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Koo AY, Rodgers DK, Hohman MH, Muise JR, Couperus KS, Phelps JF. Lessons Learned: Large-Scale Perfused Cadaver Training in Three Different Curricular Environments. Mil Med 2024:usae110. [PMID: 38554274 DOI: 10.1093/milmed/usae110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/04/2024] [Accepted: 03/04/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Perfused cadavers are viable training models for operating room surgical skills, increasing fidelity of vascular anatomy, dissection, and tissue handling. In addition, perfused cadavers may have benefits in military medical training environments with a focus on hemorrhage control and vascular access. OBJECTIVES We created a large-scale training exercise with perfused cadavers in three different environments and aim to share the curricular design and feedback from the exercise. METHODS We conducted a 4-day simulation training exercise with 13 perfused cadavers in 3 different environments: hospital environment, the austere echelons of care environment, and a controlled-settings tent for hemorrhage control and needle decompression training. Through an anonymous online survey and an after-action review (AAR), we elicited feedback on advantages, disadvantages, costs, and comparison to models of porcine and fresh cadavers for procedures and existing courses. RESULTS A total of 324 participants were trained with 13 perfused cadavers for over 4 days from a variety of specialties and on different procedures and surgical skills. Based on 130 respondents to the survey and the AAR, perfused cadavers were rated to have realistic arterial bleeding and bleeding control training. In addition, perfused cadavers provided increased realism and fidelity for surgical skills. There were disadvantages of logistical requirements, cleanup, costs, and mobility. CONCLUSION Perfused cadavers can be implemented effectively for hemorrhage control training, surgical and procedure skills, and even exercises in austere environments, but require significant logistical and planning considerations. The training value is maximized with a progressive curriculum from hemorrhage control iterations to more invasive surgical procedures, such as thoracotomy and exploratory laparotomy.
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Affiliation(s)
- Alex Y Koo
- Department of Emergency Medicine, Georgetown University, Washington, DC 20010, USA
- Charles A. Andersen Simulation Center, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - David K Rodgers
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - Marc H Hohman
- Charles A. Andersen Simulation Center, Madigan Army Medical Center, JBLM, WA 98431, USA
- Department of Otolaryngology, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - Jason R Muise
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - Kyle S Couperus
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - Jillian F Phelps
- Charles A. Andersen Simulation Center, Madigan Army Medical Center, JBLM, WA 98431, USA
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
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A High-Fidelity Agar-Based Phantom for Ultrasonography-Guided Brain Biopsy Simulation: A Novel Training Prototype with Visual Feedback. World Neurosurg 2022; 167:e333-e343. [PMID: 35961586 DOI: 10.1016/j.wneu.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE A novel agar-based phantom was developed and assessed for ultrasonography (USG)-guided brain biopsy training. The phantom provides visual cues combined with sonologic cues, allowing multimodal training. Impact of multimodal training is evaluated through pretraining and posttraining trials. METHODS Twenty-five participants were divided based on experience with USG-based procedures into familiar (≥3 procedures performed in the past) (n = 14) and unfamiliar (<3 procedures performed) (n = 11). Agar phantoms with an opaque top and transparent middle layer were constructed in transparent glass bowls, each having 12 embedded targets. Participants underwent 2 supervised trials of USG-guided biopsy with aluminum foil covering the glass bowls, eliminating visual cues. Between 2 trials, participants underwent unsupervised self-training on a phantom without foil cover, providing visual cues. Performance was measured through insonation efficiency (EfI), biopsy efficiency (EfB), efficiency score (Ef), error score (Er), and performance score (PS). Scores were compared between and within the 2 groups before and after training. Impact of the self-training session on subjective comfort levels with the procedure was assessed through feedback forms. RESULTS Familiars had better pretraining EfB, Ef, Er, and PS (P < 0.001) compared with unfamiliars. After training, both performed similarly on all metrics. After training, familiars improved only in EfI (P = 0.001), with the unfamiliars showing significance in all metrics except EfI. CONCLUSIONS Simulation and phantom-based models can never supplant training through supervised skill application in vivo but our model supplements training by enabling technical skill acquisition, especially for beginners in USG-guided brain biopsy.
