethical standards in medical training. 

ImPulse is designed to be a game-changer in pediatric cardiac surgery training. By leveraging cutting-edge 3D printing technology, we make high-quality, realistic surgical training accessible and affordable, particularly in underserved regions like the Gaza Strip. This will empower a new generation of surgeons, equip them with the necessary skills to handle complex medical cases, and ultimately enhance the level of healthcare provided to neonates with congenital heart anomalies. Through this, ImPulse aims not only to save lives but also to establish a new standard in medical education that is both ethical and effective.

As the sole founder and member of the ImPulse project, I bring a unique blend of personal and professional experiences that ideally position me to deliver this innovative solution to the target communities, particularly in the Gaza Strip and other underserved regions worldwide.

Proximity to the Target Communities: Originating from Palestine, where access to specialised medical care was limited, I have a deep personal connection to the challenges faced by communities with scarce medical resources. This background has instilled in me a profound understanding of the impact local capacity building in healthcare can have.

Guided by Community Input: In designing and developing the ImPulse modules, I have actively engaged with local healthcare providers, medical trainees, and other stakeholders in the Gaza Strip, occupied Palestinian Territories, and Tel Aviv to incorporate their specific needs and feedback. This ongoing dialogue ensures that the training modules are not only technically effective but also culturally and contextually appropriate for the users.

Understanding of Local Challenges: My firsthand knowledge of the local healthcare landscape allows me to tailor the ImPulse project specifically to address challenges such as the scarcity of pediatric cardiac surgeons and the high prevalence of congenital heart defects (CHDs). My approach integrates practical solutions with an understanding of the local infrastructure, ensuring that the modules are accessible and usable under local conditions.

Scalable and Adaptable Design: Recognising the diverse needs across different regions, I have designed the ImPulse modules to be scalable and adaptable. This flexibility allows the modules to be customised for a range of scenarios, from high-resource environments such as where I currently reside [Germany] to settings with limited technological access. This design philosophy ensures the solution can have a wide-reaching impact, enhancing surgical training in any context.

Commitment to Ethical and Sustainable Practices: My approach is deeply rooted in ethical practices and sustainability. Prioritising 3D-printed modules, the ImPulse project reduces reliance on ethically contentious and environmentally damaging practices like the use of cadaveric or animal models. This not only aligns with global ethical standards but also resonates with local communities’ values and unique connections to their children.

My deep personal connection to the target communities, combined with proactive engagement and a tailored approach, uniquely positions me to lead this project. My background as an industrial medical designer and UX designer enhances my ability to create intuitive and user-centred training tools. My dedication to ethical practices and sustainable solutions ensures that the ImPulse project is not only a pioneering educational tool but also a transformative force in pediatric cardiac surgery training globally.

I selected the "Prototype" stage for the ImPulse project because I am currently in the initial testing and feedback phase with our 3D-printed heart modules designed for pediatric cardiac surgery training. These prototypes, developed using CAD software and advanced 3D printing, mimic the physical properties of human heart tissues and have been crafted based on real medical imaging data.

So far, the prototypes have been tested in controlled lab settings for durability, realism, and anatomical accuracy. This was followed by small-scale qualitative testing with ten surgical trainees and interviews with three professional pediatric cardiac surgeons. This feedback has been crucial for making iterative improvements to the modules' design and materials.

This stage reflects my focus on refining the product based on user feedback from these initial trials, which involve a limited number of participants and settings. As I continue to enhance the prototypes, I aim to expand testing to more diverse medical environments and prepare for a pilot deployment in Germany [for easier feedback loops and testing] before sending the module files to the target regions.

I’m applying to Solve because I believe it provides the perfect ecosystem to tackle some of the specific challenges that my project, ImPulse, is facing as we aim to scale and develop. Funding is important, but I am particularly drawn to the opportunity to connect with a diverse network of experts and innovators that Solve offers.

