Emergency department resuscitative procedures: animal laboratory training improves procedural competency and speed.
Certain resuscitative procedures can be lifesaving, but are performed infrequently by emergency medicine (EM) residents on human subjects. Alternative training methods for gaining procedural proficiency must be explored and tested.


OBJECTIVE
To test whether animal laboratory training (ALT) is associated with sustained improvement in procedural competency and speed.


METHODS
After watching an educational videotape of saphenous cutdown (SAPH), thoracotomy (THOR), and cricothyroidotomy (CRIC), EM residents were randomized to receive either a tutored ALT session on live anesthetized pigs (Group A) or no ALT session (Group B). Residents were tested six months later by performing procedures on live anesthetized pigs. Videotaped procedures were evaluated by blinded examiners for the number of critical steps, complications, and procedure times.


RESULTS
Group A (n = 10) achieved a higher number of critical steps compared with Group B (n = 8) for SAPH (15.4 +/- 0.7 vs. 9.0 +/- 1.8, p = 0.03) and THOR (17.4 +/- 0.6 vs. 12.3 +/- 1.6, p = 0.009), but not CRIC (18.1 +/- 0.4 vs. 16.2 +/- 1.0, p = 0.1). Group A completed procedures in less time than Group B for SAPH (Wilcoxon chi(2) = 4.0, p = 0.04) and THOR (chi(2) = 4.4, p = 0.04), but not CRIC (chi(2) = 0.9, p = 0.3). There was no difference in the number of complications for any of the procedures.


CONCLUSIONS
Residents with animal laboratory training six months prior to testing demonstrated improved procedural competency and speed in the performance of resuscitative procedures.
Custalow
Catherine B
CB
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA. cbc3d@virginia.edu
Kline
Jeffrey A
JA
Marx
John A
JA
Baylor
Michael R
MR
D000328:Adult; D000818:Animals; D002983:Clinical Competence / Q000592:standards; D003413:Cricoid Cartilage / Q000601:surgery; D004635:Emergency Medicine / Q000193:education* / Q000592:standards; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D008297:Male; D023421:Models, Animal; D009657:North Carolina; D012151:Resuscitation / Q000379:methods*; D012501:Saphenous Vein / Q000601:surgery; D013552:Swine; D013663:Teaching / Q000379:methods*; D013908:Thoracotomy / Q000379:methods; D013957:Thyroid Cartilage / Q000601:surgery; D013995:Time; D014139:Tracheostomy / Q000379:methods; D016748:Venous Cutdown / Q000379:methods