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Robinson E, Little D. A practical guide to undergraduate radiology education. Clin Radiol 2022; 77:e826-e834. [DOI: 10.1016/j.crad.2022.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
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Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University. J Med Ultrason (2001) 2022; 49:217-230. [PMID: 35034230 PMCID: PMC8761092 DOI: 10.1007/s10396-021-01178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022]
Abstract
The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.
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Leszczyński P, Muraczyńska B, Wejnarski A, Baczewska B, Malm M, Drop B. Improving the quality of training paramedics by means of cadavers - a pilot study. BMC MEDICAL EDUCATION 2021; 21:67. [PMID: 33494736 PMCID: PMC7836173 DOI: 10.1186/s12909-021-02498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Paramedics are authorised to perform emergency procedures, including trauma assessment according to global standards. The aim of the study was to answer the question whether the use of cadavers in teaching practical competencies to medical rescue students, in the field of trauma assessment, is necessary as a supplement to learning in simulated conditions with the use of mannequins. METHODS Research included several stages. The first stage was conduction of classes for 27 students in the field of rapid trauma assessment, in accordance with the guidelines of the International Trauma Life Support. In the second stage, a plan of a test in which students had to perform an analogous procedure of rapid trauma assessment, but with the use of cadavers, human unfixed specimens, was prepared. The Delphi method was used to develop and approve checklists, as well as a scale to assess the global correctness of identification of head, torso and limb injuries by medical rescue students. RESULTS The identification rate was 76.54% in the head area, 67.90% in the torso area, while in the limb area it equalled 44.45%. A significant difference in scores, compared to the examination performed on a mannequin, was observed (Wilcoxon = 4.541; p = 0.000). The most difficult to make a correct diagnosis were injuries related to a fracture of the proximal end of the femur and a dislocated wrist (only 18.52% of correct answers). The students highly rated the usefulness of the examination, by awarding it an average of 4.76 points (SD ± 0.56) on the Likert scale (0-5). CONCLUSIONS The study shows that the use of cadavers to teach practical competencies in the field of trauma assessment to medical rescue students can be an effective supplement to simulated learning. Students could feel the difference between the human body and the mannequin. More research is needed to assess whether realistic simulation translates into objective endpoints, such as the effectiveness of diagnosis in the examination of trauma patients. However, it should be remembered that the introduction of this teaching method is expensive and requires adequate base, as well as the compliance with a number of formal requirements.
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Affiliation(s)
- Piotr Leszczyński
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland
| | - Bożena Muraczyńska
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland
| | - Arkadiusz Wejnarski
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, Siedlce, Poland
| | - Bożena Baczewska
- Chair of Internal Medicine and Department of Internal Medicine in Nursing, Medical University of Lublin, Lublin, Poland
| | - Maria Malm
- Department of Medical Informatics and Statistics with E-learning Lab, Medical University of Lublin, Lublin, Poland.
| | - Bartłomiej Drop
- Department of Medical Informatics and Statistics with E-learning Lab, Medical University of Lublin, Lublin, Poland
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Meyer LE, Thakar OV, Brown SM, Trojan JD, Mulcahey MK. Surgical Skills Course for Fourth Year Medical Students Entering an Orthopaedic Surgery Residency. MEDEDPUBLISH 2020; 9:34. [PMID: 38058880 PMCID: PMC10697433 DOI: 10.15694/mep.2020.000034.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
This article was migrated. The article was marked as recommended. Surgical skills training outside of the operating room is a critical component of surgical education. There has been little incorporation of these programs for medical students entering orthopaedic surgery residencies. As such, there is concern that incoming orthopaedic residents matriculate with skills below residency programs' expectations. This study aimed to assess the need for an orthopaedic surgical skills course during the 4 th year of medical school.An anonymous electronic survey was emailed to 1457orthopaedic surgery residents and 732 current orthopaedic residency applicants using application data from a single orthopaedic residency program during the 2015-2016 through 2017-2018 cycles. 200 resident and 31 applicant emails were returned undeliverable, resulting in distribution to 1257 residents and 701 applicants. 135 junior residents (11% response rate) and 181 applicants (26% response rate) completed portions of the survey. 76 of 117 (65%) residents and 170 of 181 (94%) applicants did not participate in a formal orthopaedic surgical skills course. 110 of 118 (93%) residents and 160 of 171 (94%) applicants indicated that implementing such a course before entering residency would be beneficial. Applicants rated basic fracture reduction (95%; 171/180), casting/splinting (94%; 170/180), and reading basic x-rays (90%; 162/180) as the most important potential course components.Most respondents were not exposed to an orthopaedic skills course prior to residency. Participants indicated that such a course would be beneficial to incoming orthopaedic residents. Pilot programs should be developed to optimize an orthopaedic preparatory skills course for 4 th year medical students pursuing careers in orthopaedic surgery.