Expanding the Team: Currently, ImPulse is a solo endeavour. With Solve’s network, I hope to find like-minded professionals who bring expertise in pediatric cardiology, medical device engineering, and global health. This expansion is crucial to deepening the project's scope and enhancing its impact, especially in severely underserved regions.

Establishing New Stakeholder Connections: Building connections with key stakeholders in the healthcare industry—hospitals, educational institutions, and nonprofits—has been a significant challenge. Those connections are crucial to having access to more digital imaging data of actual CHD patients. Through Solve, I anticipate forging relationships that can facilitate pilot programs, refine our modules, and effectively widen their deployment.

Inviting Professional Collaborations: Collaborating with technological and medical experts is vital for refining our modules' functionality and educational value. I look forward to connecting with seasoned professionals through Solve who can offer insights into cutting-edge technologies, advanced materials, and pedagogical approaches. This expertise is essential as we transition from a prototype stage to a fully functional product.

Figuring Out the Financing: Developing a sustainable business model is another area where I seek guidance. Mentorship from Solve can help explore various financing avenues, such as grants, venture capital, and partnerships with medical and educational institutions. This guidance is crucial to keep our modules affordable and accessible, particularly in low-resource settings.

Regardless, applying to Solve represents a critical opportunity for me to develop the project’s roadmap further and expose ImPulse to a new audience. This exposure could provide me with valuable and actionable insights that are essential to pushing the project forward. By tapping into Solve's rich community and resources, I hope to enhance ImPulse’s strategic planning, expand its reach, and gain the kind of feedback that will refine and improve ImPulse’s impact on pediatric cardiac surgery training globally.

ImPulse introduces an alternative and better approach to paediatric cardiac surgery training using high-fidelity, 3D-printed heart simulation modules. These modules, created from medical imaging data, replicate congenital heart defects with great accuracy and realism, significantly improving traditional training methods. By leveraging 3D printing technology, ImPulse makes surgical training more affordable and accessible, especially in low-resource settings. The solution allows for customisation and scalability, offering personalised and widespread educational applications. This innovation could catalyse a shift towards more ethical and cost-effective training methods across the medical field, potentially influencing broader policy changes and setting new standards in medical education.

ImPulse's solution utilises high-fidelity, 3D-printed simulation modules to transform pediatric cardiac surgery training, starting with underserved regions such as Gaza before extending globally. Here’s a concise breakdown of my theory of change:

Activities:

1. Develop and produce 3D-printed heart modules based on detailed medical imaging data.
2. Distribute these modules for use in training settings in Gaza and globally.
3. Provide training and support for medical educators and trainees using these modules. 

Immediate Outputs:

1. Increased availability of high-quality, realistic training modules in regions lacking resources like Gaza.
2. Enhanced skills and confidence among trainees who use these modules due to realistic, hands-on practice opportunities.
3. Reduced reliance on traditional training methods that involve ethical concerns and higher costs.

Short-term Outcomes:

1. Improved surgical preparedness and competence among trainees in Gaza, leading to better immediate surgical outcomes.
2. Increased capacity to train more surgeons within Gaza without needing external resources or travelling abroad for advanced training.

Long-term Outcomes:

1. Enhanced global standards in pediatric cardiac surgery training, promoting wider adoption of simulation-based training.
2. Improved surgical outcomes and patient safety in pediatric cardiac surgeries worldwide.
3. Broadened access to quality surgical care in low-resource settings, ultimately reducing morbidity and mortality associated with congenital heart defects.

Evidence Supporting Links:

• Research indicates that realistic surgical simulations enhance trainee skills and reduce error rates in actual surgeries (Source: Journal of Surgical Education).
• Interviews with Gaza-based and surrounding stakeholders healthcare providers highlight a critical gap in local training resources, supporting the need for accessible, realistic training tools.
• Data from initial pilot tests show improved trainee performance and confidence when using the 3D-printed modules compared to traditional methods.

