Task Trainers Research Articles

Construct validity of a low‐cost medium‐fidelity endoscopic sinus surgery simulation model

Assess construct validity of a low-cost medium-fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training. Fellowship-trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist. Thirty-two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task-specific checklist. This study demonstrated the construct validity of the low-cost medium-fidelity ESS model. NA Laryngoscope, 129:1505-1509, 2019.

High-Fidelity Hybrid Simulation: A Novel Approach to Teaching Pediatric and Adolescent Gynecology.

To describe a hybrid simulation model for pediatric and adolescent gynecology (PAG) examination teaching, to evaluate if it would be feasible to be conducted as a part of the PAG training, and to find out how it would be perceived by the trainees. The development process and a 2-day workshop is presented. An academic 2-day PAG simulation training at the Medical University of Lublin Centre of Medical Simulation. Twenty-two obstetrics and gynecology and pediatric residents from various hospitals of the Lublin county region. Participants took part in a 2-day simulation-based workshop consisting of a theoretical part and 3 high-fidelity PAG simulation scenarios, followed by an anonymous feedback survey on their opinions about the hybrid model teaching strategy. To describe and evaluate feasibility of a hybrid simulation model for PAG examination teaching and to report students' satisfaction and acceptance of this teaching modality; to share faculty experience and lessons learned during the development process. Of 22 initially enrolled residents, 16 of them completed the simulation-based session. All but 1 participant preferred a hybrid model to a task trainer as a teaching modality. The same number of surveyed residents stated that they learned more using the hybrid model. Qualitative feedback from the participants was overall positive. A hybrid model for teaching PAG examination is feasible and greatly accepted by the trainees. We are convinced that such a model of training can improve trainees' skills and translate to PAG patients' comfort and safety. It could be potentially used in teaching more difficult procedures (eg, intrauterine device insertion or examination after sexual assault).

Bedside chest compression skills: Performance and skills retention in in-hospital trained pediatric providers. A simulation study

PurposeTo assess the effects of a real-time feedback device and refresher sessions in acquiring and retaining chest compression skills. MethodsHealthcare providers participated in refresher sessions at 3-time points (blocks) over 1-year. At each block, chest compression (CC) skills were assessed on an infant and adult task trainer, in one 2-min trial without feedback (blinded), and up to three 2-min trials with feedback (unblinded). Skills retention over time was explored at three time lags: 1–3, 3–6, >6 months. Data collected included chest compression rate (100–120/min), depth (4 cm for infants and 5 cm for adults), and recoil between compressions. ResultsAmong 194 participants, achievement of excellent CC (≥90% of adequate compressions for all parameters) increased with feedback. Linear mixed models found significant (p < 0.05) improvement in rate, depth, and recoil. Performance between last unblinded trial in block 1 with the following blinded trial in block 2 significantly decayed in rate on both task trainers irrespective of time passed, while depth and recoil performance were maintained only for infants. ConclusionsA real-time visual feedback device improved CC skills with better results in infants. Skills decayed over time despite two refresher sessions with feedback.

Development and face validation of a virtual camera navigation task trainer.

The fundamentals of laparoscopic surgery (FLS) trainer box, which is now established as a standard for evaluating minimally invasive surgical skills, consists of five tasks: peg transfer, pattern cutting, ligation, intra- and extracorporeal suturing. Virtual simulators of these tasks have been developed and validated as part of the Virtual Basic Laparoscopic Skill Trainer (VBLaST) (Arikatla et al. in Int J Med Robot Comput Assist Surg 10:344-355, 2014; Zhang et al. in Surg Endosc 27(10):3603-3615, 2013; Sankaranarayanan et al. in J Laparoendosc Adv Surg Tech 20(2):153-157, 2010; Qi et al. J Biomed Inform 75:48-62, 2017). The virtual task trainers have many advantages including automatic real-time objective scoring, reduced costs, and eliminating human proctors. In this paper, we extend VBLaST by adding two camera navigation system tasks: (a) pattern matching and (b) path tracing. A comprehensive camera navigation simulator with two virtual tasks, simplified and cheaper hardware interface (compared to the prior version of VBLaST), graphical user interface, and automated metrics has been designed and developed. Face validity of the system is tested with medical students and residents from the University at Buffalo's medical school. The subjects rated the simulator highly in all aspects including its usefulness in training to center the target and to teach sizing skills. The quality and usefulness of the force feedback scored the lowest at 2.62.

