Construction of Soft Prep Cadaver Pericardiocentesis Training Model and Implementation Among Emergency Medicine Residents.

Abstract

Audience: This procedure training model is designed for all levels of emergency medicine residents.

Background: Pericardiocentesis is a relatively uncommon but potentially life-saving procedure within the scope of Emergency Medicine practice. As such, the Accreditation Council for Graduate Medical Education (ACGME) designates its competency as a requirement within emergency medicine residency programs. Because of its relative rarity, simulation-based training is often utilized to fill the gaps in clinical experience during emergency medicine residency training. There have been several models of pericardiocentesis training, including gel-based models that can be purchased or constructed,1-3 non-gel models,4 and cadaveric models.5 In this paper, we describe the fabrication of a high-fidelity cadaveric model and report emergency medicine resident experience with this model. Training programs can use this model to increase trainee competence and confidence with this high-acuity, low-frequency procedure.

Educational objectives: By the end of this session, residents will gain increased procedural competence and confidence with pericardiocentesis. Residents will be able to identify necessary supplies for the procedure, identify relevant surface anatomy and ultrasound views, and successfully aspirate fluid from model effusion.

Educational methods: We created a pericardial effusion in a soft prep cadaver by placing a catheter into the pericardial sac and then infusing normal saline via intravenous fluid tubing. Learners were then able to practice aspiration of pericardial fluid via landmark and ultrasound-guided approaches under observation by facilitators able to offer real-time feedback.

Research methods: Learners were asked to complete a survey assessing pre-intervention and post-intervention subjective confidence in their ability to perform pericardiocentesis and were asked for qualitative feedback on the experience of using the training model.

Results: All residents were able to successfully visualize the pericardial effusion and perform needle aspiration via parasternal and subxiphoid approaches under dynamic ultrasound guidance, allowing needle visualization. All residents reported a subjective increase in procedural confidence and competence after practicing with this training model.

Discussion: Overall, the primary benefit of this training model cited by emergency medicine residents was that it closely approximates reality. This model is re-usable, relatively durable, and reproducible. Emergency medicine residencies associated with academic medical centers that already utilize cadavers for education may relatively easily incorporate this training model into their procedure training curriculum.

Topics: Pericardiocentesis, simulation, task trainer.