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Khoury M, Fotsing S, Jalali A, Chagnon N, Malherbe S, Youssef N. Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943615. [PMID: 32754649 PMCID: PMC7378712 DOI: 10.1177/2382120520943615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. METHODS Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. RESULTS For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. CONCLUSION The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.
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Affiliation(s)
- Michel Khoury
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Salomon Fotsing
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Alireza Jalali
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Nicolas Chagnon
- Department of Emergency Medicine,
Montfort Hospital, Ottawa, ON, Canada
| | | | - Nermine Youssef
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
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Done AJ, Fairres MJ, Heiler JC, Smith CJ, Rappaport W. A low-cost high-fidelity model for abscess simulation. Am J Surg 2019; 219:628-631. [PMID: 31253352 DOI: 10.1016/j.amjsurg.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of a subcutaneous abscess is a commonly encountered scenario across multiple specialties. Prior simulation models for abscess incision and drainage have been limited by their cost and reproducibility. METHODS We developed a realistic abscess model with commonly available materials that can be utilized in fresh cadaver labs at a cost of less than $1 USD per use. The model was evaluated for content validity with pre- and post-measures by 25 pre-clinical medical students. RESULTS The model described herein successfully simulates commonly encountered subcutaneous abscesses. Pre and post-training surveys demonstrated a significant increase in all outcomes measures. CONCLUSIONS The model presented in this manuscript can be easily incorporated into training programs that utilize a fresh cadaver lab for multi-procedural resident training. It provides a realistic abscess that can be placed in almost any anatomical location at a fraction of the cost, and significantly reduced preparation time compared to previously described models.
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Affiliation(s)
- Aaron J Done
- College of Medicine, The University of Arizona, Tucson, AZ, USA.
| | | | - Joseph C Heiler
- College of Medicine, The University of Arizona, Tucson, AZ, USA.
| | - Cody J Smith
- College of Medicine, The University of Arizona, Tucson, AZ, USA.
| | - William Rappaport
- Department of Surgery, The University of Arizona, Tucson, AZ, USA; College of Medicine, The University of Arizona, Tucson, AZ, USA.
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Rodriguez CEG, Shah RJ, Smith C, Gay CJ, Alvarado J, Rappaport D, Adamas-Rappaport WJ, Amini R. Students Teaching Students: A Novel Solution for Teaching Procedures via Instruction on the Corpse. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2019; 7:51-55. [PMID: 31086796 PMCID: PMC6475029 DOI: 10.30476/jamp.2019.44708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Increased faculty and resident responsibilities have led to the decreased time available for teaching clinical skills to medical students. Numerous advances in education and simulation have attempted to obviate this problem; however, documented success is lacking. Our objective was to describe a novel fresh cadaver-based, student-driven procedural skills lab and to compare the educational effectiveness of student instructors to the senior instructor (SI). METHODS This was a prospective study performed at an academic medical center. A pilot program, "Students Teaching Students," was introduced where four trained first-year medical students (TMS) instructed 41 other untrained first-year medical students in technical procedures. This study compared the teaching evaluations of the SI with the TMS teaching equivalent procedures. Paired t-test was used to determine statistically significant changes in procedural confidence between pre- and post-training. Utilizing a post-training questionnaire, average post-training confidence improvement values and objective post-training test scores of the participants were compared between TMS and SI, using a 2 sample t-test. Statistical significance was considered as a P-value<0.05. All statistical analyses were conducted in Stata 11 (StataCorp LP, College Station, TX, USA). RESULTS Twenty-nine out of 39 (74%) students completed the questionnaire. Both groups demonstrated a statistically significant improvement in subjective confidence level in performing each procedure when pre- and post-training scores were compared, while there was no statistically significant difference found in cognitive knowledge between the groups (p=0.73). There was no statistically significant difference in the mean confidence improvement between the SI and TMS groups for chest tube insertion (2.06 versus 1.92 respectively, p=0.587), femoral line placement (2.00 versus 1.94 respectively, p=.734) or student test score (88% versus 85% respectively). CONCLUSION Our results demonstrate that first-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource. The Students Teaching Students procedure lab employed in this study was effective at immediately increasing first-year medical students' confidence and technical skill. First-year medical students well-trained in technical skills, such as our TMS, may be a valuable additional teaching resource.