A novel biosimulation task trainer for the deliberate practice of resuscitative hysterotomy

Resuscitative hysterotomy is a daunting and rarely performed procedure in the emergency department (ED). Given the paucity of clinical exposure to this intervention, resuscitative hysterotomy is an ideal opportunity for simulation-mediated deliberate practice. The authors propose a novel training program using a homegrown, realistic, simulation device as a means to practice resuscitative hysterotomy. Two high-fidelity, tissue-based task-trainer models were constructed and tested on a convenience sample of 14 emergency medicine (EM) residents. The simulated human placenta, bladder, amniotic sac, and uterus were constructed through the use of porcine skin, porcine stomach, transparent plastic bag, Foley tubing, and squid mantle, all secured with nylon sutures. A Gaumard S500 Articulating Newborn was inserted in the simulated uterus, and the entire model was placed into a Gaumard S500 Childbirth Simulator. Each model required less than 1 h for assembly. Emergent hysterotomy was first demonstrated by an EM faculty facilitator, followed by hands-on deliberate practice. Formal feedback on the learners’ self-reported confidence and satisfaction levels was solicited at the end of the workshop through a survey previously cited for use with a 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 (i.e., from 1, strongly disagree, to 5, strongly agree). Item scores were added for a cumulative total score, with a possible maximum score of 25 and minimum score of 5. Responses were overwhelmingly positive [24.13 (± 1.36)]. Qualitative feedback was extracted from the survey through open-ended questions; these responses 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. 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.

TARGET PRACTICE: SIMULATION-BASED MASTERY LEARNING FOR ULTRASOUND-GUIDED PERIPHERAL IV INSERTION

SESSION TITLE: Education, Research, and Quality Improvement 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Ultrasound use for peripheral IV (PIV) insertion has been shown to improve success rates and decrease overall time to placement [1,2]. Residents are often relied on to obtain venous access in patients with difficult access or an urgent need for intravenous medications; however, few studies have assessed competency-based training methods for internal medicine residents in ultrasound-guided (USG) PIV placement. We evaluated the effectiveness of simulation-based mastery learning of USG-PIV through a “train-the-trainer” approach. METHODS: Data on residents who participated in a simulation-based training on USG-PIV insertion was evaluated retrospectively. Internal medicine residents underwent a 1-hour simulation-based training with the expectation of performing USG-PIV placement to mastery standards on a task trainer. Pre and post-surveys were completed on the day of training. Survey questions regarding self-confidence and skills were rated on a numerical scale of 1-5, with 5 representing high confidence. Skill performance was assessed by an approved trainer using a detailed checklist upon completion of training. RESULTS: Eleven residents completed the training during a 2-week period. 73% (N= 8) were PGY-2 and 27% (N = 3) were PGY-3. Seventy-three percent (N=8) had received general ultrasound training previously, but none had received formal ultrasound training for PIV insertion. Forty-five percent (N=5) of residents had never placed an USG-PIV, and 55% (N=6) had placed less than 5 USG-PIVs. Self-confidence and self-skills assessment improved significantly after training. Average self-confidence in correctly identifying the vein using USG by transverse and longitudinal technique was significantly higher post-simulation (3.0 vs 4.6, p=0.008 and 2.3 vs 4.5, p=0.002, respectively). There was also a significant increase in self-confidence following the needle tip into the target vein using USG transverse and longitudinal technique (2.3 vs 4.5, p=0.001 and 1.9 vs 4.3, p=0.001, respectively). Residents met the mastery standard for skills with a 100% pass rate on the skills-based checklist. CONCLUSIONS: A simulation-based mastery learning model for USG-PIV insertion improves resident self-confidence, self-skill assessment and technical skills in a simulated environment. Deliberate practice with a mastery learning model ensures that each learner has achieved the necessary skill set to place a PIV using USG. CLINICAL IMPLICATIONS: We developed a feasible and time-efficient method for USG-PIV training that relies on developing a group of resident “super-users.” We look to evaluate the effect of this train-the-trainer approach for USGPIV insertion on internal medicine resident skill, behaviors and patient outcomes. DISCLOSURES: No relevant relationships by Karishma Bhatia, source=Web Response No relevant relationships by Hailey Gupta, source=Web Response No relevant relationships by Krystle Hernandez, source=Web Response No relevant relationships by Paru Patrawalla, source=Web Response No relevant relationships by Adam Rothman, source=Web Response No relevant relationships by Daniel Steinberg, source=Web Response

