simpl diagnostic peritoneal lavage simulator col(s) mark w. bowyer, md, facs alan liu, phd national...

SimPLSimPLDiagnostic Diagnostic

Peritoneal Lavage Peritoneal Lavage SimulatorSimulator

Col(s) Mark W. Bowyer, MD, FACSCol(s) Mark W. Bowyer, MD, FACSAlan Liu, PhDAlan Liu, PhD

National Capital Area Medical Simulation CenterNational Capital Area Medical Simulation CenterUniformed Services University Uniformed Services University

of the Health Sciencesof the Health SciencesBethesda, MDBethesda, MD

National Capital Area Medical Simulation Center

Diagnostic Peritoneal LavageDiagnostic Peritoneal Lavage

• One of the Core Skills taught in One of the Core Skills taught in ATLSATLS®® to ~ 20,000 students/yr to to ~ 20,000 students/yr to diagnose presence of blood in diagnose presence of blood in abdomenabdomen

• Traditionally taught on animal Traditionally taught on animal model (pig or goat)model (pig or goat)

• Mannequin (TraumamanMannequin (Traumaman™ ™ ) ) recently approved as alternativerecently approved as alternative


SimPLSimPL FEATURES FEATURES

• cathSIM Hardware linked with cathSIM Hardware linked with graphics interfacegraphics interface

• Low Cost (<$10,000)Low Cost (<$10,000)• Can be run from laptopCan be run from laptop

National Capital Area Medical Simulation CenterSimPL


Results Randomly Generated


VALIDATION STUDYVALIDATION STUDY

SimPL vs. Pig for teaching DPL


DPL Validation StudyDPL Validation StudyDesignDesign

• 40 Third Year Medical Students who 40 Third Year Medical Students who were all true novices (never done one, were all true novices (never done one, never seen one)never seen one)

• Divided into two groups of twentyDivided into two groups of twenty• Initial 30 item Test covering basic Initial 30 item Test covering basic

knowledge of the procedure, it’s knowledge of the procedure, it’s indications, interpretation of results indications, interpretation of results and possible complications given prior and possible complications given prior to any education.to any education.


DPL Validation StudyDPL Validation StudyDesign (Cont)Design (Cont)

• Students also asked to rate Students also asked to rate current comfort level, perceived current comfort level, perceived difficulty of the procedure, and difficulty of the procedure, and familiarity of procedure on a 5 familiarity of procedure on a 5 item Likert scaleitem Likert scale

• Both groups given standard Both groups given standard Didactic lecture on DPL Didactic lecture on DPL procedureprocedure


Pig Group (n=20) trained to do DPL Pig Group (n=20) trained to do DPL on a pig on a pig


Sim Group (n=20) trained to DPL Sim Group (n=20) trained to DPL on VR DPL simulatoron VR DPL simulator



• Both groups “tested” Both groups “tested” on ATLSon ATLS®® standard standard TraumamanTraumaman™ ™ Mannequin on ability to Mannequin on ability to perform DPL and perform DPL and ability to verbalize ability to verbalize indications, indications, techniques, positive techniques, positive results and potential results and potential complications.complications.


Performance on Mannequin Performance on Mannequin evaluated and scored by two trauma evaluated and scored by two trauma surgeons blinded to initial mode of surgeons blinded to initial mode of

training.training.



• Final 30 item test given to test Final 30 item test given to test knowledge of procedure, indications, knowledge of procedure, indications, and potential complicationsand potential complications

• Comfort level, perceived difficulty ,and Comfort level, perceived difficulty ,and familiarity with steps reassessed.familiarity with steps reassessed.