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Affiliation(s)
| | - Raj J Shah
- College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Cody Smith
- College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Christopher J Gay
- College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Jared Alvarado
- College of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Douglas Rappaport
- Department of Emergency Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | | | - Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
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Amini R, Camacho LD, Valenzuela J, Ringleberg JK, Patanwala AE, Stearns J, Situ-LaCasse EH, Acuña J, Adhikari S. Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519885638. [PMID: 31799406 PMCID: PMC6864035 DOI: 10.1177/2382120519885638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity. OBJECTIVES The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks. METHODS This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants' experience level, opinions, and procedural confidence regarding the 4 stations. RESULTS A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures. CONCLUSIONS This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.
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Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, The
University of Arizona, Tucson, AZ, USA
| | - Luis D Camacho
- College of Medicine, The University of
Arizona, Tucson, AZ, USA
| | | | | | - Asad E Patanwala
- Sydney Pharmacy School, The University
of Sydney, Sydney, NSW, Australia
| | - Jack Stearns
- Department of Molecular and Cellular
Biology, The University of Arizona, Tucson, AZ, USA
| | | | - Josie Acuña
- Department of Emergency Medicine, The
University of Arizona, Tucson, AZ, USA
| | - Srikar Adhikari
- Department of Emergency Medicine, The
University of Arizona, Tucson, AZ, USA
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Greenstein J, Das D, Acuna J, Kapoor M, Brown C, Husain A, Lally B, Hahn B. The use of cadaver models to diagnose rib fractures: A pilot study. Am J Emerg Med 2018; 37:313-316. [PMID: 30551938 DOI: 10.1016/j.ajem.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In the emergency department, rib fractures are a common finding in patients who sustain chest trauma. Rib fractures may be a sign of significant, underlying pathology, especially in the elderly patients where rib fractures are associated with significant morbidity and mortality. To date, no studies have evaluated the ability of ultrasound to detect rib fractures using cadaver models and subsequently use this model as a teaching tool. OBJECTIVES The purpose of this study was to determine if it is possible to generate rib fractures on cadaver models which could be accurately identified using ultrasound. METHODS This was a cross-sectional study performed during one session at a cadaver lab. A single hemithorax from four adult cadavers were used as models. Single rib fractures on each of rib five through eight were created. Four subjects, blinded to the normal versus fractured ribs, were asked to identify the presence of a fracture on each rib. RESULTS A total of 8 of 16 potential ribs had fractured induced by study staff. Mean accuracy was 55% for all subjects. The overall sensitivity and specificity for detecting rib fractures was 50% (CI: 31.89-68.11) and 59.38% (CI: 35.69-73.55) respectively. The overall PPV and NPV was 55.17% and 54.29% respectively. CONCLUSIONS In this pilot study, subjects were not able to detect induced rib fractures using ultrasound on cadaver models. The use of this model as a teaching tool in the detection of rib fractures requires further investigation.