A Multicenter Collaboration for Simulation-Based Assessment of ACGME Milestones in Emergency Medicine

In 2014, the six allopathic emergency medicine (EM) residency programs in Chicago established an annual, citywide, simulation-based assessment of all postgraduate year 2 EM residents. The cases and corresponding assessment tools were designed by the simulation directors from each of the participating sites. All assessment tools include critical actions that map directly to numerous EM milestones in 11 different subcompetencies. The 2-hour assessments provide opportunities for residents to lead resuscitations of critically ill patients and demonstrate procedural skills, using mannequins and task trainers respectively. More than 80 residents participate annually and their assessment experiences are essentially identical across testing sites. The assessments are completed electronically and comparative performance data are immediately available to program directors.

Improved Strategies for Teaching Surgical Skills to Medical Students: Simulation and Beyond

PURPOSE: Develop a curriculum to optimize surgical skills and to increase operating room (OR) opportunities for medical students. BACKGROUND: Simulation-based strategies for teaching surgical skills are evolving. Using an innovative task trainer, we compared one-on-one deliberate practice to video-based self-guidance in the performance of two-handed knot tying and subcuticular suturing during the OBGYN clerkship. METHODS: A randomized prospective trial compared two groups of third year medical students in the same clerkship rotations. Group A received one-on-one deliberate practice undergoing three sessions with an instructor and Group B received unlimited access to video-based self-guided practice over six weeks. At the end of the clerkship, surgical performance was assessed using the validated checklist. Self-reported data regarding OR experience was collected using a specifically designed phone application. RESULTS: Fifty-nine students participated in the study. Group A demonstrated a statistically significant improvement in two-handed knot tying and subcuticular suturing in pre-post assessments (knot-tying +4.34, P&lt;.001; suturing +19.4, P&lt;.001). Group B demonstrated a statistically significant improvement (knot-tying +6.03, P&lt;.001; suturing +22.3, P&lt;.001). No significant differences were found between groups in overall knot-tying (P=.13), suturing (P=.14), hours practiced (P=.90), or number of OR cases (P=.49). DISCUSSION: The use of simulation significantly improved surgical skills for all students from baseline. No differences were found between one-on-one deliberate practice and video-based self-guided practice. Both instructional strategies provided equal efficacy in teaching surgical skills and optimizing surgical performance for students during the OBGYN clerkship.

Continued Validation for a Task Trainer and Targeting Curriculum for Ultrasound Guided Invasive Procedures

PURPOSE: To assess the effect of training and the inter- and intra-rater variability of a targeting curriculum for ultrasound guided invasive procedures. BACKGROUND: We previously demonstrated the content, face, and construct validity of our curriculum. Here we assess its inter- and intra-rater reliability. METHODS: Echogenic targets (wooden dowels, plastic straws, and wooden balls) were placed in water filled buckets covered with simulated skin (ballistic gelatin). We assessed 23 1st year medical students performing two targeting tasks (guiding the needle to multiple targets in a random sequence), held 4 weekly one hour training sessions, and reassessed their performance. Completion time in seconds, errors (as recorded by multiple assessors), and error adjusted time (5 sec penalty/error) were recorded. These measures were compared before and after training using a repeated measures t-test. Inter- and intra-rater inter-class correlation coefficients (ICC) were calculated. RESULTS: Completion time, errors, and error adjusted time on the dowel tasks were 176±70, 7.4±, 213±95, respectively before training, and 95±61, 2.7±3.4, and 109±74, respectively after training (all P&lt;.0001). The completion time, errors, and error adjusted time on the straw task were 319±98, 9.4±4.6, and 366±114, respectively before training, and 179±57, 3.1±3.2, and 195±67, respectively after training (all P&lt;.0001). The inter-rater ICC for the dowel and straw tasks were 0.83 and 0.91, respectively. The intra-rater ICCs were 0.93 and 0.90, respectively. DISCUSSION: Conclusions: Student performance on the targeting tasks improved markedly after 4 weekly training sessions. The inter- and intra-rater reliability was excellent. This provides additional validity evidence for our novel ultrasound guided invasive procedure task targeting curriculum.

