Validation of a novel resin-porcine thorax model for chest drain insertion training

Development of an Innovative Nonanimal Training Model for Infant Pleural Effusion Drainage via Pigtail Catheter Placement

BACKGROUND

Chest tube placement is an important skill for providers and bedside nurses caring for critically ill infants, allowing for the evacuation of pleural fluid and pneumothoraces. No realistic simulation models are commercially available for trainees to practice and learn this skill on infants.

PURPOSE

Our objective was to develop an inexpensive and reproducible model for percutaneous pleural pigtail placement for pleural fluid removal via the Seldinger technique.

METHODS

The model was developed using hardware material and a discarded infant resuscitation manikin. The rib cage was constructed using electrical cable wires. Discarded and expired 250-mL bags of intravenous fluids were placed inside the chest cavity to simulate pleural fluid. Shelf liner was wrapped around the chest and abdomen of the infant model to simulate the skin layer. Pediatric critical care faculty performed the procedure on the final model and scored it for realism and utility for teaching. Without including the discarded manikin and fluid bags, the cost of the materials for the model was less than $20.

RESULTS

Eight pediatric critical care faculty tested the pleural pigtail placement model. All faculty agreed the model provides a realistic simulated reproduction of placing a pleural pigtail, felt the model was simple to use, and indicated they would use it as a teaching tool in the future.

IMPLICATIONS FOR PRACTICE

An effective model for pleural pigtail placement can be inexpensively constructed using discarded bags of intravenous fluid and easy-to-find hardware materials.

IMPLICATIONS FOR RESEARCH

Future studies are needed to assess whether this model helps providers and nurses develop and maintain the clinical skills for successful percutaneous pleural pigtail catheter placement.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=35&autoPlay=true.

The need to standardize use of the newly deceased in medical trainings

OBJECTIVES

The present study aimed to identify the characteristics of use of the deceased in invasive training and the bioethical principles that govern this practice. In this context, it has become imperative to deduce which professional skills are critical to develop.

METHODS

A prospective study investigated a cadaver's use in medical (and related) schools through a questionnaire, which was made available for 48 hours on social networks (Facebook and LinkedIn) to groups of doctors and medical students using a communication app (WhatsApp). The inclusion criteria were being a medical student or a doctor. Cases in which the answers to the questionnaire were inadequate, or when the student had reason to withdraw, were excluded. Each participant could only answer the questionnaire once, and could not modify the responses after submitting it.

RESULTS

A disproportionate relationship was found regarding the replacement of the newly deceased by other means (such as dummies and simulators). This outcome suggests that there is no substitution, concomitant with the importance of a prior request for consent from the patient and/or subsequent consent from family members.

CONCLUSION

According to the findings, the significance of-and need for-training is undeniable. Hence, it is urgent to normalize the practice and definition of the ethical limitations of medical conduct.

A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin

Objectives:

To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns.

Methods:

This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42).

Results:

The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more.

Conclusion:

Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.

Teaching project: a low-cost swine model for chest tube insertion training

OBJECTIVE

to describe and evaluate the acceptance of a low-cost chest tube insertion porcine model in a medical education project in the southwest of Paraná, Brazil.

METHODS

we developed a low-cost and low technology porcine model for teaching chest tube insertion and used it in a teaching project. Medical trainees - students and residents - received theoretical instructions about the procedure and performed thoracic drainage in this porcine model. After performing the procedure, the participants filled a feedback questionnaire about the proposed experimental model. This study presents the model and analyzes the questionnaire responses.

RESULTS

seventy-nine medical trainees used and evaluated the model. The anatomical correlation between the porcine model and human anatomy was considered high and averaged 8.1±1.0 among trainees. All study participants approved the low-cost porcine model for chest tube insertion.

CONCLUSION

the presented low-cost porcine model for chest tube insertion training was feasible and had good acceptability among trainees. This model has potential use as a teaching tool in medical education.

[Simulation training in pulmonary medicine: Rationale, review of the literature and perspectives]

Training in pulmonary medicine requires the acquisition of a great deal of knowledge, but also technical know-how and interpersonal skills. The prevailing teaching pattern is mentorship. It implies a direct transmission of knowledge, but also entails some drawbacks such as disparity in learning opportunities, subjective evaluation of the trainee and potential risks for patients. There is growing interest in simulation training as a teaching technique, where students practice their skills in a secure environment, then analyse their performance in a debriefing session. It is complementary to other learning methods (abstraction, observation or mentorship) and forms part of an ethical approach: 'never practice on a real patient for the first time'. We have reviewed the literature related to simulation training in pulmonary medicine and in particular for physical examination, technical skills, pathologies, communication with patients and therapeutic education. In most of the studies, simulation training is a way of speeding up students' training - without necessarily yielding better results - and of respecting the procedures. We then present the French regulations and official guidelines regarding the use of this training method in the teaching of medicine. Finally, we shall consider some prospects of this approach for the community of pulmonologists.

An innovative nonanimal simulation trainer for chest tube insertion in neonates

BACKGROUND AND OBJECTIVE

Competence in the chest tube insertion procedure is vital for practitioners who take care of critically ill infants. The use of animals for training is discouraged, and there are no realistic simulation models available for the neonatal chest tube insertion procedure. The objective of this study was to assess the effectiveness of teaching the chest tube insertion procedure by using an easily constructed, nonanimal simulation model.

METHODS

An inexpensive infant chest tube insertion model was developed by using simple hardware. A prospective cohort study with pre-posttest intervention design was conducted with pediatric and combined internal medicine-pediatrics residents. Residents completed a questionnaire about their previous experience of chest tube insertion, knowledge, self-evaluation of knowledge, comfort, and skills; pre, post, and a month after an individualized education session and demonstration of the procedure on the model. Clinical skills were assessed by using a 32-point scoring system when residents performed the procedure on the model immediately after training and a month later.

RESULTS

All residents had significant improvement in knowledge and self-evaluation of knowledge, comfort, and skills scores after the education session and training on the model and this improvement was retained after 1 month (P < .001). Clinical skills scores decreased slightly 1 month after training (P = .08). Scores were not significantly different between the levels of trainees.

CONCLUSIONS

An educational intervention using an easily constructed and inexpensive chest tube insertion model is effective in improving knowledge, comfort, and skills in trainees. The model can be used repeatedly to maintain proficiency.

Simulation in cardiothoracic surgical training: where do we stand?

OBJECTIVES

Simulation may reduce the risks associated with the complex operations of cardiothoracic surgery and help create a more efficient, thorough, and uniform curriculum for cardiothoracic surgery fellowship. Here, we review the current status of simulation in cardiothoracic surgical training and provide an overview of all simulation models applicable to cardiothoracic surgery that have been published to date.

METHODS

We completed a comprehensive search of all publications pertaining to simulation of cardiothoracic surgical procedures by using PubMed.

RESULTS

Numerous cardiothoracic surgical simulators at various stages of development, assessment, and commercial manufacturing have been published to date. There is currently a predominance of models simulating coronary artery bypass grafting and bronchoscopy and a relative paucity of simulators of open pulmonary and esophageal procedures. Despite the wide range of simulators available, few models have been formally assessed for validity and educational value.

CONCLUSIONS

Surgical simulation is becoming an increasingly important educational tool in training cardiothoracic surgeons. Our next steps forward will be to develop an objective, standardized way to assess surgical simulation training compared with the current apprenticeship model.