Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided Procedures Commonly Used in Interventional Radiology

Rationale and Objectives

Competency in ultrasound (US) imaging and US-guided procedures is often difficult for medical students and residents to master. The use of simulation training has been strongly encouraged but the quality of phantom models available for US-guided procedures is limited. As a feasible alternative, we describe the innovative use of a lightly embalmed cadaver for realistic practice of common interventional radiology (IR) procedures prior to direct patient care.

Materials and Methods

Lightly embalmed cadavers were positioned as patients would be in the IR suite: supine, prone, and erect seated position. Lidocaine was injected and visualized under standard percutaneous techniques and sonographic guidance was used to simulate common US-guided procedures performed in IR including liver biopsy, kidney biopsy, thoracentesis, and vascular access.

Results

The ability to position cadavers was a key factor that allowed entire procedures to be simulated. Medical students with very limited exposure to US imaging and diagnostic radiology residents with minimal exposure to US imaging successfully completed common US-guided procedures. Arterial and venous vascular access was obtained. Wires were passed and catheters easily placed via both access sites. The texture of the tissue layers provided realistic feedback for the trainees as they advanced the needle or dilated the tissues. Images from each simulated procedure resembled images expected in a living patient.

Conclusion

Lightly embalmed cadavers are an innovative and feasible tool to simulate common IR US-guided procedures in a realistic fashion for deliberate practice in advance of first-attempt encounters with patients.

Introduction

Competency in ultrasound (US) imaging and US-guided procedures is a fundamental skill required for interventional radiology (IR) physicians but often difficult for trainees to master. Although the use of US-guided procedures in the field of medicine has drastically increased in recent years, students are minimally exposed to US during medical school ( ). IR procedures are classically taught via literature, simulations, and demonstration before trainees attempt procedures under direct observation. Attempting IR procedures when patients are awake or minimally sedated creates apprehension in patients which in turn increases the resident’s anxiety and can lead to mistakes in technique, medical errors, and less effective teaching. As a learning experience, this approach limits open communication, instruction, and experimentation the resident needs to develop the appropriate skill set.

The use of simulation to achieve excellence and safety in IR patient care has been strongly encouraged ( ). Hours spent in deliberate practice, intentionally repeating an activity in order to improve performance or master a task, have correlated with the development of expertise. Simulation allows deliberate practice in a safe environment, as often as needed for mastery learning, without jeopardizing patient safety ( ). Combined with immediate feedback and self-evaluation, deliberate practice requires effort, and, though not innately enjoyable, can reduce training time and be more effective than nonfocused training ( ). With permission to fail and correct mistakes remote from patients, novice operators can practice common percutaneous procedures that range in complexity from superficial skin punctures to biopsies, aspirations, and central venous access. Likewise, experts can refresh old skills and learn new ones.

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Materials and Methods

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Results

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Table 1

First-Year Medical Student (M1) Evaluation of US-Guided Central Venous Line Placement on Lightly Embalmed Cadavers (2014)

Mean ± Standard error of the mean ( n = 16) 1. The session was well organized and material presented in a logical sequence 4.47 ± 0.14 2. The lightly embalmed cadaver was a great learning tool 5.00 ± 0.00 3. The information presented was clinically relevant 4.89 ± 0.07 4 The presenter was knowledgeable in the topic 4.84 ± 0.09 5. The overall quality of this session was outstanding 4.58 ± 0.14 6. I would recommend this session to M1 students next year 4.79 ± 0.12

Rating scale: 5—Strongly agree; 4—Agree; 3—Neither Agree or Disagree; 2—Disagree; 1—Strongly Disagree.

Table 2

First-Year Medical Student (M1) Evaluation of US Guided Liver and Kidney Biopsy on Lightly Embalmed Cadavers (2018)

Mean ± Standard error of the mean ( n = 29) 1. The session was well organized and material presented in a logical sequence 4.76 ± 0.44 2. The lightly embalmed cadaver was a great learning tool 4.93 ± 0.26 3. The information presented was clinically relevant 4.86 ± 0.44 4. The presenter was knowledgeable in the topic 4.90 ± 0.31 5. The overall quality of this session was outstanding 4.76 ± 0.44 6. I would recommend this session to M1 students next year 4.90 ± 0.31 7. As a result of this session, I feel more confident in my ability to perform US-guided procedures. 4.59 ± 0.57

Rating scale: 5 —Strongly agree; 4—Agree; 3—Neither Agree or Disagree; 2—Disagree; 1—Strongly Disagree.

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Discussion

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Appendix A

Medical Student Comments and Suggestions

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References

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Lightly Embalmed Cadavers as a Training Tool for Ultrasound-Guided Procedures Commonly Used in Interventional Radiology

Rationale and Objectives

Materials and Methods

Results

Conclusion

Introduction

Materials and Methods

Results

Discussion

Appendix A

Medical Student Comments and Suggestions

References

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