Developing a low cost model for chest drainage simulate training

Objetivo: Descrever a construção de um simulador de baixo custo de drenagem torácica para capacitar a realização deste procedimento. Métodos: A concepção do modelo se deu em 2014 por integrantes do Programa de Educação Tutorial do curso de Medicina da UNIFOR. A seguir, o modelo foi testado por 10 especialistas e posteriormente aprovado para ser aplicado em quatro edições de um curso teórico-prático de procedimentos invasivos com acadêmicos de Medicina de diferentes universidades. Para avaliar o simulador e o desempenho no seu uso, aplicou-se questionários semiestruturados e checklist. Os dados foram analisados pelo Statistical Package for the Social Sciences v. 22 usando estatística descritiva. Resultados: Usou-se um manequim plástico comercial em que foi realizado um corte de 8x8 cm na região lateral do tórax, correspondente ao local da drenagem. Neste local, foram posicionadas folhas de E.V.A. (simulando pele e músculos intercostais), esponja de estofado (subcutâneo) e folha de PVC (pleura). Na parte interna do manequim foi colocada uma estrutura de madeira contendo duas costelas e, entre elas, um copo plástico recoberto por E.V.A. contendo líquido vermelho (simulando um hemotórax). O custo inicial do modelo completo foi de R$81,00/US$ 21,00. Quando testado por especialistas, todos concordaram que o modelo pode ser usado para o ensino na graduação. Durante o curso de procedimentos invasivos, 129 acadêmicos realizaram o procedimento, em que 64,3% dos alunos inseriram corretamente o dreno e 79,1% conectaram ao sistema de drenagem. Apesar de um percentual de erros importante visto em passos iniciais básicos, os alunos conseguiram executar a técnica proposta de forma suficiente. Conclusão: O simulador de drenagem de tórax mostrou-se ser de fácil acesso e reprodução nas universidades, o que o torna uma ferramenta útil para o ensino.Objective: To describe the construction of a low-cost simulator of chest drainage for the training of undergraduate medical students. Methods: The model was conceived in 2014 by members of the Tutorial Education Program - UNIFOR. It was tested by 10 specialists and approved for application in four editions of a theory and practice course on invasive procedures with medical students from different universities. To evaluate the simulator and its performance, semi-structured questionnaires and checklists were applied. Data were analyzed in the Statistical Package for the Social Sciences v. 22, using descriptive statistics. Results: A commercial mannequin was used to build the model. An 8 x 8 cm square cut was made in the lateral wall of the chest. Inside this region, EVA sheets (simulating skin and intercostal muscles), foam padding (subcutaneous tissue) and transparent PVC sheet (pleura) were placed. In the inner part of the mannequin, a wooden structure containing two ribs was constructed and a plastic cup containing red-dyed water was placed between the two ribs. The complete model had an initial cost of R$81,00/US$ 21,00. The medical specialists agreed (100%) that it can be used for undergraduate teaching. During the course on invasive procedures, 129 students performed the procedure; 64.3% of them were able to correctly insert the drain and 79.1% connected it to the drainage system. Despite of the high percentage of errors in basic initial steps, the students were able to execute the technique satisfactorily. Conclusion: The low-cost chest drainage simulator was easy to access and to reproduce in universities, which makes it an important tool for teaching

THE OLD ONE TECHNIQUE IN A NEW STYLE: DEVELOPING PROCEDURAL SKILLS IN PARACENTESIS IN A LOW COST SIMULATOR MODEL

ABSTRACT BACKGROUND: Paracentesis is a routine medical procedure quite relevant in clinical practice. There are risks of complications related to paracentesis, so it is essential a proper trainee for the younger practicer. OBJECTIVE: The article describes the construction and the application of a low cost paracentesis simulator for undergraduate medical students and it also describes the perception of students about the simulator as well. METHODS: A low-cost model was developed by the Program of Tutorial Education for training medical students during three editions of an undergraduate theoretical-practical course of bedside invasive procedures. The authors constructed a model from very low-cost and easily accessible materials, such as commercial dummy plus wooden and plastic supports to represent the abdomen, synthetic leather fabric for the skin, upholstered sponge coated with plastic film to represent the abdominal wall and procedure gloves with water mixed with paint to simulate the ascitic fluid and other abdominal structures. One semi-structured form with quantitative and qualitative questions was applied for medical specialists and students in order to evaluate the paracentesis simulator. RESULTS: The paracentesis model has an initial cost of US$22.00 / R$70.00 for 30 simulations and US$16.00 / R$50.00 for every 30 additional simulations. It was tested by eight medical doctors, including clinical medicine, general surgeons and gastroenterologists, and all of them fully agreed that the procedure should be performed on the manikin before in the actual patient, and they all approved the model for undergraduate education. A total of 87 undergraduate medical students (56% male) individually performed the procedure in our simulator. Regarding the steps of the procedure, 80.5% identified the appropriate place for needle puncture and 75.9% proceeded with the Z or traction technique. An amount of 80.5% of the students were able to aspire the fluid and another 80.5% of students correctly performed the bandage at the end of the procedure. All the students fully agreed that simulated paracentesis training should be performed prior to performing the procedure on a real patient. CONCLUSION: The elaboration of a teaching model in paracentesis provided unique experience to authors and participants, allowing a visible correlation of the human anatomy with synthetic materials, deepening knowledge of this basic science and developing creative skills, which enhances clinical practice. There are no data on the use of paracentesis simulation models in Brazilian universities. However, the procedure is quite accomplished in health services and needs to be trained. The model described above was presented as qualified with low cost and easily reproducible

