1
|
Swain CS, Cohen HML, Helgesson G, Rickard RF, Karlgren K. A Systematic Review of Live Animal Use as a Simulation Modality ("Live Tissue Training") in the Emergency Management of Trauma. JOURNAL OF SURGICAL EDUCATION 2023; 80:1320-1339. [PMID: 37516576 DOI: 10.1016/j.jsurg.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/11/2023] [Accepted: 06/17/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Live anaesthetized animals are used as simulation models to teach techniques in the emergency management of trauma. We aimed to explore how "live tissue training" (LTT) is designed, delivered and evaluated in order to better understand and characterize aspects of educational merit. METHODS A systematic review was performed using PRISMA guidance. A combined approach, involving a 3-stage modified narrative synthesis process and reflexive thematic analysis was used to identify key concepts across the published literature. FINDINGS Qualitative synthesis of 48 selected articles suggests that LTT is mainly used to teach military and civilian physicians and military medical technicians. The procedures trained vary with the learner population, from simple pre-hospital trauma tasks to advanced operative surgical skills. Many courses use a combination of didactic and practical training, with an animal model used to train practical application of knowledge and procedural skills. Descriptions of the learning interventions are limited, and explicit use of educational theory or pedagogic frameworks were absent within the literature. Four themes were identified regarding aspects of LTT that are valued by learners: "recreating the experience," relating to fidelity and realism; "tick tock" "dynamics of hemorrhage", encompassing the impact of bleeding and urgent pressure to act; "emotional impact" of conducting the training, and "self-efficacy: I believe I can do it." CONCLUSION Thematic analysis of published literature suggests that there may be educational benefit in the use of live tissue models due to time criticality and bleeding, which creates a real-life event. LTT also invokes an emotional response, and learners experience an increase in self-efficacy from participation. We consider that these aspects and associated pedagogy should be addressed when researching and developing alternative simulation modalities, in order to intelligently replace, reduce and refine the use of animals in training practitioners in the emergency management of trauma.
Collapse
Affiliation(s)
- C S Swain
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden; Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine (RCDM) Birmingham, United Kingdom.
| | - H M L Cohen
- HQ Army Medical Services Support Unit, Camberley, United Kingdom
| | - G Helgesson
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - R F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine (RCDM) Birmingham, United Kingdom
| | - K Karlgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden; Department of Research, Education, Development and Innovation, Södersjukhuset, Stockholm, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
2
|
Champavier PG, Beyer-Berjot L, Arnoux PJ, Py M, Casanova R, Berdah S, Birnbaum DJ, Guilbaud T. An Ex Situ Cadaver Liver Training Model Continuously Pressurized to Simulate Specific Skills Involved in Laparoscopic Liver Resection: the Lap-Liver Trainer. J Gastrointest Surg 2023; 27:521-533. [PMID: 36624325 DOI: 10.1007/s11605-022-05566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) requires delicate skills. The aim of the study was to develop a training model mimicking as much as possible intraoperative bleeding and bile leakage during LLR. We also assessed the educational value of the training model. METHODS The Lap-liver trainer (LLT) combined a continuously pressurized ex situ cadaver liver and a customized mannequin. The customized mannequin was designed by computer-aided design and manufactured by 3D printing. The left lateral sectionectomy (LLS) was chosen to assess the feasibility of a LLR with the LLT. Eighteen volunteers were recruited to perform LLS and to assess the educational value of the LLT using a Likert scale. RESULTS The customized mannequin consisted of a close laparoscopic training device based on a simplified reconstruction of the abdominal cavity in laparoscopic conditions. Ex situ cadaver livers were pressurized to simulate blood and bile supplies. Each expert surgeon (n = 3) performed two LLS. They were highly satisfied of simulation conditions (4.80 ± 0.45) and strongly recommended that the LLT should be incorporated into a teaching program (5.00 ± 0.0). Eight novice and 4 intermediate surgeons completed a teaching program and performed a LLS. Overall, the level of satisfaction was high (4.92 ± 0.29), and performing such a procedure under simulation conditions benefited their learning and clinical practice (4.92 ± 0.29). CONCLUSIONS The LLT could provide better opportunities for trainees to acquire and practice LLR skills in a more realistic environment and to improve their ability to deal with specific events related to LLR.