• Surgeon evaluators provided Surgeon evaluators provided assessment of students current ability assessment of students current ability to perform a DPL if called upon to do to perform a DPL if called upon to do so tomorrow following this trainingso tomorrow following this training


Test of DPL KnowledgeTest of DPL Knowledge30 Item Written Test30 Item Written Test

0102030

405060708090100

Both Groups Pig Trained Simulator

Baseline

Final

* *

P<0.0001P<0.0001P<0.0001

*


Subjects Perceived Comfort Subjects Perceived Comfort Level Performing DPLLevel Performing DPL

0

1

2

3

4

5

Baseline Final

Pig Trained

Simulator

**P<.01*

P = .80

Extremely

Comfortable

Very

Comfortable

Comfortable

Somewhat

Not Very

Comfortable

P <.0001

P <.0001


Perceived and Reported Perceived and Reported Difficulty of DPLDifficulty of DPL

0

1

2

3

4

5

Baseline Final

Pig TrainedSimulator

Very Easy

Easy

Medium

Hard

Very Hard P< .81 P< .49

*P<.0006*

*P<.002*


Faculty Evaluation – The Faculty Evaluation – The Student Performance:Student Performance:

0

1

2

3

4

5

SiteSelection

NeedleInsertion

SeldingerTechnique

PigTrained

Simulator

Excellent

Good

Average

Fair

PoorP< .002P< .47P< .0001

**


Faculty Evaluation – The Students Ability to

Discuss:

0

1

2

3

4

5

Indications Complications Results

PigTrained

Simulator

Excellent

Good

Average

Fair

PoorP< .36P< .38P< .83


Faculty EvaluationFaculty EvaluationIf Placed in the Field Tomorrow, I Believe This Student Has If Placed in the Field Tomorrow, I Believe This Student Has

the Necessary Skills to Successfully Perform a DPLthe Necessary Skills to Successfully Perform a DPL

N = 20 each groupN = 20 each group Pig Pig TrainedTrained

Sim Sim TrainedTrained

Strongly AgreeStrongly Agree 3 (15%)3 (15%) 5 (25%)5 (25%)

AgreeAgree 9 (45%)9 (45%) 13 (65%)13 (65%)

NeutralNeutral 6 (30%)6 (30%) 2 (10%)2 (10%)

DisagreeDisagree 2 (10%)2 (10%) 00

Strongly DisagreeStrongly Disagree


Summary of Results DPL Summary of Results DPL Validation StudyValidation Study

• Knowledge increased significantly in Knowledge increased significantly in both groups over baseline (p <.0001) both groups over baseline (p <.0001) Excellent Content ValidityExcellent Content Validity

• Students self reported level of Students self reported level of comfort increased in both groups comfort increased in both groups (p<.0001)but more so in the (p<.0001)but more so in the Simulator trained group (p<0.01)Simulator trained group (p<0.01)


• Students who trained on the Students who trained on the SimPL SimPL had significantly increased had significantly increased performance on site selection performance on site selection (p<0.0001) and understanding of the (p<0.0001) and understanding of the Seldinger technique (p<0.002)Seldinger technique (p<0.002)

• Evaluators had greater faith in ability Evaluators had greater faith in ability of Simulator trained students to of Simulator trained students to perform procedure after training (90% perform procedure after training (90% vs 60%)vs 60%)

Summary of Results DPL Summary of Results DPL Validation Study – Cont.Validation Study – Cont.


ConclusionsConclusions

• SimPLSimPL compares favorably compares favorably with the Pig for teaching novices with the Pig for teaching novices DPL.DPL.

• SimPLSimPL is superior to the pig is superior to the pig for teaching of human for teaching of human anatomy/site selection, and the anatomy/site selection, and the Seldinger technique for DPLSeldinger technique for DPL


Where do we go Where do we go from here?from here?


• Improved GraphicsImproved Graphics• More ContentMore Content• Incorporate Input from end usersIncorporate Input from end users• More ValidationMore Validation• Expansion to other procedures Expansion to other procedures

that use Seldinger techniquethat use Seldinger technique• Seek Open Source Hardware so Seek Open Source Hardware so

Software can be distributed for freeSoftware can be distributed for free

simpl diagnostic peritoneal lavage simulator col(s) mark w. bowyer, md, facs alan liu, phd national...

Documents

md slide

alternative slide

goat mannequin traumaman

animal model pig

core skills

presence of blood

graphics interface low

facs alan liu