Ford Tabitha, Fix Megan L, Madsen Troy E, Stroud Susan
University of Utah School of Medicine, Department of Emergency Medicine, Salt Lake City, UT.
J Educ Teach Emerg Med. 2020 Jan 15;5(1):I10-I14. doi: 10.21980/J82S85. eCollection 2020 Jan.
This corneal foreign body simulator is designed to instruct junior emergency medicine (EM) residents and medical students with an interest in emergency medicine.
Eye complaints are common in the emergency department (ED), accounting for approximately 2 million ED visits each year.1 Corneal foreign bodies (CFB) account for approximately 7.5% of these presentations, and many EM providers are uncomfortable with removal procedures.1-3 Simulation has been demonstrated to improve provider comfort with this skill.4,5 Previous models for CFB removal have been created using wax over glass spheres, molded materials with silicone and ballistics gel, bovine eyes, cardboard glove boxes with ink stains simulating foreign bodies and rust rings, and agar plates with pepper-corns. 4-9 Often, these models are expensive or time-consuming to create or lack spatial realism.We propose that a simple, inexpensive model will be effective in increasing emergency provider comfort with CFB removal under slit lamp magnification in addition to increasing provider comfort using a slit lamp.
By the end of the session, the learner should be able to adequately focus a slit lamp in order to identify and magnify a corneal foreign body and demonstrate safe technique for removal of a corneal foreign body under slit lamp guidance.
We created a low-fidelity CFB simulator for approximately $15 utilizing a Styrofoam ball, toothpicks, grapes, novelty glasses, and magnesium shavings. Toothpicks secured grapes into simulated orbits, scooped out of a Styrofoam ball. We fastened the Styrofoam ball to the slit lamp using medical tape. We added novelty glasses to simulate working around facial features. A senior resident instructor then used forceps to insert small magnesium shavings into the grapes to simulate foreign bodies. Participants received an introduction on techniques for successful CFB removal using the bevel of a needle under slit lamp guidance.10,11 They practiced using the models under supervision of an instructor.
We conducted a prospective trial using a convenience sample of 19 learners at a university-based EM residency program, including EM interns, one emergency advanced-practice clinician, and fourth-year medical students participating in an EM sub-internship. We analyzed results using a Fisher's exact test.
Before training, few participants (36.8%) had observed a corneal foreign body removal, and only 15.8% had performed the procedure. More than half (52.6%) of participants said they were somewhat or very comfortable using a slit lamp before the training and 89.5% were somewhat or very comfortable after training (p=0.029). None of the participants were somewhat or very comfortable removing CFBs before the training and 84.2% were somewhat or very comfortable post-training (p<0.001).
Results suggest that simulation with this low-cost model effectively improves provider comfort in CFB removal in addition to improving comfort using a slit lamp.
Eye exam, eye injury, ocular injury, corneal injury, corneal foreign body, slit lamp, corneal foreign body removal.
这款角膜异物模拟器旨在指导初级急诊医学（EM）住院医师以及对急诊医学感兴趣的医学生。
眼部不适在急诊科很常见，每年约有200万人次就诊。角膜异物（CFB）约占这些就诊病例的7.5%，许多急诊医学提供者对取出操作并不熟练。模拟已被证明可以提高提供者对这项技能的熟练度。之前用于CFB取出的模型有玻璃球上涂蜡、硅胶和弹道凝胶制成的模制材料、牛眼、带有模拟异物和锈环墨渍的硬纸板手套箱以及带有胡椒粒的琼脂平板。通常，这些模型制作成本高或耗时，或者缺乏空间真实感。我们认为，一个简单、低成本的模型除了能提高提供者使用裂隙灯的熟练度外，还能有效提高急诊提供者在裂隙灯放大下取出CFB的熟练度。
课程结束时，学习者应能够正确聚焦裂隙灯以识别和放大角膜异物，并展示在裂隙灯引导下安全取出角膜异物的技术。
我们用大约15美元制作了一个低保真度的CFB模拟器，使用了一个泡沫塑料球、牙签、葡萄、新奇眼镜和镁屑。用牙签将葡萄固定到从泡沫塑料球中挖出的模拟眼眶中。我们用医用胶带将泡沫塑料球固定在裂隙灯上。我们添加新奇眼镜以模拟在面部特征周围操作。然后，一位高级住院医师教员用镊子将小镁屑插入葡萄中以模拟异物。参与者接受了关于在裂隙灯引导下使用针斜面成功取出CFB技术的介绍。他们在教员的监督下使用模型进行练习。
我们在一个大学急诊医学住院医师项目中，对19名学习者的便利样本进行了一项前瞻性试验，包括急诊医学实习生、一名急诊高级实践临床医生以及参加急诊医学见习的四年级医学生。我们使用Fisher精确检验分析结果。
培训前，很少有参与者（36.8%）观察过角膜异物取出操作，只有15.8%的人进行过该操作。超过一半（52.6%）的参与者表示在培训前使用裂隙灯时有些或非常熟练，培训后这一比例为89.5%（p = 0.029）。培训前没有参与者在取出CFB时有些或非常熟练，培训后这一比例为84.2%（p < 0.001）。
结果表明，使用这种低成本模型进行模拟除了能提高使用裂隙灯的熟练度外，还能有效提高提供者取出CFB的熟练度。
眼部检查、眼外伤、眼损伤、角膜损伤、角膜异物、裂隙灯、角膜异物取出。
