Validation of a Cost-effective Cast Saw Simulation-based Educational Module to Improve Cast Removal Safety.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
01 Feb 2022
01 Feb 2022
Historique:
pubmed:
12
10
2021
medline:
12
1
2022
entrez:
11
10
2021
Statut:
ppublish
Résumé
Inexperience in cast removal in the pediatric population can lead to a range of cast saw-related injuries. The purpose of this study is to validate a simple simulation-based wax model that is both reproducible and economical while providing a valuable tool that can be used to grade cast saw use performance in trainees. Cylindrical wax models were used as an analog for a pediatric upper extremity. The wax models were casted in a proscribed reproducible fashion for consistency. Two groups, the first consisting of 15 experienced cast saw users and the second consisting of 15 inexperienced individuals, completed 4 sequential longitudinal cuts in the casted wax models. After removal of the cast material, marks left by the cast saw in the wax were counted and measured. Indentation length, maximum depth, and maximum width were measured on each wax model. The total length of the cast saw indentations per cast saw user was also calculated. For the inexperienced cast saw users, the average total length of the cast saw indentations was 526.56 mm, average maximum depth was 1.91 mm, and average maximum width was 3.24 mm. For experienced cast saw users, the average total length of the cast saw indentations was 156.57 mm with an average maximum depth of 1.06 mm and average maximum width of 2.19 mm. Receiver operating characteristic curves of the total number of errors, total error length, maximum error depth, and maximum error width show effective discrimination of experienced from inexperienced trainees. This study provides valid evidence supporting a cost-effective, time-efficient, and easily reproducible educational simulation module that can objectively measure cast saw the performance in trainees. This model demonstrates construct validity and can distinguish novice from experienced cast saw users. It is sensitive enough to identify mistakes even in the most experienced cast saw users, creating a platform that can provide performance-based feedback to cast saw users of all experience levels. Level III-diagnostic test.
Sections du résumé
BACKGROUND
BACKGROUND
Inexperience in cast removal in the pediatric population can lead to a range of cast saw-related injuries. The purpose of this study is to validate a simple simulation-based wax model that is both reproducible and economical while providing a valuable tool that can be used to grade cast saw use performance in trainees.
METHODS
METHODS
Cylindrical wax models were used as an analog for a pediatric upper extremity. The wax models were casted in a proscribed reproducible fashion for consistency. Two groups, the first consisting of 15 experienced cast saw users and the second consisting of 15 inexperienced individuals, completed 4 sequential longitudinal cuts in the casted wax models. After removal of the cast material, marks left by the cast saw in the wax were counted and measured. Indentation length, maximum depth, and maximum width were measured on each wax model. The total length of the cast saw indentations per cast saw user was also calculated.
RESULTS
RESULTS
For the inexperienced cast saw users, the average total length of the cast saw indentations was 526.56 mm, average maximum depth was 1.91 mm, and average maximum width was 3.24 mm. For experienced cast saw users, the average total length of the cast saw indentations was 156.57 mm with an average maximum depth of 1.06 mm and average maximum width of 2.19 mm. Receiver operating characteristic curves of the total number of errors, total error length, maximum error depth, and maximum error width show effective discrimination of experienced from inexperienced trainees.
CONCLUSIONS
CONCLUSIONS
This study provides valid evidence supporting a cost-effective, time-efficient, and easily reproducible educational simulation module that can objectively measure cast saw the performance in trainees. This model demonstrates construct validity and can distinguish novice from experienced cast saw users. It is sensitive enough to identify mistakes even in the most experienced cast saw users, creating a platform that can provide performance-based feedback to cast saw users of all experience levels.
LEVEL OF EVIDENCE
METHODS
Level III-diagnostic test.
Identifiants
pubmed: 34629432
doi: 10.1097/BPO.0000000000001987
pii: 01241398-202202000-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-76Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Puddy AC, Sunkin JA, Aden JK, et al. Cast saw burns: evaluation of simple techniques for reducing the risk of thermal injury. J Pediatr Orthop. 2014;34:e63–e66.
Bae DS, Valim C, Connell P, et al. Bivalved versus circumferential cast immobilization for displaced forearm fractures: a randomized clinical trial to assess efficacy and safety. J Pediatr Orthop. 2017;37:239–246.
Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am. 2008;33:1911–1923.
Difazio RL, Harris M, Feldman L, et al. Reducing the incidence of cast-related skin complications in children treated with cast immobilization. J Pediatr Orthop. 2017;37:526–531.
Halanski MA. How to avoid cast saw complications. J Pediatr Orthop. 2016;36(suppl 1):S1–S5.
Brubacher JW, Karg J, Weinstock P, et al. A novel cast removal training simulation to improve patient safety. J Surg Edu. 2016;73:7–11.
Samora BJ, Samora WP, Dolan K, et al. A quality improvement initiative reduces cast complications in a pediatric hospital. J Pediatr Orthop. 2018;38:e43–e49.
Ruder JA, Brighton B, Vander Have K, et al. Effectiveness of a low fidelity cast removal module in orthopaedic surgical simulation. J Surg Educ. 2018;75:1329–1332.
Shay SG, Chrin JD, Wang MB, et al. Initial and long-term retention of robotic technical skills in an Otolaryngology Residency Program. Laryngoscope. 2019;129:1380–1385.
Mokadam N, Fann J, Hicks G. Experiences with the cardiac surgery simulation curriculum: results of the resident and faculty survey. Ann Thorac Surg. 2017;103:322–328.
Binkley J, Bukoski A, Doty J. Surgical simulation: markers of proficiency. J Surg Educ. 2019;76:234–241.
Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839–843.
Obuchowski N, McClish D. Sample size determination for diagnostic accuracy studies involving binormal ROC curve indices. Stat Med. 1997;16:1529–1542.
Vetter MH, Palettas M, Hade E, et al. Time to consider integration of a formal robotic-assisted surgical training program into obstetrics/gynecology residency curricula. J Robot Surg. 2018;12:517–521.
Gutiérrez-Baños JL, Ballestero-Diego R, Truan-Cacho D, et al. Urology residents training in laparoscopic surgery. Development of a virtual reality model. Actas Urol Esp. 2015;39:564–572.
Butler BA, Lawton CD, Burgess J, et al. Simulation-based educational module improves intern and medical student performance of closed reduction and percutaneous pinning of pediatric supracondylar humeral fractures. J Bone Joint Surg Am. 2017;99:e128.
Bae DS, Lynch H, Jamieson K, et al. Improved safety and cost savings from reductions in cast-saw burns after simulation-based education for orthopaedic surgery residents. J Bone Joint Surg Am. 2017;99:e94.
Atesok K, Satava R, Marsh JL, et al. Measuring surgical skills in simulation-based training. J Am Acad Orthop Surg. 2017 2017;25:665–672.
Atesok K, Satava RM, Van Heest A, et al. Retention of skills after simulation-based training in orthopaedic surgery. J Am Acad Orthop Surg. 2016;24:505–514.
Derevianko AY, Schwaitzber SD, Tsuda S, et al. Malpractice carrier underwrites fundamentals of laparoscopic surgery training and testing: a benchmark for patient safety. Surg Endosc. 2010;24:616–623.