In-utero stenting: development of a low-cost high-fidelity task trainer

Development of a High-Fidelity Simulator for Teaching Chorionic Villus Sampling

OBJECTIVE

The objective of this study was to develop a synthetic high-fidelity simulator for teaching chorionic villus sampling.

METHODS

Working with a medical sculptor, the authors developed a simulator, constructed from various synthetic rubber materials, of a gravid female pelvis, including the vulva, vagina, cervix, and a 13-week-sized uterus with a gestational sac.

RESULTS

This simulator is high fidelity and durable, and it does not require any organic materials. Maternal-fetal medicine trainees valued this educational tool.

CONCLUSION

This novel, high-fidelity simulator is an additional tool for educators involved in teaching chorionic villus sampling.

A Method for Functional Task Alignment Analysis of an Arthrocentesis Simulator

INTRODUCTION

During simulation-based education, simulators are subjected to procedures composed of a variety of tasks and processes. Simulators should functionally represent a patient in response to the physical action of these tasks. The aim of this work was to describe a method for determining whether a simulator does or does not have sufficient functional task alignment (FTA) to be used in a simulation.

METHODS

Potential performance checklist items were gathered from published arthrocentesis guidelines and aggregated into a performance checklist using Lawshe's method. An expert panel used this performance checklist and an FTA analysis questionnaire to evaluate a simulator's ability to respond to the physical actions required by the performance checklist.

RESULTS

Thirteen items, from a pool of 39, were included on the performance checklist. Experts had mixed reviews of the simulator's FTA and its suitability for use in simulation. Unexpectedly, some positive FTA was found for several tasks where the simulator lacked functionality.

CONCLUSIONS

By developing a detailed list of specific tasks required to complete a clinical procedure, and surveying experts on the simulator's response to those actions, educators can gain insight into the simulator's clinical accuracy and suitability. Unexpected of positive FTA ratings of function deficits suggest that further revision of the survey method is required.

Second-Trimester Uterine Model for Teaching Ultrasound-Guided Obstetric Procedures

The declining number of ultrasound-guided obstetric procedures in clinical practice mandates a shift toward simulation-based teaching. Current uterine simulation aids are animal tissue-sourced or expensive, and improvement is needed. We describe a low-cost reusable uterine model with "fetus," cord and skin, constructed from synthetic gel and silicone rubber. Ultrasound appearance and tactile feedback approximate clinical use, and all parts of the model are portable, durable, and shelf-stable. Those made of ballistics gel can be recycled numerous times without noticeable effect. This appears to be ideal for proctored learning and independent practice within an ultrasound procedural curriculum.

Impact of an Inexpensive Anatomy-Based Fetal Pig Simulator on Obstetric Ultrasound Training

OBJECTIVES

The purpose of this study was to construct an inexpensive anatomy-based obstetric ultrasound task trainer and investigate whether introduction of this trainer into a hands-on obstetric ultrasound course improved course participants' ultrasound scanning skills.

METHODS

The trainer was created by placing fetal pigs into preservative-filled heat-sealed polyethylene bags. Twenty-four participants in an obstetric ultrasound course at Wake Forest School of Medicine were randomized to receive hands-on scanning with pregnant women or hands-on scanning and fetal pig simulation. Biometric scans were performed before and after the course. The time to complete the scans, margin of error of biometric measurements, and number of technically adequate images per scan were compared between groups.

RESULTS

Twelve participants were randomized into each group. Although a direct comparison of postcourse biometric scans demonstrated no difference between groups, participants that received simulation training showed significant improvements in the time to complete the biometric scan (P < .05) and number of technically adequate images obtained (P < .05), whereas those who did not receive simulation training did not show significant improvements.

CONCLUSIONS

Addition of the fetal pig ultrasound task trainer resulted in improvements in the course participants' scanning efficiency even after very limited exposure. Incorporating the task trainer earlier and more broadly into obstetric ultrasound training may benefit trainees.

The impact of noninvasive fetal evaluation: its effect on education, training, and the maintenance of clinical competence in prenatal diagnosis

PURPOSE OF REVIEW

To highlight the evolution of prenatal diagnosis from invasive procedures to noninvasive assessments and to describe the efforts to educate both trainees and experienced physicians via simulation techniques.