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Affiliation(s)
- Josh Greenstein
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America.
| | - Devjani Das
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Josie Acuna
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Monica Kapoor
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Cara Brown
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Abbas Husain
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Brendan Lally
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
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Meek ME(M, Meek JC, Hollowoa B, Li R, Deloney LA, Phelan KD. Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided Procedures Commonly Used in Interventional Radiology. Acad Radiol 2018; 25:1503-1509. [PMID: 30017501 DOI: 10.1016/j.acra.2018.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care. MATERIALS AND METHODS Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access. RESULTS The ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient. CONCLUSION Lightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.
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Davis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in Undergraduate Medical Education: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2667-2679. [PMID: 29708268 DOI: 10.1002/jum.14628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/18/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students. METHODS A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full-text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors. RESULTS Ninety-five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US-related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non-US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed. CONCLUSIONS There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.
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Affiliation(s)
- Joshua J Davis
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Jacqueline Potts
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Charles A Pohl
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Matthew Fields
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
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14
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de Souza TH, Brandão MB, Santos TM, Pereira RM, Nogueira RJN. Ultrasound guidance for internal jugular vein cannulation in PICU: a randomised controlled trial. Arch Dis Child 2018; 103:952-956. [PMID: 29618485 DOI: 10.1136/archdischild-2017-314568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We investigated whether ultrasound guidance was advantageous over the anatomical landmark technique when performed by inexperienced paediatricians. DESIGN Randomised controlled trial. SETTING A paediatric intensive care unit of a teaching hospital. PATIENTS 80 children (aged 28 days to <14 years). INTERVENTIONS Internal jugular vein cannulation with ultrasound guidance in real time or the anatomical landmark technique. MAIN OUTCOME MEASURES Success rate, success rate on the first attempt, success rate within three attempts, puncture time, number of attempts required for success and occurrence of complications. RESULTS We found a higher success rate in the ultrasound guidance than in the control group (95% vs 61%, respectively; p<0.001; relative risk (RR)=0.64, 95% CI (CI) 0.50 to 0.83). Success on the first attempt was seen in 95% and 34% of venous punctures in the US guidance and control groups, respectively (p<0.001; RR=0.35, 95% CI 0.23 to 0.54). Fewer than three attempts were required to achieve success in 95% of patients in the US guidance group but only 44% in the control group (p<0.001; RR=0.46, 95% CI 0.32 to 0.66). Haematomas, inadvertent arterial punctures, the number of attempts and the puncture time were all significantly lower in the ultrasound guidance than in the control group (p<0.015 for all). CONCLUSIONS Critically ill children may benefit from the ultrasound guidance for internal jugular cannulation, even when the procedure is performed by operators with limited experience. TRIAL REGISTRATION NUMBER RBR-4t35tk.
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Affiliation(s)
| | | | | | | | - Roberto José Negrão Nogueira
- Deparment of Pediatrics, University of Campinas (UNICAMP), Campinas, Brazil.,Department of Pediatrics, School of Medicine São Leopoldo Mandic, Campinas, Brazil
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15
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Theodoulou I, Nicolaides M, Athanasiou T, Papalois A, Sideris M. Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2018; 75:1374-1388. [PMID: 29422405 DOI: 10.1016/j.jsurg.2018.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/19/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL. METHODS We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database. RESULTS Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized. CONCLUSIONS SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level.
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Affiliation(s)
- Iakovos Theodoulou
- Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital Great Maze Pond, London, United Kingdom.
