IDEA Series: DIY Suture Kit Station

laceration suture repair closure

In medical training there is a lack of simulation based activities including procedural labs. Suturing is a critical skill for trainees to master in the emergency department. However, supervised practice is needed prior to suturing a real patient for the first time. This innovation allows early trainees to master suturing while on shift, using easy to find materials, which increases procedural competency and confidence. This activity allows the teacher to assess and correct the trainees procedural skills prior to attempting to suture a real patient.

Name of innovation

  • This Do-It-Yourself Suture Kit Station incorporates easy to find materials available in every emergency department, allowing early trainees to master suturing prior to suturing real patients.

Learners targeted

  • Medical students and early trainees who need suture practice

General group size

  • One-on-one student training is ideal, but can have multiple students who can practice using multiple suturing stations
  • If teacher unable to instruct while on shift, trainees can be shown a suture training video and practice alongside the video

DIY suture training kit for laceration repair

Materials needed

  • Blue chuck pad
  • Paper/cloth tape
  • Scalpel
  • Suture material
  • Suture kit

More detailed description of the activity and how it was run

  • Make the DIY Suture Kit Station (see above video):
    • Place a thick chuck pad on a flat sturdy surface.
    • Apply cloth tape to the entire surface of the chuck, and tape over the chuck. This is now the suturing pad.
    • Use a scalpel to make an incision to the pad.
    • Use the back blunt end of the scalpel to ‘fluff’ up incision edges to make laceration.
  • Use a laceration repair kit and suture to close the laceration.
  • Instruct the trainee on proper suturing technique on the suture station (or show a suture training video)
  • Have the trainee continue practicing until adequate comfort and proficiency level is achieved
  • Suture real patient!

Lessons learned, especially with regard to increasing resident and program buy in

  • Procedural skills require much repetition to gain proficiency. This is best done with video tutorials, supervision, and deliberate practice.
  • Practicing in a simulated environment greatly improves skill and confidence in real clinical practice.

Educational theory behind the innovation including specifics/styles of teaching involved

  • Simulation practice increases procedural competency.
  • Practicing on shift allows trainees to reach the number of repetitions required to gain mastery in suturing, Routt [1] showed that the number of repetitions required to gain proficiency was 41 times.
  • Competency in suturing is required even when cases are low. Wongkietachorn et al. demonstrated that tutoring suturing improves the trainees’ skillset. A practice suture kit helps improve retention for real-life scenarios [2].

Pearls

  • This DIY suture pad station technique is easily available and inexpensive.
  • To improve suturing techniques and enhance skill retention, medical students and early trainees need to learn with guided supervision on simulated task trainers.

 

References

  1. Routt E, Mansouri Y, de Moll EH, Bernstein DM, Bernardo SG, Levitt J. Teaching the Simple Suture to Medical Students for Long-term Retention of Skill. JAMA Dermatol. 2015 Jul;151(7):761-5. doi: 10.1001/jamadermatol.2015.118. PMID: 25785695.
  2. Wongkietkachorn A, Rhunsiri P, Boonyawong P, Lawanprasert A, Tantiphlachiva K. Tutoring Trainees to Suture: An Alternative Method for Learning How to Suture and a Way to Compensate for a Lack of Suturing Cases. J Surg Educ. 2016 May-Jun;73(3):524-8. doi: 10.1016/j.jsurg.2015.12.004. Epub 2016 Feb 20. PMID: 26907573.
By |2021-10-08T10:19:05-07:00Oct 15, 2021|IDEA series, Trauma|

IDEA Series: Handheld Ultrasound for Emergency Medicine Residents Rotating on Cardiology Services

US System

Point-of-care ultrasound (PoCUS) has become an essential skill that emergency medicine (EM) residents learn during their training [1]. Accordingly, most EM programs schedule a block early in residency dedicated to obtaining and interpreting high-quality PoCUS images. Likewise, the ability to efficiently diagnose and manage acute cardiovascular pathologies is a critical aspect of EM, and most EM residents also rotate on a cardiology service to develop these skills. Despite evidence that PoCUS improves the ability of both cardiologists and non-cardiologists to quickly diagnose cardiac disease at the bedside, integration of this relatively novel technology on cardiology services is often limited by lack of PoCUS availability as well as lack of a convenient platform to share recorded images [2]. Equipping EM residents on cardiology rotations with a portable, handheld ultrasound (US) system (Figure 1. Philips Lumify handheld US system with tablet) can enhance the learning of echocardiography acquisition and interpretation while simultaneously providing cardiology teams with clinically actionable information [3]. In addition to improving patient care, performing and interpreting PoCUS from the lens of a cardiologist is a simple yet innovative way to solidify the skills that are crucial to becoming an excellent bedside echocardiographer.