Belas artes para estudantes de medicina: motivando debates transformadores

Introdução: Debater artes durante a graduação pode ser uma forma criativa de desenvolver novas percepções e perspectivas para estudantes de medicina. Promover atividades que visem criar momentos envolvendo temáticas humanísticas, simultaneamente ao conhecimento técnico médico, como artes e atividades físicas em um ambiente lúdico, continua sendo um desafio. Nesse contexto, foi criado um Programa Extracurricular de Aperfeiçoamento Global de Estudantes de Medicina (GIPMS) da Universidade de Fortaleza, que incluiu encontros envolvendo diversos estímulos artísticos. Objetivo: O objetivo deste trabalho é avaliar se o contato com a arte durante a graduação no contexto do GIPMS pode gerar percepções, sentimentos e reflexões para proporcionar importantes debates. Métodos: Foi realizado um estudo qualitativo prospectivo com um total de 42 sessões de grupo focal, que foram gravadas e transcritas na íntegra. Cada grupo foi conduzido por 2 mentores, e todos os 6 grupos focais utilizaram questionários qualitativos padronizados nas sessões, que foram realizadas a cada 45 dias. Foi realizada uma análise temática das transcrições, confirmada com o software QSR NVIVO (versão 11). Resultados: Um total de 40 alunos (15 homens e 25 mulheres) participaram deste estudo de um ano. As categorias encontradas foram: Os estímulos artísticos foram capazes de fazer os participantes pensarem (124 citações), sentirem (78, 65 sobre sentimentos positivos e 13 sobre sentimentos negativos) e lembrarem (41). Destacaram-se: a influência da carga horária de estudos no tempo dedicado às artes e às reflexões (61); relação entre arte e vida e produtividade acadêmica (75); mudanças de atitudes proporcionadas pelos estímulos artísticos propostos (38 citações). Conclusões: O programa foi capaz de gerar, de forma inovadora, novas percepções de sentimentos, sensações e reflexões, bem como evocar memórias que proporcionaram debates importantes, que, segundo os próprios alunos, serviram de inspiração para mudar perspectivas e atitudes e proporcionou benefícios subjetivos na vida acadêmica.Introduction: Debating arts during graduation can be a creative way to develop new perceptions and perspectives for medical students. To promote activities that aim to create moments involving humanistic themes, simultaneously to technical medical knowledge, such as arts and physical activities in a playful setting, remains a challenge. A extracurricular Global Improvement Programme of Medical Students (GIPMS) of the University of Fortaleza was created on this context, and included meetings involving various artistic stimuli. Purpose: The objective of this paper is to evaluate if the contact with art during graduation in the context of GIPMS can generate perceptions, feelings and reflections to provide important debates. Methods: A prospective qualitative study was conducted including a total of 42 focal group sessions, which were recorded and fully transcribed. Each group was conducted by 2 mentors, and all 6 focal groups used standardized qualitative questionnaires each session, which were performed every 45 days. A thematic analysis of the transcripts was performed, confirmed with the QSR NVIVO software (version 11). Results: A total of 40 students (15 men and 25 women) participated in this one-year study. The categories found were: Artistic stimuli were able to make participants think (124 quotes), feel (78, 65 about positive feelings and 13 about negative ones) and remember (41). The following stood out: the influence of the time load of studies in the time dedicated to the arts and the reflections. (61); relationship between the arts and life and academic productivity (75); changes in attitudes provided by the proposed artistic stimuli (38 citations). Conclusions: The program was able to generate, in an innovative way, new perceptions of feelings, sensations and reflections, as well as to evoke memories that provided important debates, which, according to the students themselves, served as inspiration to change perspectives and attitudes and provided subjective benefits in academic life