Cadaver-based training is superior to simulation training for cricothyrotomy and tube thoracostomy.

Abstract

Emergency medicine (EM) training mandates that residents be able to competently perform low-frequency critical procedures upon graduation. Simulation is the main method of training in addition to clinical patient care. Access to cadaver-based training is limited due to cost and availability. The relative fidelity and perceived value of cadaver-based simulation training is unknown. This pilot study sought to describe the relative value of cadaver training compared to simulation for cricothyrotomy and tube thoracostomy. To perform a pilot study to assess whether there is a significant difference in fidelity and educational experience of cadaver-based training compared to simulation training. To understand how important this difference is in training residents in low-frequency procedures. Twenty-two senior EM residents (PGY3 and 4) who had completed standard simulation training on cricothyrotomy and tube thoracostomy participated in a formalin-fixed cadaver training program. Participants were surveyed on the relative fidelity of the training using a 100 point visual analogue scale (VAS) with 100 defined as equal to performing the procedure on a real patient. Respondents were also asked to estimate how much the cadaveric training improved the comfort level with performing the procedures on a scale between 0 and 100%. Open-response feedback was also collected. The response rate was 100% (22/22). The average fidelity of the cadaver versus simulation training was 79.9±7.0 vs. 34.7±13.4 for cricothyrotomy (p<0.0001) and 86±8.6 vs. 38.4±19.3 for tube thoracostomy (p<0.0001). Improvement in comfort levels performing procedures after the cadaveric training was rated as 78.5±13.3 for tube thoracostomy and 78.7±14.3 for cricothyrotomy. All respondents felt this difference in fidelity to be important for procedural training with 21/22 respondents specifically citing the importance of superior landmark and tissue fidelity compared to simulation training. Cadaver-based training provides superior landmark and tissue fidelity compared to simulation training and may be a valuable addition to EM residency training for certain low-frequency procedures.