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, London, United Kingdom
| | | | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
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16
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Sevak S, Lurvey B, Woodfin AA, Hothem Z, Callahan RE, Robbins J, Ziegler K. Solid, Cystic, and Tubular: Novice Ultrasound Skills Training Using a Versatile, Affordable Practice Model. JOURNAL OF SURGICAL EDUCATION 2018; 75:1403-1409. [PMID: 29650483 DOI: 10.1016/j.jsurg.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/08/2018] [Accepted: 02/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures. Many medical schools and residency programs lack a formal ultrasound training curriculum. We describe an affordable ultrasound training curriculum and versatile, inexpensive practice model. DESIGN Participants underwent a didactic session to teach the theory required to perform ultrasound-guided procedures. Motor skills were taught using a practice model incorporating analogs of common anatomic and pathologic structures into an opacified gelatin substrate. SETTING The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI. PARTICIPANTS The model was tested in a cohort of 50 medical students and general surgery residents. RESULTS The gelatin model can be constructed for $1.03 per learner. The solid, cystic, and vascular structural analogs were readily identifiable on ultrasound and easily differentiated based on their echotextures. Eighty-four percent of participants successfully aspirated the cystic structure, 88% successfully biopsied a portion of the solid structure, and 76% successfully cannulated the tubular structure. Overall, 82% of participants achieved a passing score for the exercise based on a validated Objective Structured Assessment of Technical Skill instrument. There were no significant differences between the medical students and residents. CONCLUSION This model can be used to teach basic ultrasound skills such as aspiration, biopsy, and vessel cannulation, providing a foundation for the use of ultrasound in a broad range of clinical procedures, as well as providing practice opportunities for medical students and residents to gain increased ultrasound competency and confidence.
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Affiliation(s)
- Shruti Sevak
- Department of Surgery, Beaumont Health, Royal Oak, Michigan
| | - Benjamin Lurvey
- OUWB School of Medicine, Beaumont Health, Royal Oak, Michigan
| | | | - Zachary Hothem
- Department of Surgery, Beaumont Health, Royal Oak, Michigan
| | | | - James Robbins
- Department of Surgery, Beaumont Health, Royal Oak, Michigan; OUWB School of Medicine, Beaumont Health, Royal Oak, Michigan; Section of Trauma Surgery, Beaumont Health, Royal Oak, Michigan
| | - Kathryn Ziegler
- Department of Surgery, Beaumont Health, Royal Oak, Michigan; OUWB School of Medicine, Beaumont Health, Royal Oak, Michigan; Marcia and Eugene Applebaum Surgical Learning Institute, Beaumont Health, Royal Oak, Michigan.
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17
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Kovacs G, Levitan R, Sandeski R. Clinical Cadavers as a Simulation Resource for Procedural Learning. AEM EDUCATION AND TRAINING 2018; 2:239-247. [PMID: 30051097 PMCID: PMC6050063 DOI: 10.1002/aet2.10103] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/14/2018] [Accepted: 04/21/2018] [Indexed: 05/28/2023]
Abstract
"See one, do one, teach one" remains an unofficial, unsanctioned framework for procedural skill learning in medicine. Appropriately, medical educators have sought alternative simulation venues for students to safely learn their craft. With the end goal of ensuring competence, educational programming will require the use of valid simulation with appropriate fidelity. While cadavers have been used for teaching anatomy for hundreds of years, more recently they are being repurposed as a "high-fidelity" procedural skill learning simulation resource. Newly deceased, previously frozen, and soft-preserved cadavers, such as those used in Baltimore and Halifax, produce clinical cadavers with high physical and functional fidelity that can serve as simulators for performing many high-acuity procedures for which there is otherwise limited clinical or simulation opportunities to practice. While access and cost may limit the use of cadavers for simulation, there are opportunities for sharing resources to provide an innovative procedural learning experience using the oldest of medical simulation assets, the human body.
