PURPOSE: In an attempt to familiarize medical trainees with chest drain insertion, we sought to find a successful way of instructing students with its insertion technique.
METHODS: Students were given a thirty-minute lecture on chest anatomy, indications for insertion and then the insertion was demonstrated. Students were then taught the Seldinger (tube over guide-wire) technique and also the surgical drain (directly-visualized) insertion technique in a one-hour lab session. No direct comparison was made between other popular simulation mediums (such as plastic models or pork back ribs) nor then were students subsequently directly observed inserting tubes on actual patients.
RESULTS: The students were instructed then monitored and scored on successful insertion in the pleural space by an examiner informally. In discussion it was felt that the tactile feedback from the lamb’s carcasses demonstrated outstanding anatomical correlation and also demonstrated similar difficulties to human chest drain insertion. Both the anterior and mid-axillary lines were clearly visualized as well as the costal margins. There was also the opportunity to demonstrate administration of local anaesthetic agents as well as one of the most common pitfalls of chest tube insertion: “hitting the bone”. The session was received very well and positive/constructive /critical feedback revealed that the session was the appropriate length with both an appropriate amount of time spent on instruction and demonstration. Feedback also revealed that the students felt comfortable with the equipment used.
CONCLUSIONS: Lamb’s thoraces are a superb medium for simulation-based instruction of chest tube insertion. The use of an animal model has its benefits with respect to anatomical realism and the tactile realism of feeling actual muscle and bone. It likely provided a good stepping-stone between abstract classroom insertion instruction and hospital patient insertion. It would be a useful follow up note to suggest a head-to-head comparison of common chest tube insertion plastic trainers with animal models.
CLINICAL IMPLICATIONS: In a day where Internal medicine residents are expected to show competence in a variety of procedures from an early training stage and with less opportunities to practice, perhaps new simulation techniques/strategies (such as the use of lamb's thoraces) should be employed.
DISCLOSURE: The following authors have nothing to disclose: Alasdair Nazerali
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