Presentation on theme: "5/5/14 Evaluation of Tube Thoracostomy Teaching Models: An Argument for Developing Low-Fidelity Simulators Azmath Mohammed, MD; Christina Jenkins, MD;"— Presentation transcript:
5/5/14 Evaluation of Tube Thoracostomy Teaching Models: An Argument for Developing Low-Fidelity Simulators Azmath Mohammed, MD; Christina Jenkins, MD; Jimmi Mangla, MD; James Robbins, MD INTRODUCTION Tube thoracostomy (TT) is a common surgical procedure performed in both acute and non-acute settings. Often, it is performed in trauma setting which can be life-saving to patients. With the recent resident work hour restrictions, there may be a deficit of TT placement skills in junior residents. In addition, there are avoidable risks associated among inexperienced operators. Several simulation models for TT placement have been described in the American College of Surgeons skills curriculum. The models allow feedback to the trainees with regards to anatomic knowledge and also their technique in placing chest tubes. Our purpose is to evaluate three different models for simulating chest tube placement: low-fidelity rib model (LFRM), TraumaMan ® and cadaver. We would further evaluate each model's validity, effectiveness, costs and make an argument for cost-effective low-fidelity rib model. MATERIALS & METHODS Residents and attending physicians were selected to complete our TT module which consisted of a pre-test. This assesses knowledge of indications, pre-procedure timeout elements, and pertinent anatomy. A TT instructional video performed by an expert is shown to the trainees as well. The hands-on skills lab consists of three models: low-fidelity rib model (LFRM), TraumaMan ® and cadaver. Each trainee performed chest tube placement on each model. Upon completion, a post-test was given. The final task consisted of the trainees evaluating four categories in each model: Set-up confidence Performance confidence Ability to apply procedural skills Realism RESULTS Figure 1. Number of TT Performed by Trainees Prior to Module Pre-TestPost-Test Percent 2 Correct Answers5.56 3 Correct Answers16.6722.22 4 Correct Answers55.5633.33 5 Correct Answers22.2238.89 Table 1. Pre-test and Post-test Results Table 2. Improvement in Overall Confidence After Module Table 3. Confidence in Applying Proper Steps and Technique After Module Table 3. Model Which Felt Most Realistic Cost Analysis Cadaver: $3,000 - $4,000 per body TraumaMan ® : $23,500 purchase; lease for $100-$150 per student Low Fidelity Rib Model: $35 per student Both experts and novices rated cadaver model the highest in all categories. However, LFRM had better results compared to TraumaMan ®. Most common reason for low scores was absence of realistic subcutaneous tissue. In addition, comparing the vast difference in cost of the three models, this study supports that Low Fidelity Rib Model is a cost effective simulation model for tube thoracostomies. CONCLUSIONS A cadaver may be ideal with regards to face and content validity for tube thoracostomy simulation but is often cost prohibitive. The LFRM appears to provide effective training in TT placement in an economic fashion. Further correlative work using larger cohorts is required to establish use of this technique. REFERENCES 1.McDougall EM, Corica FA, Boker JR, et al. Construct Validity Testing of a Laparoscopic Surgical Simulator. American College of Surgeons. 2006;202:779-787. 2.Lyons C, Goldfarb D, Jones SL, et al. Which Skills Really Matter? Proving Face, Content, and Construct Validity for a Commercial Robotic Simulator. Surg Endosc. 2013;27: 2020-2030. 3.Vick LR, Vick KD, Borman KR, et al. Face, Content, and Construct Validities of Inanimate Intestinal Anastomosis Simulation. Journal of Surgical Education. 2007;64:365-368.