title: Cadaver-based training is superior to simulation training for cricothyrotomy and tube thoracostomy.
abstract: Emergency medicine (EM) training mandates that residents be able to competently perform low-frequency critical procedures upon graduation. Simulation is the main method of training in addition to clinical patient care. Access to cadaver-based training is limited due to cost and availability. The relative fidelity and perceived value of cadaver-based simulation training is unknown. This pilot study sought to describe the relative value of cadaver training compared to simulation for cricothyrotomy and tube thoracostomy. To perform a pilot study to assess whether there is a significant difference in fidelity and educational experience of cadaver-based training compared to simulation training. To understand how important this difference is in training residents in low-frequency procedures. Twenty-two senior EM residents (PGY3 and 4) who had completed standard simulation training on cricothyrotomy and tube thoracostomy participated in a formalin-fixed cadaver training program. Participants were surveyed on the relative fidelity of the training using a 100 point visual analogue scale (VAS) with 100 defined as equal to performing the procedure on a real patient. Respondents were also asked to estimate how much the cadaveric training improved the comfort level with performing the procedures on a scale between 0 and 100 %. Open-response feedback was also collected. The response rate was 100 % (22/22). The average fidelity of the cadaver versus simulation training was 79.9 ± 7.0 vs. 34.7 ± 13.4 for cricothyrotomy (p < 0.0001) and 86 ± 8.6 vs. 38.4 ± 19.3 for tube thoracostomy (p < 0.0001). Improvement in comfort levels performing procedures after the cadaveric training was rated as 78.5 ± 13.3 for tube thoracostomy and 78.7 ± 14.3 for cricothyrotomy. All respondents felt this difference in fidelity to be important for procedural training with 21/22 respondents specifically citing the importance of superior landmark and tissue fidelity compared to simulation training. Cadaver-based training provides superior landmark and tissue fidelity compared to simulation training and may be a valuable addition to EM residency training for certain low-frequency procedures.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA. jtakayesu@partners.org.
authors.forename: James Kimo
authors.initials: JK
authors.lastname: Takayesu
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: David
authors.initials: D
authors.lastname: Peak
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Stearns
mesh_terms: D002102:Cadaver; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000193:education / Q000706:statistics & numerical data; D006801:Humans; D007821:Laryngeal Muscles / Q000601:surgery*; D008404:Massachusetts; D010865:Pilot Projects; D000066908:Simulation Training / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013663:Teaching / Q000592:standards* / Q000706:statistics & numerical data; D013907:Thoracostomy / Q000379:methods*
keywords: Airway management; Cadaver; Competence; Emergency medicine; Graduate medical education; Patient care; Patient simulation; Procedures; Residency