234 Feasibly Mitigating Provider Terror: Introducing a High-Fidelity, Tissue-Based Task Trainer for the Deliberate Practice of Emergent Hysterotomies

Abstract

Simulation has become a standard pedagogy for training emergency medicine providers by offering the opportunity to deliberately practice procedural skills and prepare for low frequency, life-threatening clinical events. Resuscitative hysterotomy is perhaps the most daunting and infrequently performed procedure in the emergency department (ED). Given the paucity of clinical exposure to this intervention, resuscitative hysterotomy is an ideal candidate for simulation-mediated deliberate practice. To date, there are only a few resuscitative hysterotomy task-trainers available for training; further complicated by costly components and maintenance fees. To address this problem, the authors: 1) developed a homegrown, hybrid, high-fidelity, tissue-based simulation task trainer that can easily insert into any childbirth task-trainer to enhance procedural training of resuscitative hysterotomies; and 2) tested the feasibility of using this simulation model for hands-on, rapid cycle training with emergency medicine residents. Two high-fidelity, tissue-based task-trainer models were constructed and tested on a convenience sample of 14 emergency medicine residents. The simulated human placenta, bladder and uterus were constructed through the use of porcine skin, stomach, and a squid mantle, and secured in place with nylon sutures. The amniotic sac was constructed with a transparent plastic bag that contained a flexible Sim Baby and filled with warm water (ie, amniotic fluid) through a Foley catheter. Each model was placed into a Guamard S500 Childbirth Simulator with an overlying porcine belly to simulate a gravid abdomen. Each model required <1 hour for assembly. Emergent hysterotomy was first demonstrated by the EM faculty facilitator and followed by hands-on deliberate practice. Formal quantitative and qualitative feedback were solicited at the end using a previously validated survey for low-fidelity resuscitative hysterotomy. Quantitative evaluation of the simulated training session was extracted through a 5-item questionnaire using a 5-point Likert-type scale. The response rate was 100% from participants (5 PGY-1 residents, 6 PGY-2s, 3 PGY-3s). Responses were overwhelmingly positive [24.13 (+/- 1.36)]. Nearly all residents indicated the model was a good representation of human anatomy [4.63 (+/- 0.62)] that helped them become more familiar [4.94 (+/- 0.25)] and prepared [4.88 (+/- 0.34)] to perform resuscitative hysterotomy. Qualitative feedback highlighted learners’ appreciation for hands-on practice and the development of a novel, tissue-based simulation task trainer. All participants recommended the training session be available to future learners. Resuscitative hysterotomy is a high-stakes, low-frequency procedure that demands provider practice and confidence. Review of procedural steps, indications, and materials needed is imperative to the success of this procedure in pregnant patients in extremis. Our hybrid, tissue-based hysterotomy model represents a feasible opportunity for training. The model is cost conscious, easily reproducible, and portable, and allows for ample deliberate practice of the procedure.