In-house-developed mannequin for emergency medicine training among medical students

Deskripsi

Development of an in-house mannequin

An in-house developed mannequin was developed according to 3 OSCE modules, 1) sampling techniques, 2) fluid resuscitation and IV drug administration, and 3) minor surgery. Briefly, the model was 3D-printed onto four parts and then assembled. The transparent tube was connected to a water container containing red-stained water (as blood), a catheter (as vein or artery), water aerator equipped with a potentiometer and adaptor. Melted sealant glue was used to fill the holes in the model (as transparent skin), while polyvinyl alcohol (PVA) cloth was implemented as the skin for suturing technique.

Evaluation and OSCE simulation assessment

Students were asked to rate the mannequins' overall quality, usability, and comparability on a 5-point Likert scale and open questions. The usability of the mannequins was compared in each module. In addition, the teachers were asked and interviewed regarding their perceptions toward the development of a new mannequin for teaching and examination purposes. The OSCE simulation consisted of 3 scenarios, one dealing with a patient requiring arterial blood gas analysis (ABG) due to a metabolic disorder (Scenario 1), one patient suffering from hypovolemic shock (Scenario 2), and the third one involving a patient suffering skin lacerations due to a motor vehicle accident (Scenario 3). Assessment requires participants to perform each scenario using both in-house (A) and standard (B) mannequins. The participants had a 10-minute time frame to complete each task. Students' performance were evaluated using a well-defined checklist assessing their competencies.

Results and Discussion

The implementation of mannequins as teaching media is becoming more important in medical school to introduce and obtain clinical skills for students. Although there is a variety of commercially available mannequins in the market, the effectiveness of these models in the teaching process and curricula remains unclear. In this present study, students' performance, effectiveness, perceived realism, and cost-analysis derived from both an in-house developed (substitute) and standard commercial mannequin in emergency medicine training for undergraduate medical students were analyzed. Most students believed that a standard mannequin was more realistic than the substitute one. This is possibly because the substitute mannequin did not reflect the color and elasticity of human skin. However, despite the less realistic appearance, students' performance did not differ between the two groups. In fact, the substitute mannequin outperformed the standard mannequin in terms of usability, implying that a substitute mannequin is just as effective as a standard mannequin in attaining minimum clinical skills competencies.

Currently, there is limited data regarding the comparison between substitute and standard mannequins on teaching success. Similar to our findings, a previous study demonstrated that a substitute mannequin did not affect the students' scores and technical skill performance. Moreover, although high-fidelity mannequins may improve students' confidence, no evidence indicates that students who used high-fidelity mannequins increase their performance more than those who used low-fidelity mannequins 5. Indeed, our data suggest that a substitute mannequin was comparable with a commercial mannequin in terms of functionality. Hence, the choice of teaching and evaluation media should be assessed by their suitability according to the LO.    

The costs of the materials needed to develop a substitute mannequin were less than 100 USD, being seventy times less expensive than the price of three commercial mannequins. It should be noted that similar to the standard mannequins, spare parts, such as a catheter, sealant glue gun, and PVA cloth, are still required. Nonetheless, the price of spare parts in the substitute mannequin is relatively lower than in a commercial one. Thus, our new substitute mannequin is economically affordable, sustainable, functionally comparable, enables the initiation of several skills related to emergency medicine for every medical student, and can be implemented in any medical school around the world.

There are several limitations identified in the current study. Firstly, during OSCE simulation, students may have prior knowledge on how to handle the commercial medium, which could have influenced the results of the study. Secondly, our developed mannequin is far away from reality. Therefore, further modification and improvement are necessary. Altogether, we conclude that the in-house-developed, low-cost, multi-module mannequin was well accepted by students and teachers and could be used as an alternative to commercial mannequins in teaching and assessing the students' skills and competencies in emergency medicine-related topics, particularly in low- and medium-resources countries.

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