BACKGROUND: Paracentesis is a routine medical procedure quite relevant in clinical practice. There are risks of complications related to paracentesis, so it is essential a proper trainee for the younger practicer. OBJECTIVE: The article describes the construction and the application of a low cost paracentesis simulator for undergraduate medical students and it also describes the perception of students about the simulator as well. METHODS: A low-cost model was developed by the Program of Tutorial Education for training medical students during three editions of an undergraduate theoretical-practical course of bedside invasive procedures. The authors constructed a model from very low-cost and easily accessible materials, such as commercial dummy plus wooden and plastic supports to represent the abdomen, synthetic leather fabric for the skin, upholstered sponge coated with plastic film to represent the abdominal wall and procedure gloves with water mixed with paint to simulate the ascitic fluid and other abdominal structures. One semi-structured form with quantitative and qualitative questions was applied for medical specialists and students in order to evaluate the paracentesis simulator. RESULTS: The paracentesis model has an initial cost of US$22.00 / R$70.00 for 30 simulations and US$16.00 / R$50.00 for every 30 additional simulations. It was tested by eight medical doctors, including clinical medicine, general surgeons and gastroenterologists, and all of them fully agreed that the procedure should be performed on the manikin before in the actual patient, and they all approved the model for undergraduate education. A total of 87 undergraduate medical students (56% male) individually performed the procedure in our simulator. Regarding the steps of the procedure, 80.5% identified the appropriate place for needle puncture and 75.9% proceeded with the Z or traction technique. An amount of 80.5% of the students were able to aspire the fluid and another 80.5% of students correctly performed the bandage at the end of the procedure. All the students fully agreed that simulated paracentesis training should be performed prior to performing the procedure on a real patient. CONCLUSION: The elaboration of a teaching model in paracentesis provided unique experience to authors and participants, allowing a visible correlation of the human anatomy with synthetic materials, deepening knowledge of this basic science and developing creative skills, which enhances clinical practice. There are no data on the use of paracentesis simulation models in Brazilian universities. However, the procedure is quite accomplished in health services and needs to be trained. The model described above was presented as qualified with low cost and easily reproducible.
Objetivo: Descrever a construção de um simulador de baixo custo de drenagem torácica para capacitar a realização deste procedimento. Métodos: A concepção do modelo se deu em 2014 por integrantes do Programa de Educação Tutorial do curso de Medicina da UNIFOR. A seguir, o modelo foi testado por 10 especialistas e posteriormente aprovado para ser aplicado em quatro edições de um curso teórico-prático de procedimentos invasivos com acadêmicos de Medicina de diferentes universidades. Para avaliar o simulador e o desempenho no seu uso, aplicou-se questionários semiestruturados e checklist. Os dados foram analisados pelo Statistical Package for the Social Sciences v. 22 usando estatística descritiva. Resultados: Usou-se um manequim plástico comercial em que foi realizado um corte de 8x8 cm na região lateral do tórax, correspondente ao local da drenagem. Neste local, foram posicionadas folhas de E.V.A. (simulando pele e músculos intercostais), esponja de estofado (subcutâneo) e folha de PVC (pleura). Na parte interna do manequim foi colocada uma estrutura de madeira contendo duas costelas e, entre elas, um copo plástico recoberto por E.V.A. contendo líquido vermelho (simulando um hemotórax). O custo inicial do modelo completo foi de R$ 81,00/US$ 21,00. Quando testado por especialistas, todos concordaram que o modelo pode ser usado para o ensino na graduação. Durante o curso de procedimentos invasivos, 129 acadêmicos realizaram o procedimento, em que 64,3% dos alunos inseriram corretamente o dreno e 79,1% conectaram ao sistema de drenagem. Apesar de um percentual de erros importante visto em passos iniciais básicos, os alunos conseguiram executar a técnica proposta de forma suficiente. Conclusão: O simulador de drenagem de tórax mostrou-se ser de fácil acesso e reprodução nas universidades, o que o torna uma ferramenta útil para o ensino.
Introduction: Debating arts during graduation can be a creative way to develop new perceptions and perspectives for medical students. To promote activities that aim to create moments involving humanistic themes, simultaneously to technical medical knowledge, such as arts and physical activities in a playful setting, remains a challenge. A extracurricular Global Improvement Programme of Medical Students (GIPMS) of the University of Fortaleza was created on this context, and included meetings involving various artistic stimuli. Purpose: The objective of this paper is to evaluate if the contact with art during graduation in the context of GIPMS can generate perceptions, feelings and reflections to provide important debates. Methods: A prospective qualitative study was conducted including a total of 42 focal group sessions, which were recorded and fully transcribed. Each group was conducted by 2 mentors, and all 6 focal groups used standardized qualitative questionnaires each session, which were performed every 45 days. A thematic analysis of the transcripts was performed, confirmed with the QSR NVIVO software (version 11). Results: A total of 40 students (15 men and 25 women) participated in this one-year study. The categories found were: Artistic stimuli were able to make participants think (124 quotes), feel (78, 65 about positive feelings and 13 about negative ones) and remember (41). The following stood out: the influence of the time load of studies in the time dedicated to the arts and the reflections. (61); relationship between the arts and life and academic productivity (75); changes in attitudes provided by the proposed artistic stimuli (38 citations). Conclusions: The program was able to generate, in an innovative way, new perceptions of feelings, sensations and reflections, as well as to evoke memories that provided important debates, which, according to the students themselves, served as inspiration to change perspectives and attitudes and provided subjective benefits in academic life.
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