RECENT FINDINGS

The rapid development of noninvasive serum analyte screening as well as molecular genetic and sonographic techniques to evaluate the fetus has altered our ability to both educate trainees as well as to maintain physician competence to perform invasive procedures. Simulation-based learning is being incorporated into medical training across a broad range of specialties, including obstetrics and gynecology.

SUMMARY

Prenatal diagnosis procedures will continue to be necessary for direct fetal assessment but on a much more limited scale. It is possible that all trainees will not be able to become competent in amniocentesis and other even less common procedures. Furthermore, experienced physicians may lose competence, given the lack of available procedures for skill retention. Innovative methods of skill acquisition and maintenance may be required in the near future. Although long-term assessments of efficacy are currently lacking, the introduction of comprehensive, simulation-based curriculia has the potential to both educate trainees and help maintain physician competence.

Obstetric ultrasound simulation

Obstetric ultrasound is becoming an increasingly important part of the practice of maternal-fetal medicine. Thus, it is important to develop rigorous and effective training curricula for obstetrics and gynecology residents and maternal-fetal medicine fellows. Traditionally, this training has come almost entirely from exposure to ultrasound in the clinical setting. However, with the increased complexity of modern ultrasound and advent of duty-hour restrictions, a purely clinical training model is no longer viable. With the advent of high-fidelity obstetric ultrasound simulators, a significant amount of training can occur in a non-clinical setting which allows learners to obtain significant skill prior to their first patient ultrasound encounter and obtain proficiency in a shorter period of time. In this manuscript we discuss the available obstetric ultrasound simulators and ways to construct a comprehensive ultrasound training curricula to meet the increasing demands of modern maternal-fetal medicine.

The use of simulation in maternal-fetal medicine procedure training

Many fields of medicine now routinely employ simulation while educating all levels of medical trainees. Unfortunately, OB-GYN has been slow to incorporate these beneficial adjuncts to traditional medical education, but thankfully the use of simulation is now increasing. Maternal-Fetal medicine procedures such as amniocentesis, in-utero stent placement, chorionic villus sampling, percutaneous umbilical blood sampling, and cervical cerclage placements are an area where simulation has great potential benefit. Here we describe the currently available simulation models for these procedures and outline specific training curricula designed to aid trainees in obtaining procedural competency in each. Although initial experiences with these training models and the curricula centered around them have been positive, in many cases their use remains limited. Our hope is that this manuscript will encourage others to incorporate simulation into their training programs as we believe it will enhance medical training and improve patient safety.

A cervical cerclage task trainer for maternal-fetal medicine fellows and obstetrics/gynecology residents

INTRODUCTION

Performance of cervical cerclage is a difficult procedure for learners with limited operative experience. We present a task trainer for cervical cerclage, which can facilitate learner training in a preclinical environment.

METHODS

A simulated vagina is first fashioned out of polyvinyl chloride pipe material to allow an appropriately shaped pelvic structure. To simulate collapsible vaginal sidewalls, a foam covered with latex sheets is used to line the inside of the task trainer. A "cervix" is made by cutting cylinders approximately 2 in in diameter and 4 in in length in frozen cow muscle. After thawing, the cervical models are fastened to a semirigid foam disk with suture, which is used to secure the cervix inside the polyvinyl chloride pipe at the top of the simulated vagina. The full cervical cerclage task trainer is then secured in a holder to stabilize it in place. Placement of a cervical cerclage can then be practiced with standard vaginal cerclage instruments.

RESULTS

Cervical cerclage can be practiced in a nonclinical environment using this model. Several aspects of the procedure can be modified including the amount of vaginal tissue, length and caliber of the vagina, and pubic arch angle. This model allows beginning learners sequential training of increasing difficulty. Faculty and trainees alike found the trainer to be useful and felt that it helped in the acquisition of the surgical skills needed for cerclage placement in a clinical setting.

CONCLUSIONS

This low-cost task trainer can provide Maternal-fetal Medicine fellows and obstetric/gynecology residents the opportunity to practice cervical cerclage placement in a nonclinical environment. It may help physicians to obtain or maintain proficiency despite the relative low frequency of the procedure in modern obstetric practice.