Board #305 - Technology Innovation TITUS (Thoracic Intervention Training Unit Simulator)

Abstract

Introduction Procedural competency is a vital component of emergency medicine (EM) and general surgery residency training and is a dedicated focus in the ACGME Milestone Project. Chest tube thoracostomy can be an emergent lifesaving procedure that all graduating EM and general surgery residents should be competent in performing. Practicing emergent lifesaving procedures through the use of simulation affords the learner the opportunity to learn and perform these crucial actions prior to performing an invasive procedure on a live patient. Simulation manikins and devices for chest tube thoracostomy are commercially available and described in the literature, however, financial constraints and anatomical inconsistencies are potential barriers to trainees experiencing an optimal simulation experience. Educational Objectives: TITUS (Thoracic Intervention Training Unit Simulator) was developed to create a chest tube thoracostomy model that is basic to assemble, provides a lifelike experience to the learner, and is portable, affordable, and easily reusable. The aim of TITUS is to be an effective education device capable of multiple uses in a timely manner to promote proficiency in chest tube thoracostomy. Description TITUS is comprised of a plastic clothing manikin torso, supplies obtainable at a local hardware store, and basic power tools. The manikin is divided in half and attached to a stable base. A rectangular section of the manikin from the axilla/lateral chest wall is removed. A bracket assembly is attached to the inside of the manikin. When in use, a segment of porcine ribs (available at a local grocer) is placed from inside the manikin to cover the open section of the chest wall and tightly secured with the metal brackets. The materials for a TITUS cost approximately $50 (not including power tools). A single person can assemble a TITUS in two hours or less. TITUS follows anatomical landmarks given the presence of an axilla and pectoral region (simulating the “triangle of safety”) and the installed bracket assembly within TITUS allows for easy and secure loading of porcine ribs which provide realistic tactile feedback. Conclusion TITUS has been successfully used in training sessions for providers at various levels of practice. The unique design of TITUS allows for multiple providers to perform a tube thoracostomy in uncompromised tissue despite the short time allotment between groups of trainees. TITUS is easy to build and inexpensive, making it ideal for training locally and in resource-limited settings. Feedback from trainees and instructors regarding their experience with TITUS has been consistently positive. Disclosures None