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Affiliation(s)
- George Kovacs
- Departments of Emergency MedicineAnaesthesia, Medical Neurosciences & Division of Medical EducationHalifaxNova ScotiaCanada
- Clinical Cadaver ProgramDalhousie UniversityHalifaxNova ScotiaCanada
- QEII Health Sciences CentreHalifaxNSCanada
| | - Richard Levitan
- Dartmouth Geisel School of MedicineDepartment of MedicineDartmouth‐Hitchcock Medical CenterLebanonNH
| | - Rob Sandeski
- Department of Medical NeurosciencesHalifaxNova ScotiaCanada
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18
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Budić I, Pavlović S, Stević M, Petrov I, Perić V, Jović M, Simić D. MEDICAL SIMULATION: MORAL AND ETHICAL ISSUES. ACTA MEDICA MEDIANAE 2018. [DOI: 10.5633/amm.2018.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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19
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Fisher J, Viscusi R, Ratesic A, Johnstone C, Kelley R, Tegethoff AM, Bates J, Situ-Lacasse EH, Adamas-Rappaport WJ, Amini R. Clinical skills temporal degradation assessment in undergraduate medical education. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2018; 6:1-5. [PMID: 29344523 PMCID: PMC5757151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/11/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Medical students' ability to learn clinical procedures and competently apply these skills is an essential component of medical education. Complex skills with limited opportunity for practice have been shown to degrade without continued refresher training. To our knowledge there is no evidence that objectively evaluates temporal degradation of clinical skills in undergraduate medical education. The purpose of this study was to evaluate temporal retention of clinical skills among third year medical students. METHODS This was a cross-sectional study conducted at four separate time intervals in the cadaver laboratory at a public medical school. Forty-five novice third year medical students were evaluated for retention of skills in the following three procedures: pigtail thoracostomy, femoral line placement, and endotracheal intubation. Prior to the start of third-year medical clerkships, medical students participated in a two-hour didactic session designed to teach clinically relevant materials including the procedures. Prior to the start of their respective surgery clerkships, students were asked to perform the same three procedures and were evaluated by trained emergency medicine and surgery faculty for retention rates, using three validated checklists. Students were then reassessed at six week intervals in four separate groups based on the start date of their respective surgical clerkships. We compared the evaluation results between students tested one week after training and those tested at three later dates for statistically significant differences in score distribution using a one-tailed Wilcoxon Mann-Whitney U-test for non-parametric rank-sum analysis. RESULTS Retention rates were shown to have a statistically significant decline between six and 12 weeks for all three procedural skills. CONCLUSION In the instruction of medical students, skill degradation should be considered when teaching complex technical skills. Based on the statistically significant decline in procedural skills noted in our investigation, instructors should consider administering a refresher course between six and twelve weeks from initial training.
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Affiliation(s)
- Joseph Fisher
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Rebecca Viscusi
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Adam Ratesic
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Ross Kelley
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Jessica Bates
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | - Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
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20
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Mohty KM, Cravens MG, Adamas-Rappaport WJ, Amini-Shervin B, Irving SC, Stea N, Adhikari S, Amini R. Cadaver-based Necrotizing Fasciitis Model for Medical Training. Cureus 2017; 9:e1168. [PMID: 28507840 PMCID: PMC5429149 DOI: 10.7759/cureus.1168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Necrotizing fasciitis is a devastating infectious disease process that is characterized by extensive soft tissue necrosis along deep fascial planes, systemic toxicity, and high mortality. Ultrasound imaging is a rapid and non-invasive tool that can be used to help make the diagnosis of necrotizing fasciitis by identifying several distinctive sonographic findings. The purpose of this study is to describe the construction of a realistic diagnostic training model for necrotizing fasciitis using fresh frozen cadavers and common, affordable materials. Presently, fresh non-embalmed cadavers have been used at medical institutions for various educational sessions including cadaver-based ultrasound training sessions. Details for the preparation and construction of a necrotizing fasciitis cadaver model are presented here. This paper shows that the images obtained from the cadaver model closely imitate the ultrasound appearance of fluid and gas seen in actual clinical cases of necrotizing fasciitis. Therefore, it can be concluded that this cadaver-based model produces high-quality sonographic images that simulate those found in true cases of necrotizing fasciitis and is ideal for demonstrating the sonographic findings of necrotizing fasciitis.
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Affiliation(s)
| | | | | | | | | | - Nicholas Stea
- Department of Emergency Medicine, University of Arizona
| | | | - Richard Amini
- Department of Emergency Medicine, University of Arizona
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21
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Ellis MS, Nelson JT, Kartchner JZ, Yousef KA, Adamas-Rappaport WJ, Amini R. Cadaver-based abscess model for medical training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:85-88. [PMID: 28176889 PMCID: PMC5260941 DOI: 10.2147/amep.s124648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.
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Affiliation(s)
| | - Joseph T Nelson
- Department of Orthopedic Surgery, The University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Richard Amini
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
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