By following this theory of change, ImPulse aims to directly address the gaps in current pediatric cardiac surgery training, particularly in resource-limited settings, enhancing both the quality of training and the overall health outcomes for children with congenital heart defects.

Impact Goals:

1. Enhance Pediatric Cardiac Surgery Training: Use high-fidelity, 3D-printed simulation modules to improve the competency and readiness of pediatric cardiac surgeons, particularly in low-resource settings such as Gaza.
2. Increase Accessibility to Quality Surgical Training: Make advanced surgical training more accessible and affordable worldwide, reducing disparities in medical education.
3. Improve Surgical Outcomes for Neonates with CHDs: Reduce the rates of morbidity and mortality associated with congenital heart defects through better-prepared surgeons.

Measuring Progress:

To gauge the effectiveness of ImPulse in achieving these goals, we employ several specific indicators:

• The number of Training Modules Distributed: Tracks the reach and scale of the training modules across various regions, with a focus on underserved areas.
• Surgeon Competency Levels Pre- and Post-Training: These are assessed through standardised tests and practical evaluations conducted before and after the training sessions. This measures the direct impact of the modules on the surgeons' skills and confidence.
• Surgical Outcome Metrics: Monitoring the outcomes of surgeries performed by those trained with ImPulse modules, specifically looking at complication rates, success rates, and recovery times of patients.
• Feedback from Trainees and Trainers: Qualitative assessments through surveys and interviews to gather insights on the usability, realism, and educational value of the modules.

These indicators are aligned with the UN Sustainable Development Goal 3 (Good Health and Well-being), particularly targets related to reducing child mortality and improving healthcare services. By systematically collecting and analysing these metrics, we aim to continually refine our approach and expand our impact, ensuring that ImPulse contributes to transformational changes in pediatric cardiac surgery training globally.

The core technology behind ImPulse involves advanced 3D printing techniques combined with medical imaging data to create high-fidelity, anatomically accurate heart simulation modules. This technology uses the following components:

1. Medical Imaging Data: We use detailed scans such as MRI and CT images to capture the complex internal structures of congenital heart defects. This data serves as the blueprint for our simulations.
2. Computer-Aided Design (CAD): CAD software converts imaging data into digital 3D models. This allows for precise manipulation and customisation of the heart models to replicate specific congenital defects accurately.
3. 3D Printing Technology: We utilise stereolithography (SLA) and fused deposition modelling (FDM), which are forms of additive manufacturing. These technologies enable us to produce tactile models that mimic the texture and flexibility of human tissues, which is crucial for realistic surgical training.
4. Material Science: The choice of materials is vital. We use a combination of synthetic polymers that closely simulate the mechanical properties of human heart tissue, providing realistic feedback during surgical training.

Together, these technologies create a scalable, cost-effective training tool that enhances the educational experience for pediatric cardiac surgeons, particularly in resource-limited settings. By integrating cutting-edge 3D printing with traditional medical imaging, ImPulse leverages both modern and established technologies to improve surgical outcomes and training accessibility worldwide.

Currently, the ImPulse project is spearheaded solely by myself, Bashar Zapen, as a full-time commitment. No part-time staff, contractors, or other workers are officially associated with the project at this stage. However, I collaborate informally with medical professionals and technical experts on an ad-hoc basis to refine the design and functionality of the 3D-printed simulation modules. These collaborations are project-specific and do not constitute formal employment within the ImPulse project.

I have been working on the ImPulse project since it originated as my master's thesis in 2021. The project formally began about six months before its completion in 2021. Including the time since my graduation, I have been developing and refining ImPulse [on and off] for approximately three years now. This includes ongoing enhancements to the 3D-printed modules and expansion of the project's applications to better meet the needs of pediatric cardiac surgery training, particularly in underserved areas like the Gaza Strip.

I am the sole member of the ImPulse project team. As I expand the team, I'll prioritise fostering a diverse, equitable, and inclusive environment. I am keen to collaborate with like-minded and skilled individuals from various disciplines.

