Brighton and Sussex Medical School, Brighton, UK.
University Hospitals Sussex Foundation Trust, Worthing Hospital, Worthing, UK.
Surg Innov. 2023 Dec;30(6):739-744. doi: 10.1177/15533506231208572. Epub 2023 Oct 24.
Clamshell thoracotomy (CST) is an emergency procedure performed during traumatic cardiac arrest. Emergency physicians and surgeons are expected to perform this procedure in the Emergency Department. However, the procedure has a low occurrence rate, therefore physicians are often poorly prepared. Current teaching methods include expensive simulators and anatomically inaccurate animal models. The goal of this study was to design, produce and test, a low-cost, high-fidelity model for the teaching of CST.
DESIGN, SETTING AND PARTICIPANTS: The model was produced from inexpensive, commercially available materials as well as ADAMgel; a custom, recyclable, inexpensive tissue analogue. The model was tested across 19 physicians, mostly consultants and senior registrars in emergency medicine, anaesthesia and surgery. Participants completed comparative questionnaires before and after testing the model. The questionnaires were adapted from previous anaesthetic-based simulation studies and used a modified Likert scale to assess prior knowledge, anatomical realism and the teaching benefits of the model.
Participants had varied prior knowledge and experience before testing the model. Results showed that 89.47% (n = 17) of trainees felt the model was a reasonable substitute for practice and 100% (n = 19) agreed that the model was a good training aid for inexperienced trainees and would recommend it to others.
The model proved a successful teaching tool, improving physicians' knowledge and confidence with performing CST. This high fidelity, low cost model demonstrated that a high standard simulation teaching tool can be made which improves teaching of CST.
贝壳式开胸术（CST）是在创伤性心脏骤停期间进行的紧急手术。急诊医生和外科医生预计将在急诊室进行此手术。然而，该手术的发生率较低，因此医生通常准备不足。目前的教学方法包括昂贵的模拟器和解剖不准确的动物模型。本研究的目的是设计、制作和测试一种用于 CST 教学的低成本、高保真模型。
设计、设置和参与者：该模型由廉价的商用材料以及 ADAMgel 制成；ADAMgel 是一种定制的、可回收的、廉价的组织模拟物。该模型在 19 名医生中进行了测试，这些医生主要是急诊医学、麻醉和外科的顾问和高级住院医师。参与者在测试模型前后完成了比较问卷。这些问卷改编自以前基于麻醉的模拟研究，并使用改良的李克特量表来评估模型的先验知识、解剖学真实性和教学效果。
参与者在测试模型之前具有不同的先验知识和经验。结果表明，89.47%（n=17）的受训者认为该模型是一种合理的替代练习方法，100%（n=19）的受训者认为该模型是一种为缺乏经验的受训者提供良好培训的辅助工具，并将向他人推荐。
该模型被证明是一种成功的教学工具，提高了医生进行 CST 的知识和信心。这种高保真、低成本的模型表明，可以制作出高标准的模拟教学工具，从而提高 CST 的教学效果。
