Giurin Ida, Bréaud Jean, Rampal Virginie, Rosello Olivier, Solla Federico
Emergency Department, Lenval University Children's Hospital, Nice, France.
Pediatric Surgery, Lenval University Children's Hospital, Nice, France.
J Surg Res. 2018 Aug;228:142-146. doi: 10.1016/j.jss.2018.03.017. Epub 2018 Apr 11.
Wounds of the finger nail bed represent a frequent injury, especially in children. Residents often learn nail bed repair on patients without prior training. We aimed to develop and evaluate a "low-fidelity" simulation model of nail bed repair.
The model consists of a false nail on a plastic finger and a hydrocolloid dressing, which is pasted on the nail bed site and cut horizontally. This model allows nail bed suture and nail fixation. The cost of each model is about $1. Thirty-three doctors evaluated this model on 10 items, rated out of five, concerning the realism, the difficulty of the procedure, and the educational value. The duration of the procedure was also noted. We evaluated the clinical effectiveness by comparing through Fisher's exact test the ratio of unsuitable events (revision surgeries, surgical site infections, and complaint letters) on two periods-3 y before and 18 mo after the implementation of this model in our institution, respectively.
Average mark was 4.16/5. The model was considered reliable, reproducible, and realistic. All the testers recognized a big educational value. The overall duration of the procedure averaged 23 min for residents and 11 min for surgeons. We collected 17 unsuitable events out of 84 patients from the period "before" and 2 out of 54 patients from the period "after" (P = 0.005). Revision surgeries were 10/84 from the period before and 2/54 from the period after (P = 0.04).
The results of the internal and clinical evaluations are encouraging. We suggest integration of this model into the training program of residents.
指甲床损伤是一种常见的损伤，尤其是在儿童中。住院医师常常在没有事先培训的情况下就为患者进行指甲床修复。我们旨在开发并评估一种“低保真度”的指甲床修复模拟模型。
该模型由一个塑料手指上的假指甲和一片水胶体敷料组成，水胶体敷料粘贴在指甲床部位并水平切开。此模型可用于指甲床缝合和指甲固定。每个模型的成本约为1美元。33名医生对该模型在10个项目上进行了评估，每项满分为5分，评估内容包括逼真度、操作难度和教育价值。同时记录了操作的持续时间。我们通过Fisher精确检验比较了在我们机构实施该模型之前3年和之后18个月这两个时间段内不适当事件（再次手术、手术部位感染和投诉信）的发生率，以此评估临床效果。
平均得分为4.16/5。该模型被认为可靠、可重复且逼真。所有测试者都认可其具有很大的教育价值。住院医师操作的总时长平均为23分钟，外科医生为11分钟。我们收集到“之前”时间段84例患者中有17例不适当事件，“之后”时间段54例患者中有2例（P = 0.005）。再次手术在“之前”时间段为10/84，“之后”时间段为2/54（P = 0.04）。
内部评估和临床评估的结果令人鼓舞。我们建议将该模型纳入住院医师培训项目。