Collapse
Affiliation(s)
| | - Laura Beyer-Berjot
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| | | | - Max Py
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | | | - Stéphane Berdah
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| | - David Jérémie Birnbaum
- Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| | - Théophile Guilbaud
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| |
Collapse
|
3
|
Du WQ, Zhong X, Jiang RQ, Zong ZW, Jia YJ, Ye Z, Zhou XL. Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries. Chin J Traumatol 2023; 26:41-47. [PMID: 36008213 PMCID: PMC9912295 DOI: 10.1016/j.cjtee.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees' performance for emergent and urgent thoracic surgeries. METHODS With a homemade machine, animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage, urgent sternotomy, and emergent thoracotomy. Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models. Five operation teams from basic-level hospitals (group A) and five operation teams from level III hospitals (group B) were included to be trained and tested. Testing standards for the operations were established after thorough literature review, and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Tests were carried out after the training. Pre- and post-training performances were compared. Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches. RESULTS Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%. After literature review, testing standards were established, and expert questionnaire results showed that the scientific score was 7.30 ± 1.49, and the feasibility score was 7.50 ± 0.89. Post-training performance was significantly higher in both group A and group B than pre-training performance. Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury. CONCLUSIONS Animal model-based simulation training established in the current study could improve the trainees' performance for emergent and urgent thoracic surgeries, especially of the surgical teams from basic-level hospitals.
Collapse
Affiliation(s)
- Wen-Qiong Du
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Xin Zhong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care & Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Ren-Qing Jiang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Zhao-Wen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care & Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
| | - Yi-Jun Jia
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Zhao Ye
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| | - Xiao-Lin Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Department for Combat Casualty Care Training, Training Base for Army Health Care, Army Medical University, Chongqing, 400037, China
| |
Collapse
|
4
|
Joosten M, Bökkerink GMJ, Levitt MA, Diefenbach KA, Reck CA, Krois W, de Blaauw I, Botden SMBI. The Use of an Inanimate Simulation Model for the Correction of an Anorectal Malformation in the Training of Colorectal Pediatric Surgery. Eur J Pediatr Surg 2022; 32:287-293. [PMID: 33567465 DOI: 10.1055/s-0041-1723035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION An anorectal malformation (ARM) is a congenital malformation that requires surgical correction. To acquire the skills needed to perform this complex procedure, an affordable simulation model has previously been developed and validated. The aim of this study is to evaluate the suitability of this ARM model (with perineal fistula) for training in hands-on workshops. MATERIALS AND METHODS The ARM model consists of a wooden casing with disposable perineal body. Participants in several international pediatric colorectal hands-on workshops in 2019 and 2020 were asked to participate. They were divided in a target group and an experienced group based on experience. All practiced the posterior sagittal anorectoplasty procedure on the model with multimodality guidance. Subsequently, statements on the suitability of the model for use during hands-on workshops were scored on a 5-point Likert scale. RESULTS A total of 80 participants were included (43 surgical specialists, 13 pediatric surgery fellows, and 25 residents). Nearly, all statements scored at least a mean of >4.0, all scored significantly better than a neutral opinion. The target group (n = 58) scored higher compared with the experienced group (n = 22) on "transferability of the skills to the clinical setting" (means 4.4 vs. 4.0, p = 0.038); however, the "suitability as a replacement for an animal model" scored significantly lower (means 3.6 vs. 3.9, p = 0.049). No other differences were found. CONCLUSION This affordable ARM model was regarded a suitable model for training during preclinical hands-on workshops and could be used for the specified steps of the procedure.
Collapse
Affiliation(s)
- Maja Joosten
- Department of Pediatric Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Guus M J Bökkerink
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marc A Levitt
- Department of Pediatric Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Carlos A Reck
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | - Wilfried Krois
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Sanne M B I Botden
- Department of Pediatric Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| |
Collapse
|
5
|
Bredmose PP, Stave H, Eriksen M, Osbakk SA, Farstad G, Hagemo JS. Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews. Air Med J 2021; 40:60-64. [PMID: 33455629 DOI: 10.1016/j.amj.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. METHODS Participants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants' perception of any change in their skills as a result of the course. RESULTS The self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001). CONCLUSION Experienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.
