Hands-On Practice on Sustainable Simulators in the Context of Training for Rural and Remote Practice Through a Fundamental Skills Workshop

Advancing Surgical Precision in Z-Plasty and Melanoma Excision Through Quality Improvement Initiatives in Rural Settings

Rural healthcare provider shortages have a severe impact on Canadians who seek care in rural and remote (R&R) settings, often arriving with poor health or medical emergencies. Healthcare providers working in such settings often face significant challenges in accessing skills development and maintenance courses to meet the unique medical demands of rural communities. As a result, it is vital to provide R&R healthcare providers with the appropriate simulation-based skills training. This approach led to the development of a Z-plasty and melanoma simulator tool, which was presented at a workshop during the Society of Rural Physicians of Canada (SRPC) conference in Niagara Falls, Ontario, from April 20 to 22, 2023. The workshop aimed to familiarize participants with the procedures and instruments required for Z-plasty and melanoma excisions in R&R practice. This paper describes the development of the simulators used in the foundational skills workshop, attended by medical students, residents, and physicians. It also analyzes the workshop's findings to guide future enhancements. The Z-plasty and melanoma simulators were created using additive manufacturing techniques, including three-dimensional printing and silicone. Participants in the SRPC Rural and Remote Medicine Course evaluated the functionality and realism of the simulators and provided feedback for improvements, using the Michigan Standard Simulation Experience Scale. Quantitative data indicated that the Z-plasty simulator achieved an overall score of 4.03 on a 5-point Likert scale, while the melanoma simulator scored 4.15. Participants' feedback was categorized into three main areas: self-efficacy, realism, and educational value. Qualitative analysis of the data revealed three themes for the Z-plasty simulator: physical resilience, materials science, and skills development. Similarly, the melanoma simulator yielded two main themes: physical reliance and materials science. Overall, the simulators demonstrated effective hands-on practice, representing a sustainable method for developing skills-based competencies in Z-plasty and melanoma excisions for R&R settings. Feedback from workshop participants will inform ongoing improvements to the simulators and their integration into future training events.

The Use of Silicone Simulators for Bile Duct Anastomosis Education in Medical Conferences for the Purpose of Improving the Canadian Medical Education Directives for Specialists (CanMEDS) Competencies

This technical report explores the potential of including silicone bile duct simulators for the purpose of completing a bile duct anastomosis (BDA) in medical conferences. The purpose is to target the need for exposure to more surgical skills and to contribute to the Canadian Medical Education Directives for Specialists (CanMEDS) requirements, as per the Royal College of Physicians and Surgeons of Canada.  Data collection was completed at the 2023 Canadian Conference for the Advancement of Surgical Education (C-CASE) in Montreal, Canada. For several years, the quality improvement feedback received at the end of these conferences suggested a few areas of improvement, one of which was related to the concept of return on investment (ROI). The participants spend a considerable amount of funds to travel to the conferences but feel that the only measurable gains are at a research capacity and thus only relate to two CanMEDS competencies. By leveraging C-CASE, the aim is to enhance students' educational experience during events they already intend to attend. Initially, students participated in a five-part simulation workshop and engaged in a think-aloud protocol (TAO). From there, nine participants were recruited for a focus group to further understand the perceived educational value and feedback on both the simulators and the conference structure.

Adapting the Gamified Educational Networking Online Learning Management System to Test a Decentralized Simulation-Based Education Model to Instruct Paramedics-in-Training on the Emergency Intraosseous Access and Infusion Skill

Intraosseous (IO) access and infusion is a safe and rapid alternative to intravenous access in obtaining vascular access for administering fluids and drugs. Healthcare professionals, such as primary and advanced care paramedics, use IO access and infusion in emergency circumstances where peripheral intravenous routes are inaccessible. IO access skills require hands-on training, which can be done remotely if the participants have access to simulation, instructions, guidance, and feedback. For the purpose of moving the training outside of the simulation laboratories, we have developed (1) an inexpensive and scalable three-dimensional (3D) printed and silicone-based advanced adult proximal tibial IO access and infusion simulator and (2) a unique learning management system (LMS) for remote simulation-based training. The LMS was built using the Django platform and supports experiential learning by providing access to educational and instructional content (including virtual simulation and serious games), allowing peers to communicate among themselves and with subject-matter experts, provide and receive feedback asynchronously, and engage in learning using gamification elements. The aim of this technical report is to describe the process of development and the final product of the LMS as a research and educational tool to scaffold remote learning of emergency IO skills by paramedics-in-training.

Development and Initial Assessment of a Novel and Customized Bile Duct Simulator for Handsewn Anastomosis Training

Simulation-based medical education allows for the training and maintenance of healthcare skills in a safe and controlled environment. In this technical report, the development and initial evaluation of a bile duct anastomosis simulator are described. The simulator was developed using additive manufacturing techniques such as three-dimensional (3D) printing and silicone work. The final product was produced by maxSIMhealth, a research lab at Ontario Tech University (Oshawa, ON, Canada), and included four individual silicone bile ducts, based on the expert opinions from surgeons at the Centre Hospitalier de l'Université de Montréal (Montreal, QC, Canada), and a 3D-printed maxSIMclamp, which was described in a previous report. The evaluation was conducted by nine individuals consisting of surgeons, surgical residents, and medical students to assess the fidelity, functionality, and teaching quality of the simulator. The results from the evaluation indicate that the simulator needs to improve its fidelity by being softer, thinner, and beige. On the other hand, the results also indicate that this simulator is extremely durable and can be used as a training tool for surgical residents with some minor improvements.

Hacking Intraosseous Infusion Skills Training With 3D Printing: maxSIMIO Drilling System

Intraosseous (IO) infusion is an alternative way to access the vascular system to administer drugs and fluids, which is particularly helpful when the commonly used peripheral intravenous route is inaccessible. The IO procedure can be done using a drill that involves disinfecting the area, landmarking the insertion point, seating the needle in a firm and stable position in the bone, and then delivering a smooth fluid flush. However, in the current medical training landscape, access to commercially available IO drills such as the Arrow® EZ-IO® Power Driver (EZ-IO; Teleflex, Morrisville, North Carolina, United States) is difficult, especially for rural and remote areas, due to the high costs. Furthermore, the EZ-IO is not rechargeable and does not clearly indicate the remaining battery life, which could potentially put patients at risk during the IO procedure. This technical report aims to address these concerns by describing the development of an alternative, affordable, and reliable IO drilling system for training use: the maxSIMIO Drilling System. This system consists of a cordless and rechargeable IKEA screwdriver which connects to a conventional, hexagon-shaped 3D-printed drill bit needle adapter. Two needle adapters were created: Version A was designed to use a friction-based mechanism to couple the screwdriver with the EZ-IO training needle, while Version B relies on a magnetic mechanism. The major differences between the EZ-IO and the screwdriver are that a) the EZ-IO has only one rotation to advance the cannula while the screwdriver features both directions, b) the EZ-IO is not rechargeable while the screwdriver is, and c) the EZ-IO has a custom needle holder that can fit any EZ-IO training needle size while the screwdriver needs to have a custom needle adapter made to connect to the EZ-IO training needle. Overall, through this exploration, the features of the maxSIMIO Drilling System in comparison to the EZ-IO appear more accessible for IO training. Future considerations for this development include gathering clinical expertise through rigorous testing of this novel system.