Surgical Management of Postpartum Hemorrhage—Building a Standardized, Validated Task Trainer

Faculty Advisor: Erika Banks, MD PURPOSE: To develop a validated, reproducible, cost-effective task-trainer used to teach surgical management of postpartum hemorrhage. BACKGROUND: Postpartum hemorrhage is the third leading cause of preventable maternal death. While the use of compression and ligation sutures is infrequent, simulation teaching of skills is important. METHODS: Study participants (N=77) consisted of junior residents (35), senior residents (17) and faculty attending physicians (25) at a large, urban academic hospital. Pre and post- test were collected assessing prior experience, comfort, and perception regarding the model. Participants were de-identified and individually filmed performing bilateral O’Leary Stitch and B-Lynch. Two evaluators independently reviewed recordings and completed the task-specific evaluation tools, both the new untested and objective skill-assessment tool (OSAT) and previously validated Global Rating Scale (GRS). Intra-rater and inter-rater reliability were assessed, and validity was tested by comparing OSAT scores stratified by different characteristics to GRS scores. RESULTS: Intrarater reliability was demonstrated for both raters across each simulation and scoring tool (P&lt;.0001). Interrater reliability for OSAT showed high agreement (Kappa 0.97 B-Lynch, 0.90 O’Leary). Construct validity was demonstrated for B-Lynch; attendings and seniors scoring higher than juniors on OSATS (17 vs. 16.7 vs. 3, P&lt;.0001) and GRS (5 vs. 23 vs. 25, P&lt;.0001), as well as for O’Leary simulation for both OSATS (15.5 vs. 15.0 vs. 11.0, P&lt;.0001) and GRS (25 vs. 24 vs. 12, P&lt;.0001). DISCUSSION: We have shown validation of a simple task-specific trainer that can be used to teach B-Lynch and O’Leary. The respective OSATs are reliable to assess performance.

Pediatric Emergency Medicine Simulation Curriculum: Cardiac Tamponade.

Cardiac tamponade is an uncommon presentation to the pediatric emergency department and requires early recognition and emergent intervention. We developed this patient simulation case to simulate a low-frequency, high-acuity scenario for pediatric emergency medicine fellows and resident physicians in emergency medicine, pediatrics, and family medicine. We ran the case in a pediatric emergency department using a high-fidelity pediatric mannequin and equipment found in the clinical environment, including a bedside ultrasound machine. The case involved a 10-year-old patient with Hodgkin lymphoma who presented with fever, neutropenia, and shock and was found to have a pericardial effusion with tamponade after evaluation. The providers were expected to identify signs and symptoms of shock, as well as cardiac tamponade, and demonstrate appropriate emergent evaluation and management. Required personnel included a simulation technician, instructors, and a nurse. Debriefing tools tailored specifically for this scenario were created to facilitate a formal debriefing and formative learner assessment at the end of the simulation. This case has been implemented with 10 pediatric emergency medicine fellows during two 3-year cycles of fellow education. Session feedback reflected a high level of satisfaction with the case and an increased awareness of bedside ultrasound in the identification of cardiac tamponade. This resource for teaching the critical components for diagnosing and managing unstable cardiac tamponade in the pediatric patient, including use of bedside ultrasound, was well received by pediatric emergency medicine fellows.