I wish to build a team that reflects various cultural, social, and professional backgrounds. While a pro-Palestinian perspective is valued, it is not a requirement; above all, team members must believe in the dignity and humanity of all global citizens and support the universal right to quality, affordable healthcare—nothing more except passion for change and doing good.

The ImPulse project operates under a hybrid business model, blending non-profit and revenue-generating activities to sustain its mission. This model allows us to maximise impact while ensuring the project's financial sustainability and scalability. 

Non-Profit Activities (Gaza and Other Low-Resource Settings):

In regions like Gaza, where the need for pediatric cardiac surgery training is critical yet financial resources are scarce, ImPulse provides high-fidelity, 3D-printed heart simulation modules free of charge. This is facilitated through donations, grants, and partnerships with international health organisations and local medical institutions. The goal here is purely impact-driven, aiming to improve the skills of local surgeons and thus enhance surgical outcomes for neonates with congenital heart defects.

Revenue-Generating Activities (Global Market):

For financially capable markets, ImPulse offers these simulation modules through a direct sales model to medical schools, hospitals, and training centres worldwide. These entities purchase the modules for advanced surgical training, helping their trainees gain practical experience in a risk-free environment. The revenue generated from these sales supports the non-profit activities, research and development, and operational costs.

Value Proposition:

1. For Beneficiaries in Low-Resource Settings (like Gaza): ImPulse provides an opportunity for local surgeons to access world-class surgical training tools free of charge. This directly addresses the lack of training resources and helps mitigate the risks associated with practising on patients without adequate preparation.
2. For Paying Customers: Medical institutions benefit from incorporating advanced, realistic, and cost-effective surgical simulations into their training programs. These tools help improve the proficiency and confidence of their surgical trainees, ultimately leading to better patient outcomes and reduced training costs compared to traditional methods.

Distribution and Service Delivery:

Depending on the logistical and economic considerations, the 3D-printed heart modules are produced locally in target regions or at centralised manufacturing sites. This flexible production approach allows us to minimise costs and ensure timely delivery of modules to both paying customers and beneficiaries in non-profit settings.

Why They Want or Need Our Product:

The demand for ImPulse's simulation modules stems from the need to improve surgical training efficacy and safety. Traditional methods often involve high costs, ethical concerns, and practical challenges, which our product effectively addresses. For non-profit beneficiaries, the need is also driven by a lack of available alternatives to gain necessary surgical skills in their local contexts.

This business model ensures the project's sustainability by balancing revenue generation with social impact goals. It aligns with our commitment to providing equitable access to quality healthcare education across different socio-economic contexts.

The financial sustainability of the ImPulse project is based on a hybrid model that blends self-financing, revenue generation through sales, and potential funding through grants and awards.

• Self-Financing: Initially, the charitable activities of ImPulse, especially in regions like Gaza, are partially funded by my personal income from a full-time position as a design researcher in academia. This approach allows the project to initiate and maintain momentum without immediate external financial dependencies.
• Revenue Generation: The long-term plan for financial sustainability involves selling high-fidelity, 3D-printed heart simulation modules to medical institutions in economically developed regions. These sales are intended to subsidise the free distribution of modules in low-resource settings. The pricing strategy will be based on covering production costs and generating a small profit margin to fund ongoing research, development, and charitable distributions.
• Grants and Awards: ImPulse has already gained recognition through multiple design awards, highlighting its innovative approach and potential impact. These accolades validate the project and enhance its visibility, which is crucial for attracting future grants and philanthropic funding. The project will actively pursue grants from medical research foundations, educational grants, and international health organisations aligned with our mission to improve global health outcomes.

Evidence of Potential Success:

While I have not yet generated revenue or raised formal investment funding for ImPulse, the project's reception has been overwhelmingly positive among stakeholders and potential users, particularly in Gaza. This positive feedback, coupled with the design awards and international exhibitions, indicates a strong interest and perceived value in the solution, suggesting a promising potential for future funding and revenue streams.