The Old One Technique in a New Style: Developing Procedural Skills in Paracentesis in a Low Cost Simulator Model

Abstract

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.

Assembly and use of a low-cost paracentesis simulator for the teaching of puncture and drainage of ascites

“…The use of simulators has been increasingly important as a tool for medical education as they bring students closer to professional reality. In addition, there is a growing demand from society for greater safety in surgical procedures and better training for physicians 3,12 .…”

“…However, the training of undergraduates, through simulators, is made difficult due to the high market value of these products, which makes it impossible to purchase by institutions with smaller funds and, even when present in reference education centers, there may be certain restrictions use by academics, such as exclusive access to inmates and residents 3,11,17 .…”

“…The motivation for this procedure can be diagnostic or therapeutic. In the first case, it is useful to define behavior and, in the second, essential to alleviate symptoms [1][2][3] .…”

“…Due to the varied etiology and high incidence of patients with ascites in medical services, the technique of paracentesis must be well-founded by medical professionals to avoid complications arising from execution errors [2][3][4] .…”

“…This makes the acquisition often unfeasible for several educational institutions, especially those with low economic investment. Therefore, the creation of affordable cost models became an advantageous alternative by having simulation models as an instrument of greater accessibility and, thus, enabling and expanding the use of this resource by the academic public [3][4][5][6][7][9][10][11] The aim of this article is to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students.…”