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

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.

Teaching Residents Chest Tubes: Simulation Task Trainer or Cadaver Model?

Objective To compare simulation task trainers (sim) with cadaver for teaching chest tube insertion to junior residents. Methods Prospective study involving postgraduate year (PGY) one and two emergency medicine (EM) and PGY-1 surgery residents. Residents were randomized into sim or cadaver groups based on prior experience and trained using deliberate practice. Primary outcomes were confidence in placing a chest tube and ability to place a chest tube in a clinical setting during a seven-month follow-up period. Secondary outcomes include skill retention, using an objective assessment checklist of 15 critical steps in chest tube placement, and confidence after seven months. Results Sixteen residents were randomized to cadaver (n=8) and simulation (n=8) groups. Both groups posttraining had statistically significant increase in confidence. No significant difference existed between groups for median posttraining assessment scores (13.5 sim v 15 cadaver). There was no statistically significant difference between groups for confidence at any point measured. There was moderate correlation (0.58) between number of clinical attempts reported in a seven-month follow-up period and final assessment score. Conclusion Both sim and cadaver models are effective modalities for teaching chest tube placement. Medical education programs can use either modalities to train learners without notable differences in confidence.

Acute Ischemic Priapism Management: An Educational and Simulation Curriculum.

Ischemic priapism is a urologic emergency managed by both urologic and nonurologic providers in the community. Given ischemic priapism's rare occurrence and the time-sensitive nature of treatment, effective provider education on management of this entity is imperative. We sought to develop a low-cost effective simulation model and curriculum to enhance trainee education. A comprehensive didactic curriculum based on national urologic guidelines was developed, along with a low-cost, easily reproducible priapism simulator using hot dogs and Red Vines candy. The simulators cost $1.25 each, and assembly took 10 minutes. All materials were reviewed by three urology faculty members. The curriculum was piloted with two andrology fellowship-trained urology faculty among eight urology residents (PGY2-PGY4/U1-U2) and one medical student. Participants provided feedback regarding the overall course as well as the face and content validity of the simulator. Cognitive test scores significantly improved on average by 15.0% (p = .002), and confidence improved from baseline somewhat or very much among 88.9% of participants after completion of the curriculum. The task trainer was rated easy to use (average score: 4.78 out of 5), and 77.8% of participants though it was somewhat or very useful for training (average score: 4.00 out of 5). Additionally, 77.8% recommended its incorporation into resident training (average score: 4.00 out of 5). This simulation curriculum is effective, inexpensive, and easily reproducible, making it ideal for groups with limited resources. Expanding access to simulation-based curricula on priapism management may improve education of both urologic and nonurologic trainees.

Objective Evaluation of a New Epidural Simulator by the CompuFlo® Epidural Instrument.

Background In this study, we describe a custom-made new epidural simulator, created by modifying the inner structure of a commercially available one, in the attempt to make it adequately realistic. To validate and evaluate the realism of our device, we used the Computerized Epidural Instrument CompuFlo. Method The Compuflo CompuFlo curves obtained from 64 experiments on the epidural simulator were compared to 64 curves obtained from a previous human study, from consecutive laboring parturients requesting epidural analgesia. Results Epidural simulator and human pressure curves were very similar. There was a significant difference between the drop of pressure due to false and true loss of resistance (LOR) in both the groups. Discussion Our simulator can realistically reproduce the anatomical layers the needle must pass as demonstrated by the similarity between the simulator and human pressure curves and the small differences of pressure values recorded. CompuFlo may be used as an objective tool to create and assess and compare objectively the epidural task trainers.

