Medical Simulation Growing Part of Medical Residents’ Education, Training

Approximately seven years ago, Dr. Malekzadeh did just this, when she noticed that her junior residents were having trouble mastering sinus procedures. She started reading about what her general surgery colleagues were doing with box trainers to teach their residents surgical techniques before going into the OR. “I thought that was genius, so I collaborated with our simulation center and nurse educator to develop a low-cost sinus trainer,” she said. The result? Her residents became much more skilled and proficient at sinus surgery once the time came to work with real patients.

Make your own learning tools: Another thing to keep in mind: Simulation tools don’t have to be high tech. In fact, many of the training tools that Dr.

Malekzadeh uses she first made and tested in her own kitchen. For less than five dollars, for example, Dr. Malekzadeh created an endoscopic sinus surgery task trainer. In this paper, she described the final version of the training device that she perfected with a team of otolaryngologists and simulation center staff:

The model is prepared using a ballistics gel substrate by mixing 1 pound of Knox gelatin powder with 1 gallon of water. Once thoroughly saturated, the gel is warmed to 130°F using a double boiler. A 10 × 24 × 6-cm stainless steel bread pan serves as the gelatin mold. Two 100-mL cups are placed upside down in the pan and stabilized with a weight to prevent capsizing, forming the right and left sinonasal cavities. A 2-cm layer of warm gel is poured into the mold and allowed to cool for two hours.

Once solid, two eggs, representing the maxillary sinuses, are placed adjacent to each of the medicine cups. Six beads of varying colors, placed on the base of each cup, are held in place with a small amount of room temperature gel. A second layer of room temperature gel is poured in the bread pan until the cups are completely submerged.

The model is refrigerated for eight hours to allow solidification. The mold is delivered from the pan, and the cups are carefully removed. Four 1-inch strands of expired 1-0 PDS suture are inserted into the superior quadrant of the gel. An expired 8-mm dermal biopsy punch creates an opening in the superior medial aspect of each sinonasal cavity. Last, three target lesions are drawn on the lateral aspect of each nasal cavity using a permanent marker. A silicone CPR manikin mask, placed over the trainer, creates a life-like model, allowing learners to perform through correct anatomic features (Otolaryngol Head Neck Surg. 2011;145:530-533).