SimPL Diagnostic Peritoneal Lavage Simulator

1. SimPLDiagnostic Peritoneal Lavage Simulator Col(s) Mark W. Bowyer, MD, FACS Alan Liu, PhD National Capital Area Medical Simulation Center Uniformed Services University of the Health Sciences Bethesda, MD

2. Diagnostic Peritoneal Lavage • One of the Core Skills taught in ATLS® to ~ 20,000 students/yr to diagnose presence of blood in abdomen • Traditionally taught on animal model (pig or goat) • Mannequin (Traumaman™ ) recently approved as alternative National Capital Area Medical Simulation Center

3. SimPL FEATURES • cathSIM Hardware linked with graphics interface • Low Cost (<$10,000) • Can be run from laptop National Capital Area Medical Simulation Center

4. SimPL National Capital Area Medical Simulation Center

5. National Capital Area Medical Simulation Center

6. Results Randomly Generated National Capital Area Medical Simulation Center

7. VALIDATION STUDY SimPL vs. Pig for teaching DPL National Capital Area Medical Simulation Center

8. DPL Validation StudyDesign • 40 Third Year Medical Students who were all true novices (never done one, never seen one) • Divided into two groups of twenty • Initial 30 item Test covering basic knowledge of the procedure, it’s indications, interpretation of results and possible complications given prior to any education. National Capital Area Medical Simulation Center

9. DPL Validation StudyDesign (Cont) • Students also asked to rate current comfort level, perceived difficulty of the procedure, and familiarity of procedure on a 5 item Likert scale • Both groups given standard Didactic lecture on DPL procedure National Capital Area Medical Simulation Center

10. Pig Group (n=20) trained to do DPL on a pig National Capital Area Medical Simulation Center

11. Sim Group (n=20) trained to DPL on VR DPL simulator National Capital Area Medical Simulation Center

12. DPL Validation StudyDesign (Cont) • Both groups “tested” on ATLS® standard Traumaman™ Mannequin on ability to perform DPL and ability to verbalize indications, techniques, positive results and potential complications. National Capital Area Medical Simulation Center

13. Performance on Mannequin evaluated and scored by two trauma surgeons blinded to initial mode of training. National Capital Area Medical Simulation Center

14. DPL Validation StudyDesign (Cont) • Final 30 item test given to test knowledge of procedure, indications, and potential complications • Comfort level, perceived difficulty ,and familiarity with steps reassessed. • Surgeon evaluators provided assessment of students current ability to perform a DPL if called upon to do so tomorrow following this training National Capital Area Medical Simulation Center

15. Test of DPL Knowledge30 Item Written Test * * * Percent P<0.0001 P<0.0001 P<0.0001 National Capital Area Medical Simulation Center

16. Subjects Perceived Comfort Level Performing DPL Extremely Comfortable Very Comfortable Comfortable Somewhat Not Very Comfortable P <.0001 * P <.0001 *P<.01* P = .80 National Capital Area Medical Simulation Center

17. Perceived and Reported Difficulty of DPL Very Easy Easy Medium Hard Very Hard *P<.002* *P<.0006* P< .81 P< .49 National Capital Area Medical Simulation Center

18. Faculty Evaluation – The Student Performance: Excellent Good Average Fair Poor * * P< .0001 P< .47 P< .002 National Capital Area Medical Simulation Center

19. Faculty Evaluation – The Students Ability to Discuss: Excellent Good Average Fair Poor P< .83 P< .38 P< .36 National Capital Area Medical Simulation Center

20. Faculty EvaluationIf Placed in the Field Tomorrow, I Believe This Student Has the Necessary Skills to Successfully Perform a DPL National Capital Area Medical Simulation Center

21. Summary of Results DPL Validation Study • Knowledge increased significantly in both groups over baseline (p <.0001) Excellent Content Validity • Students self reported level of comfort increased in both groups (p<.0001)but more so in the Simulator trained group (p<0.01) National Capital Area Medical Simulation Center

22. Summary of Results DPL Validation Study – Cont. • Students who trained on the SimPL had significantly increased performance on site selection (p<0.0001) and understanding of the Seldinger technique (p<0.002) • Evaluators had greater faith in ability of Simulator trained students to perform procedure after training (90% vs 60%) National Capital Area Medical Simulation Center

23. Conclusions • SimPL compares favorably with the Pig for teaching novices DPL. • SimPL is superior to the pig for teaching of human anatomy/site selection, and the Seldinger technique for DPL National Capital Area Medical Simulation Center

24. Where do we go from here? National Capital Area Medical Simulation Center

25. Improved Graphics • More Content • Incorporate Input from end users • More Validation • Expansion to other procedures that use Seldinger technique • Seek Open Source Hardware so Software can be distributed for free National Capital Area Medical Simulation Center