The measurement of intraocular pressure via ocular tonometry is a skill necessary for the evaluation of emergency department patients with ocular complaints. Accurate results inform the use of time-sensitive medications or invasive procedures. We sought to develop and evaluate an affordable, realistic, and reproducible task trainer to allow Emergency Medicine residents and medical students to practice tonometry.We placed an angiocatheter into the vitreous chamber of a swine eye through the optic nerve stump and sealed it with a purse string suture and cyanoacrylate glue. This allowed us to connect intravenous extension tubing and use a saline-filled syringe to repeatedly adjust intraocular pressure in real time. Optionally, this model can be mounted in a polystyrene foam mannequin head to enhance realism and facilitate practice.The task trainer was implemented in medical student and Emergency Medicine resident education at Vanderbilt University Medical Center. Thirty-six learners participated in the study, all of whom completed pre-course and post-course surveys. Among all learners, the mean comfort with performing tonometry improved significantly (3.26 to 7.64 {Z = -4.95, p < 0.005}). The mean confidence in the accuracy of measurements also increased (3.11 to 7.56 {Z = -4.8, p < 0.005}). On a 10-point scale, learners felt this task trainer was highly helpful in increasing their comfort with and the ability to perform tonometry (mean 9.19 {SD 1.19}).We have developed a low-cost and easily constructed ocular tonometry task trainer that resulted in significant improvement in learner comfort and confidence.
Resuscitative hysterotomy (RH) is a rare, time-sensitive, invasive procedure that can be frightening for emergency physicians and yet potentially life-saving for fetus and mother. Several low-cost RH task trainers have been described in the literature. We set out to construct a model using improved synthetic materials for the uterine and abdominal wall and to devise hemorrhage capability. The primary aim of this study was to evaluate the model's perceived usefulness of its features. Secondarily, we wished to assess the confidence of emergency medicine (EM) residents before and after performing a RH using our task trainer in a simulated environment.We constructed an inexpensive task trainer that can function both as a table-top model (TTM) and be adapted to a high-fidelity simulator. We created the abdominal wall and uterus from polyurethane carpet padding, subcutaneous fat from upholstery foam, fascia from synthetic chamois, and blood vessels from IV tubing and angio-catheters. We utilized the task trainer during our monthly EM residency simulation conference. After completing a simulation of a gravid female in cardiac arrest requiring a RH on a highfidelity simulator adaptated model (HFSAM), residents repeated the procedure during debriefing on a TTM. Residents then completed anonymous paper surveys in which they rated aspects of the RH model and their procedural confidence on a 10-point Likert scale. 20 EM residents took part in the RH simulation scenario followed by a TTM demonstration. All (100%) residents completed the survey. 11 (55%) of the residents performed a RH on either the HFSAM or the TTM while the others assisted. The residents rated the overall educational value of the training event as very high (mean 9.8 (SD 0.68)). Both the TTM (mean 8.9 (SD 1.15)) and HFSAM (mean 8.7 (SD 1.29)) were similarly rated as highly realistic. Before the simulation session, residents rated their confidence in performing a RH as low (mean 4.0 (SD 2.62)). After the session, they were much more confident in their ability to perform a RH (mean 7.9 (SD 1.48); P<0.001). Most residents rated bleeding as very important to the utility of a RH model (mean 8.6 (SD 1.74)).We demonstrate an inexpensive but realistic RH task trainer that can be used as a stand-alone model or adapted to a high-fidelity simulator. A single simulation using the TTM and the HFSAM lead to increased resident confidence in their ability to perform a RH.
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