title: Simulation trainer for practicing emergent open thoracotomy procedures.
abstract: BACKGROUND
  An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a cost-effective Cardiothoracic (CT) Surgery trainer and assessed its potential for improving technical and interprofessional skills during an emergent simulated OT.
  
  
  METHODS
  We modified a commercially available mannequin torso with artificial tissue models to create a custom CT Surgery trainer. The trainer's feasibility for simulating emergent OT was tested using a multidisciplinary CT team in three consecutive in situ simulations. Five discretely observable milestones were identified as requisite steps in carrying out an emergent OT; namely (1) diagnosis and declaration of a code situation, (2) arrival of the code cart, (3) arrival of the thoracotomy tray, (4) initiation of the thoracotomy incision, and (5) defibrillation of a simulated heart. The time required for a team to achieve each discrete step was measured by an independent observer over the course of each OT simulation trial and compared.
  
  
  RESULTS
  Over the course of the three OT simulation trials conducted in the coronary care unit, there was an average reduction of 29.5% (P < 0.05) in the times required to achieve the five critical milestones. The time required to complete the whole OT procedure improved by 7 min and 31 s from the initial to the final trial-an overall improvement of 40%.
  
  
  CONCLUSIONS
  In our preliminary evaluation, the CT Surgery trainer appears to be useful for improving team performance during a simulated emergent bedside OT in the coronary care unit.
authors.affiliation: Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona Health Sciences Center, University of Arizona, Tucson, Arizona. Electronic address: allan@surgery.arizona.edu.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Hamilton
authors.affiliation: Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona Health Sciences Center, University of Arizona, Tucson, Arizona.
authors.forename: Hannes
authors.initials: H
authors.lastname: Prescher
authors.affiliation: Arizona Simulation Technology and Education Center, College of Medicine, University of Arizona Health Sciences Center, University of Arizona, Tucson, Arizona.
authors.forename: David E
authors.initials: DE
authors.lastname: Biffar
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona Medical Center, University of Arizona, Tucson, Arizona.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Poston
mesh_terms: D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D004630:Emergencies; D005240:Feasibility Studies; D006801:Humans; D007400:Interprofessional Relations; D008348:Manikins; D017145:Models, Educational; D010348:Patient Care Team; D013903:Thoracic Surgery / Q000193:education*; D013908:Thoracotomy / Q000193:education* / Q000379:methods; D013997:Time Factors; D014481:United States
keywords: Cardiothoracic; Medical; Simulation; Surgical education; Thoracotomy