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

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

4. National Capital Area Medical Simulation Center SimPL

5. National Capital Area Medical Simulation Center

6. Results Randomly Generated

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

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

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

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

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

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

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

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

15. National Capital Area Medical Simulation Center Test of DPL Knowledge 30 Item Written Test ** P<0.0001 *

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

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

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

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

20. National Capital Area Medical Simulation Center Faculty Evaluation If Placed in the Field Tomorrow, I Believe This Student Has the Necessary Skills to Successfully Perform a DPL N = 20 each group Pig Trained Sim Trained Strongly Agree 3 (15%) 5 (25%) Agree 9 (45%) 13 (65%) Neutral 6 (30%) 2 (10%) Disagree 0 Strongly Disagree

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

22. National Capital Area Medical Simulation Center 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) 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%) Evaluators had greater faith in ability of Simulator trained students to perform procedure after training (90% vs 60%) Summary of Results DPL Validation Study – Cont.

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

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

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