Evaluating Changes in Clinical Decision-Making in Physical Therapy Students After Participating in Simulation

PurposePhysical therapy students are not consistently prepared to practice in the dynamic healthcare environment immediately after graduation. Implementing other teaching modalities may help to better prepare physical therapy graduates. Medical and nursing student education have effectively used simulation to help prepare students for clinical practice. The purpose of the quasi-experimental design study was to assess the effect of simulation on clinical decision-making (CDM) in Doctor of Physical students in a physical therapy program. MethodsOne-hundred and twenty-two students in two class years participated in the study, with 71 partaking in a simulation activity and 51 students serving as the control. The first-year students participated in a task trainer simulation and the second-year students completed a hybrid simulation. The students’ CDM was measured prior to and after completing the simulation. ResultsThe results demonstrated that the students who participated in simulation had statistically significantly higher scores on the CDM Tool than the students who did participate in simulation. The results also further validated the CDM Tool by demonstrating that second year students had significantly higher scores on the CDM Tool than first year students at both time points. DiscussionStudents demonstrated statistically significant changes in CDM after participating in one simulation experience. Further research is required to replicated these results and determine the optimal dosage of simulation experiences for long-term learning.

Improving Clinical Proficiency Using a 3-Dimensionally Printed and Patient-Specific Thoracic Spine Model as a Haptic Task Trainer.

Advanced haptic simulators for neuraxial training are expensive, have a finite life, and are not patient specific. We sought to demonstrate the feasibility of developing a custom-made, low-cost, 3-dimensionally printed thoracic spine simulator model from patient computed tomographic scan data. This study assessed the model's practicality, efficiency as a teaching tool, and the transfer of skill set into patient care. A high-fidelity, patient-specific thoracic spine model was used for the study. Thirteen residents underwent a 1-hour 30-minute training session prior to performing thoracic epidural analgesia (TEA) on patients. We observed another group of 14 residents who were exposed to the traditional method of training during their regional anesthesia rotation for thoracic epidural placement. The TEA was placed for patients under the supervision of attending anesthesiologists, who were blinded to the composition of the study and control groups. As a primary outcome, data were collected on successful TEAs, which was defined as a TEA that provided full relief of sensation across the entire surgical area as assessed by both a pinprick and temperature test. Secondary outcomes included whether any assistance from the attending physician was required and failed epidurals. A total of 27 residents completed the study (14 in the traditional training, 13 in the study group). We found that the residents who underwent training with the simulator had a significantly higher success rate (11 vs 4 successful epidural attempts, P = 0.002) as compared with the traditional training group. The control group also required significantly more assistance from the supervising anesthesiologist compared with the study group (5 vs 1 attempt requiring guidance). The number needed to treat (NNT) for the traditional training group was 1.58 patients over the study period with a 95% confidence interval of 1.55 to 1.61. By using patient-specific, 3-dimensionally printed, thoracic spine models, we demonstrated a significant improvement in clinical proficiency as compared with traditional teaching models.

Retention of cricothyrotomy skills by paramedics using a wire guided technique

IntroductionCricothyrotomy may be necessary for airway management when a patient's airway cannot be maintained through standard techniques such as oral airway placement, blind insertion airway device, or endotracheal intubation. Wire-guided cricothyrotomy is one of many techniques used to perform a cricothyrotomy. Although there is some controversy over which cricothyrotomy technique is superior, there is no published data regarding long term retention rates. The purpose of this study is to determine whether ground based paramedics can be taught and are able to retain the skills necessary to successfully perform a wire-guided cricothyrotomy. MethodsThis retrospective study was performed in a suburban county with a population of 160,000 with 23,000 EMS calls per year. Participants were ground-based paramedics who were taught wire-guided cricothyrotomy as part of a standardized paramedic educational update program. After viewing an instructional video, the paramedics were shown each the steps of the procedure on a simulation model, using a low fidelity task trainer previously developed to train emergency medicine residents. Using a 16 step procedural checklist, participants were allowed open-ended practice using the task trainer. Critical steps in the checklist were marked in bold lettering indicating automatic failure. Each paramedic was then individually supervised performing a minimum of 5 successful simulations. Retention was assessed using the same 16 step checklist 6 to 12 weeks following the initial training. ResultsA total of 55 paramedics completed both the initial training and reassessment during the time period studied. During the initial training phase 100% (55 of 55) of the paramedics were successful in performing all 16 steps of the wire-guided cricothyrotomy. During the retention phase, 87.3% (48 of 55) of paramedics retained the skills necessary to successfully perform the wire-guided cricothyrotomy. On the 16 step checklist, most steps were performed successfully by all the paramedics or missed by only 1 of the 55 paramedics. The step involving removal of the needle prior to advancing the airway device over the guide wire was missed by 34.5% (19 of 55) of the participants. This was not an automatic failure since most participants immediately self-corrected and completed the procedure successfully. ConclusionParamedics can be taught and can retain the skills necessary to successfully perform a wire-guided cricothyrotomy on a simulator. Future research is necessary to determine if paramedics can successfully transfer these skills to real patients.