Collapse
Affiliation(s)
- Per P Bredmose
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.
| | - Halvard Stave
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Morten Eriksen
- Institute for Experimental Medical Research, Section for Preclinical Physiology, Oslo University Hospital, Oslo, Norway
| | - Svein Are Osbakk
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Gunnar Farstad
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Jostein S Hagemo
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway; Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| |
Collapse
|
6
|
A new platform for laparoscopic training: initial evaluation of the ex-vivo live multivisceral training device. Surg Endosc 2020; 35:374-382. [PMID: 32415369 DOI: 10.1007/s00464-020-07411-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Various training models have been developed for laparoscopic training. Inanimate models including cadavers, ex-vivo simulator, and virtual reality (VR), are less realistic and often fail to display specific events such as bleeding, bile leakage, etc. Animal models provide more realistic experience, but constraints like cost involved, anesthetic requirement, and ethical approval have limited its application. We have designed a new training ex-vivo simulator-Smagister to address these issues. METHODS The Smagister consists of a normothermic machine perfusion platform, multivisceral organ of porcine abdominal cavity (liver, gallbladder, pancreas, stomach, intestine, kidney, uterus, bladders, etc.), high-definition display, and software system. Blood gas analysis and number of peristalsis per hour were recorded. A questionnaire was used to subjectively assess vitality of the organ cluster every hour. Three laparoscopic procedures including cholecystectomy (LC), enterotomy closure (LEC) and hepatectomy (LLR) were performed on Smagister, with demonstration of specific events for each procedure. Six experts compared the procedures with actual surgery in terms of feasibility to complete procedures and demonstration of complications. RESULTS The fluctuation of perfusate glucose (6.1-8.2 mmol/L) and lactate (5.82-6.55 mmol/L) suggested metabolic function of the multivisceral organs. The mean number of peristalsis was 2.2/min. The simulated surgical view and anatomic structures closely resembled actual surgery during continuous perfusion (3.5 ± 1.0, 3.8 ± 0.8, respectively). The evaluation scores of haptic feedbacks were 3.8 ± 0.8, resembling live tissue handling. LC, LEC, and LLR were performed well on the Smagister, with clear display of the specific events. All six experts considered Smagister as a suitable training modality for both basic and advanced laparoscopic surgery. CONCLUSION The amalgamation of live animal model and ex-vivo simulation in Smagister centralizes the virtue of both modalities, expands the training field, and provides high-fidelity laparoscopic training for both novice and senior surgeons.
Collapse
|
7
|
Assessment of prehospital hemorrhage and airway care using a simulation model. J Trauma Acute Care Surg 2018; 85:S27-S32. [DOI: 10.1097/ta.0000000000001800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Lefor AK. Trauma surgery simulation education in Japan: the Advanced Trauma Operative Management course. Acute Med Surg 2018; 5:299-304. [PMID: 30338073 PMCID: PMC6167403 DOI: 10.1002/ams2.352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
Simulation has become an important teaching tool, in part because of changes mandated by restrictions in resident work hours. Simulation models include life‐like mannequins, ex vivo tissue, cadavers, and live animal models. The Advanced Trauma Operative Management (ATOM) course teaches a standard approach for the treatment of traumatic injuries. The 1‐day course includes six lectures in the morning and a live animal surgery laboratory in the afternoon. The animal laboratory includes five standard injury scenarios. Advanced Trauma Operative Management was brought to Japan in 2008 and has carried out 60 courses, training more than 250 surgeons and 70 instructors at six training sites throughout Japan. There have been a number of innovations initiated by ATOM Japan including Nurse Participation Certificates and a course for Trauma Nurses that runs concurrently with the ATOM course. There are other trauma courses given throughout the world, which are scenario‐based and include concurrent nurse training. It is difficult to quantitatively assess the benefits of trauma training to patients. There are a number of documented cases in Japan of surgeons who have had good operative outcomes in the care of traumatically injured patients who attribute the successful management of these patients to participation in the ATOM course. Training in trauma surgery using simulation models and the ATOM course have had a positive impact on surgical training and patient care in Japan. These courses will continue to be modified and refined, resulting in better education and clinical outcomes. Education research is essential to determine the optimum use of the available models.
Collapse
|
9
|
Blokhina SV, Volkova TV, Golubev VA, Perlovich GL. Understanding of Relationship between Phospholipid Membrane Permeability and Self-Diffusion Coefficients of Some Drugs and Biologically Active Compounds in Model Solvents. Mol Pharm 2017; 14:3381-3390. [DOI: 10.1021/acs.molpharmaceut.7b00401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Svetlana V. Blokhina
- Institute of Solution Chemistry, Russian Academy of Sciences, 153045 Ivanovo, Russia
| | - Tatyana V. Volkova
- Institute of Solution Chemistry, Russian Academy of Sciences, 153045 Ivanovo, Russia
| | - Vasiliy A. Golubev
- Institute of Solution Chemistry, Russian Academy of Sciences, 153045 Ivanovo, Russia
| | - German L. Perlovich
- Institute of Solution Chemistry, Russian Academy of Sciences, 153045 Ivanovo, Russia
| |
Collapse
|