An inexpensive, easily constructed, reusable task trainer for simulating ultrasound-guided pericardiocentesis.

BACKGROUND: Pericardiocentesis is a low-frequency, high-risk procedure integral to the practice of emergency medicine. Ultrasound-guided pericardiocentesis is the preferred technique for providing this critical intervention. Traditionally, emergency physicians learned pericardiocentesis in real time, at the bedside, on critically ill patients. Medical education is moving toward simulation for training and assessment of procedures such as pericardiocentesis because it allows learners to practice time-sensitive skills without risk to patient or learner. The retail market for models for pericardiocentesis practice is limited and expensive. DISCUSSION: We have developed an ultrasound-guided pericardiocentesis task trainer that allows the physician to insert a needle under ultrasound guidance, pierce the "pericardial sac" and aspirate "blood." Our model can be simply constructed in a home kitchen, and the overall preparation time is 1 h. Our model costs $20.00 (US, 2008). Materials needed for the construction include 16 ounces of plain gelatin, one large balloon, one golf ball, food coloring, non-stick cooking spray, one wooden cooking skewer, surgical iodine solution, and a 4-quart sized plastic food storage container. Refrigeration and a heat source for cooking are also required. Once prepared, the model is usable for 2 weeks at room temperature and may be preserved an additional week if refrigerated. When the model shows signs of wear, it can be easily remade, by simply recycling the existing materials. CONCLUSION: The self-made model was well liked by training staff due to accessibility of a simulation model, and by learners of the technique as they felt more at ease performing pericardiocentesis on a live patient.

Measures of stress and learning seem to be equally affected among all roles in a simulation scenario.

INTRODUCTION: Simulation scenarios provide a realistic, stressful environment in which participants can gain new clinical knowledge. It is unclear whether the role a participant plays in a scenario affects these goals. We measured heart rate, self-perceived stress and learning value, and objective written test results of participants in two simulation scenarios. Our hypothesis was that measurements of participants' stress and learning would be similar among all team members in our simulated scenarios. METHODS: Residents and medical students were prospectively randomized to take part in two difficult airway scenarios in the roles of team leader, procedure chief, or team member. Heart rate was recorded using pulse oximetry preprocedure and at the critical airway intervention. After debriefing, participants completed a data collection form that included visual analog scales for perceived stress and learning and objective questions related to scenario teaching points. RESULTS: We obtained 53 measurements during a single day. Heart rates increased during the airway intervention (median 4 beats per minute, P = 0.04). Self-reported learning values increased with self-reported stress level (rs = 0.373, P = 0.01); however, no correlation was found between a participant's role in the scenario and heart rate, test score, stress level, or perceived learning benefit. CONCLUSIONS: In our limited scenarios, measurements of stress and learning did not differ by role. Our results support the concept that all participants may benefit from simulation scenarios.

Hybrid simulation combining a high fidelity scenario with a pelvic ultrasound task trainer enhances the training and evaluation of endovaginal ultrasound skills.

OBJECTIVES: In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills. METHODS: A total of 45 EM residents at two institutions were randomized into two groups. Each group was assigned to one of two formats involving an ectopic pregnancy scenario. One format incorporated the new hybrid model, in which residents had to manipulate an endovaginal US probe in a task trainer; the other used the standard high-fidelity simulation mannequin together with static photo images. After finishing the scenario, residents self-rated their overall learning experience and how well the scenario evaluated their ability to interpret endovaginal US images. Faculty members reviewed video recordings of the other institution's residents and rated their own ability to evaluate residents' skills in interpreting endovaginal US images and diagnosing and managing the case scenario. Visual analog scales (VAS) were used for the self-ratings. RESULTS: Compared to the residents assigned to the standard simulation scenario, residents assigned to the hybrid model reported an increase in their overall educational experience (Delta VAS = 10, 95% confidence interval [CI] = 4 to 18) and felt the hybrid model was a better measure of their ability to interpret endovaginal US images (Delta VAS = 17, 95% CI = 7 to 28). Faculty members found the hybrid model to be better than the standard simulation for evaluating residents' skills in interpreting endovaginal US images (Delta VAS = 13, 95% CI = 6 to 20) and diagnosing and managing the case (Delta VAS = 10, 95% CI = 2 to 18). Time to reach a diagnosis was similar in both groups (p = 0.053). CONCLUSIONS: Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents.

High fidelity simulation can discriminate between novice and experienced residents when assessing competency in patient care.

BACKGROUND: High fidelity (HF) simulators have become more common in residency training programs. AIMS: We hypothesized that high fidelity (HF) simulation-based assessment of patient care competency could differentiate novice from experienced residents. METHODS: Prospective study of 44 emergency medicine residents. A simulated case of anaphylactic shock was administered to each participating resident utilizing a HF patient simulator. Management of the case required epinephrine, airway management including a surgical airway, and i.v. fluids. Data was recorded using a standardized form and stop watch. PRIMARY OUTCOME: Time to completion of surgical airway. SECONDARY OUTCOMES: Times to administration of epinephrine/attempt intubation/start surgical airway/complete case; checklist items: epinephrine as first action, pre-oxygenation, cricoid pressure and type of surgical airway. RESULTS: Novice residents took significantly longer than the experienced residents to achieve our primary outcome, time to completion of surgical airway (621/512 sec; p = 0.03). The novice residents took significantly longer to achieve three of our secondary outcomes: time to start of surgical airway (534 versus 442 sec; p = 0.04), time to case completion (650 versus 513 sec; p = 0.006), and epinephrine as a first action (73% versus 100%; p = 0.02). CONCLUSIONS: HF simulation-based assessment using objective measures, particularly time to action, discerned our novice from our experienced residents.

Gender and the council of emergency medicine residency directors standardized letter of recommendation.

OBJECTIVES: Until 2002, the Council of Emergency Medicine Residency Directors standardized letter of recommendation (SLOR) prompted authors to predict how an applicant would rank on their match list. A ranking of guaranteed match (GM) was identified as the least common superlative response on the SLOR. That knowledge allowed precise identification of the best SLORs. The authors correlated GM with every possible author/applicant gender combination. METHODS: This was a retrospective, observational study of 835 SLORs submitted in the 1998-1999 and 1999-2000 application cycles to one emergency medicine residency program. A standardized data collection instrument was used. Author/applicant gender combinations (M/M, M/F, F/F, F/M, M/M + F/F, and M/F + F/M) were analyzed with respect to GM by chi-square test, odds ratios with 95% confidence intervals, and logistic regression. RESULTS: There was a statistically significant association between a female-authored/female-applicant SLOR and GM, with a female applicant two times more likely to get a GM from a female author than any other author/applicant gender combination (odds ratio, 2.0; 95% confidence interval = 1.1 to 3.8; p = 0.023). No other combination was significantly associated with GM. CONCLUSIONS: Female applicants to the authors' emergency residency program had a two times better chance of receiving a GM recommendation on a SLOR written by a female faculty member compared with any other possible gender combination of applicants and letter authors. Although the choice of GM has now been eliminated from the SLOR, the role of gender in relation to the SLOR merits further study.