P015: Staff skills: a procedural skills curriculum for emergency medicine attending physicians in Calgary

Introduction: Emergency medicine attending physicians perform many essential procedures but some infrequently. Skill proficiency and familiarity declines over time. We intended to identify skills where colleagues felt deficient and create an opportunity to demonstrate and practice in a safe environment. Methods: Sessions began from a review of ultrasound guided central line and pacemaker insertion. Other procedures have been added as a result of critical incidents, needs assessments by attending physicians, acquisition of new technology/equipment and expert consensus. An evaluation and needs assessment is performed after each session to adjust curricula. Results: Since 2011, we have held 2-3 skill sessions per year at the Advanced Trauma Surgical Skills Laboratory at the University of Calgary. Sessions are taught by attending emergency physicians, employ task trainers, simulators, animal and human cadaveric models, ultrasound, and procedural equipment stocked in our local hospitals. We are able to accommodate ~30 participants per session for 3 hours of rotating 7-8 participants through various stations. Every session has been fully attended with a wait list. Physicians register by email with preference given to new participants and those identified during clinical practice review of requiring remediation. Costs of sessions are covered by voluntary contribution to an emergency department physician support fund. Procedures practiced have included airway (basic, adjuncts, bronchoscopy, video laryngoscopy, surgical airway, chest tube), vascular access (ultrasound guided central venous insertion, transvenous pacemaker insertion, nerve blocks, IO insertion), surgical skills (thoracotomy, chest tube, canthotomy, surgical airway) and other percutaneous procedures (paracentesis, thoracentesis, nerve block, lumbar puncture). High fidelity skills videos were created to augment the sessions, available on the department website. Four point scale evaluations from our most recent session yielded 100% excellent rating for overall workshop and relevance to practice. The 6 facilitators performance received 100% excellent or good ratings. Conclusion: We have developed a fun, nonthreatening opportunity for attending physicians to practice infrequent but important ED procedures. The sessions are well received, well attended, foster collegiality, confidence and competence in performance of infrequent ED skills. Our model could be generalized to other centres.

Improved laparoscopic skills in gynaecology trainees following a simulation-training program using take-home box trainers.

Lack of time and access to equipment are recognised barriers to simulation training. To investigate the effect of a take-home laparoscopic simulator training program on the laparoscopic skills of gynaecology trainees. Participants (n=17 in 2015, n=16 in 2016) were supplied with a box trainer, associated equipment and instructions on self-directed training. A program was designed and implemented in 2015 comprising of ten weekly laparoscopic skills tasks and modified in 2016 to eight monthly tasks. Half of the participants were randomly allocated a supervisor. Participants performed baseline and post-training assessments of laparoscopic skills in a box trainer task (thread transfer) and virtual reality simulator tasks (laparoscopic tubal ligation and bilateral oophorectomy). Trainees in 2015 demonstrated an improvement in the median time to complete the laparoscopic tubal ligation task (baseline 124s vs post-training 91s, P=0.041). There was no difference in the number of tubal ligation bleeding incidents, or in the time taken to complete the box trainer thread transfer task. In 2016 trainees demonstrated improvement in tubal ligation time (baseline 251 vs 71 post-training, P=0.021) and bilateral oophorectomy time (baseline 891s vs 504 post-training, P=0.025). There was no significant difference in other outcome measures. There was no difference found in performance when groups were compared by supervisor allocation. A take-home box trainer simulation-training program was associated with improvement in laparoscopic skills. This type of program may improve trainee access to simulation training.