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By |2021-02-03T21:14:52-08:00Feb 5, 2021|IDEA series, Medical Education, Ultrasound|

IDEA Series: Virtual “Faux-tation” Rotation for 4th Year Medical Students Interested in Emergency Medicine

Visiting clerkships have traditionally offered the opportunity for extended contact among medical student applicants and residency program representatives, allowing for enhanced assessment of mutual compatibility. Accordingly, visiting clerkships are consistently rated as an essential consideration among residency program leadership when reviewing applications, and among medical students, as they determine “fit” [1,2]. The COVID-19 pandemic has resulted in institutional restrictions on visiting clerkships. Despite the now limited opportunities for medical students to see residency programs of interest in-person, demand for these experiences remains high. Opportunities that allow for increased interaction among medical student applicants and residency programs that maintain compliance with COVID-19 restrictions are needed to fill this gap. Virtual rotations have previously been described in the literature in multiple other specialties [5]. Several emergency medicine programs have advertised a formal virtual rotation experience via the Council of Residency Directors’ (CORD) listserv that offers course credit to student rotators.

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IDEA Series: 3D-printed pediatric lumbar puncture trainer

Pediatric lumbar puncture trainers are less available than adult trainers; most are the newborn size and quite expensive. Due to age-based practice patterns for fever diagnostic testing, most pediatric lumbar punctures are performed on young infants, and residents have fewer opportunities to perform lumbar punctures on older children.1 Adult lumbar puncture trainers have been created using a 3D-printed spine and ballistics gel, which allows for ultrasound guidance.2 No previous model has been described for pediatric lumbar puncture.

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IDEA Series: Pre-recorded Video Simulation Series for Residency Conference

During medical simulation, the inherent unpredictability of learners’ performances and decisions can make it challenging to consistently achieve desired learning objectives. The amount learned and the errors made can vary wildly between groups. Paradoxically, a stellar student can minimize the learning for the other providers if he or she takes over and effortlessly completes the case. Likewise, the visceral impact of seeing a case go horribly wrong can have tremendous teaching value.1

In addition to these challenges, the COVID-19 pandemic has introduced additional barriers to medical simulation training; physical distancing measures have resulted in limited or canceled simulation activities for most emergency medicine residency programs.

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IDEA Series: Big Screen Ultrasound in Resuscitation Bays

Bedside ultrasound (US) often plays a crucial role in medical and trauma resuscitations in the emergency department (ED) [1]. Performing and interpreting bedside US studies such as the Extended Focused Assessment with Sonography for Trauma (E-FAST) during traumas or echocardiography during medical resuscitations are key skills for emergency medicine residents to learn during their training and adopt into clinical practice [2]. During trauma resuscitations timely and efficient dissemination of critical information is paramount. Information obtained via bedside US can be critical in determining further clinical actions (need for urgent thoracostomy for a pneumothorax, need for urgent exploratory laparotomy in a hypotensive patient with free fluid in the abdomen, etc.) through shared decision making between ED and trauma teams [3]. Information obtained via bedside US, however, is often difficult to convey during resuscitations given crowded rooms, simultaneous interventions, and limited viewing of the US screen. For ED and trauma providers wishing to better understand the utility of bedside US during resuscitations and how this powerful tool can change clinical management, a clearly visualized representation of what is displayed on the US screen could provide an ideal learning opportunity.

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By |2020-07-17T10:35:07-07:00Jul 24, 2020|IDEA series, Medical Education, Ultrasound|

IDEA Series: Toxicology Virtual Escape Room during COVID-19

In order to enhance emergency medicine (EM) residents’ knowledge of toxicology core content, we previously created an immersive escape room experience complete with team-based puzzle solving in a geographical maze to find an antidote. The subsequent COVID-19 pandemic and physical distancing guidelines resulted in canceled in-person EM conferences, thereby requiring a rapid adaptation to virtual formats [1-4]. Our toxicology division sought a novel method of engaging learners with toxicology core content remotely. 

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