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SimPL Diagnostic Peritoneal Lavage Simulator. Col(s) Mark W. Bowyer, MD, FACS Alan Liu, PhD National Capital Area Medical Simulation Center Uniformed Services University of the Health Sciences Bethesda, MD. Diagnostic Peritoneal Lavage.

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Simpl diagnostic peritoneal lavage simulator l.jpg
SimPLDiagnostic Peritoneal Lavage Simulator

Col(s) Mark W. Bowyer, MD, FACS

Alan Liu, PhD

National Capital Area Medical Simulation Center

Uniformed Services University

of the Health Sciences

Bethesda, MD


Diagnostic peritoneal lavage l.jpg
Diagnostic Peritoneal Lavage

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

  • Traditionally taught on animal model (pig or goat)

  • Mannequin (Traumaman™ ) recently approved as alternative

National Capital Area Medical Simulation Center


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SimPL FEATURES

  • cathSIM Hardware linked with graphics interface

  • Low Cost (<$10,000)

  • Can be run from laptop

National Capital Area Medical Simulation Center


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SimPL

National Capital Area Medical Simulation Center



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Results Randomly Generated

National Capital Area Medical Simulation Center


Validation study l.jpg
VALIDATION STUDY

SimPL vs. Pig

for teaching DPL

National Capital Area Medical Simulation Center


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DPL Validation StudyDesign

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

  • Divided into two groups of twenty

  • Initial 30 item Test covering basic knowledge of the procedure, it’s indications, interpretation of results and possible complications given prior to any education.

National Capital Area Medical Simulation Center


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DPL Validation StudyDesign (Cont)

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

  • Both groups given standard Didactic lecture on DPL procedure

National Capital Area Medical Simulation Center


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

National Capital Area Medical Simulation Center


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

National Capital Area Medical Simulation Center


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DPL Validation StudyDesign (Cont)

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

National Capital Area Medical Simulation Center


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

National Capital Area Medical Simulation Center


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DPL Validation Study surgeons blinded to initial mode of training.Design (Cont)

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

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

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

National Capital Area Medical Simulation Center


Test of dpl knowledge 30 item written test l.jpg
Test of DPL Knowledge surgeons blinded to initial mode of training.30 Item Written Test

*

*

*

Percent

P<0.0001

P<0.0001

P<0.0001

National Capital Area Medical Simulation Center


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Subjects Perceived Comfort Level Performing DPL surgeons blinded to initial mode of training.

Extremely Comfortable

Very Comfortable

Comfortable

Somewhat

Not Very Comfortable

P <.0001

*

P <.0001

*P<.01*

P = .80

National Capital Area Medical Simulation Center


Perceived and reported difficulty of dpl l.jpg
Perceived and Reported Difficulty of DPL surgeons blinded to initial mode of training.

Very Easy

Easy

Medium

Hard

Very Hard

*P<.002*

*P<.0006*

P< .81

P< .49

National Capital Area Medical Simulation Center


Faculty evaluation the student performance l.jpg
Faculty Evaluation – The Student Performance: surgeons blinded to initial mode of training.

Excellent

Good

Average

Fair

Poor

*

*

P< .0001

P< .47

P< .002

National Capital Area Medical Simulation Center


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Faculty Evaluation – The Students Ability to Discuss: surgeons blinded to initial mode of training.

Excellent

Good

Average

Fair

Poor

P< .83

P< .38

P< .36

National Capital Area Medical Simulation Center


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Faculty Evaluation surgeons blinded to initial mode of training.If Placed in the Field Tomorrow, I Believe This Student Has the Necessary Skills to Successfully Perform a DPL

National Capital Area Medical Simulation Center


Summary of results dpl validation study l.jpg
Summary of Results DPL Validation Study surgeons blinded to initial mode of training.

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

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

National Capital Area Medical Simulation Center


Summary of results dpl validation study cont l.jpg
Summary of Results DPL Validation Study – Cont. surgeons blinded to initial mode of training.

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

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

National Capital Area Medical Simulation Center


Conclusions l.jpg
Conclusions surgeons blinded to initial mode of training.

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

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

National Capital Area Medical Simulation Center


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Where do we go from here? surgeons blinded to initial mode of training.

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  • Improved Graphics surgeons blinded to initial mode of training.

  • More Content

  • Incorporate Input from end users

  • More Validation

  • Expansion to other procedures that use Seldinger technique

  • Seek Open Source Hardware so Software can be distributed for free

National Capital Area Medical Simulation Center


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